04080033 CITY OF CUPERTINOpaw, nwg�+ •# 'p^"■7�'(}
BUILDING DIVISION' PERMIT
BUILDING ADDRESS: LOVELACE CONST. PERMITNIb4080033
10255 VIRGINIA SWAN PT,
OWNER'S NAME: PERMIT ISSUE DATE
ilah& PAM & DAVID MCCALLOH 10144 CAMINO VISTA DR.- ii /n-4 ,12n04
E: SANITARY NO. CONTROL NO.
(408) 255-4923
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGMECH PLO O
L00 LICENSED CONTRACTOR'S DECLARATION li
Job Description
I Mmby.hire that I am licensed under prmhi as of Chapter 9(commencing
with Smile. )ofDividon 3ofthc Business alnasions Code.And Items is
nfa deffm
ADD 660 SQ.FT. (2ND STORY)
L1Ce �a BEDROOMS/1 BATHROOM
Dear— AIC1 Cmtracmr
/� ARCH17EC1'3 DECLARA , N
J�//' 1 undo��'a—m�Y plan pub' sit
a� IcemeL d9n�cssno lI «- --
OW NER-BUILDER DECLARATION
y 1 hereby a1Rrm that I em exempt from the Contractors License Law for the
S O O following mated.(Section 7001.5.Bummers and Professiues Code:My city or county
sed$ which requires a Permit to eonatmet,aitst improve,demolish.ar repair any arumure
�Y Pder in its lOWKe.mso ICQYlma the applicant for toth permit w file a signed statement
< that be is licensed pursuant tothcprovisions nfthe Contucter'i License Law(Chapter 9 Sq.Ft. Floor Area V"60000
(cmnmeming wit Semon 7000)of Division 3 of the Business and Profession Cade)or
S
that he is exempt therefrom and the bass for the alleged exemption.My violation of
Section 7031.5 by ary applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
ant mom thud live hundred dollars($50y. 03020041 . 0 0
❑ er 1.gaownof the property,or my employ¢withwages As their sale mnpenaadon, /•�
wllldo thework.and theawerura Is nut intended m offered let aan(Sm.7044,Business u
ate Pedfesdona code:The Conuacures License law dead am, m m owner or Required Inspections
property whobulldsorimprovea thacan,andwhodoes tuchwork hnuelfmthrough his Ir
own employees,provided thumb improvements an not intended marinated formic,If. ti, (�1 (
however.the building m Improvement scold within one yearofampladon,the owner- j �s�
builder will have the taken of proving that he did not build or.improve for purpose of
gale.).
❑I.As owner of the property,am exclusively contracting with licura d conuamom to �-
construct the prejen(Sec.7044,Edwards and Pro(cssons Code:)The Contaerocs U.
m re7J70✓- lI1
cause Law does not apply an Owner of property who builds or improves thereon,and,
who contacts for such projects with a comonar(O licensed pursuant in the Cosu¢mM1
0 1 Am exemptlaw. ee
❑ Y Jf, q '
lam exempt under S . .BA PC fm No
is man %Ir/ `�/,G
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afrou under Mousy of peQury one of the following declar almer
I have and will maintain
aCctifrae of Consent k self-insuro for Wader's Comfort.
As Provided for by Section 3]00 0(the labor Code,fm the pedormana of the
work for which this pcnnit is issued.
❑1 have and will maintain Workers Compensation Insurance,ar required by Section
37000(die labor Code,for the performance of the work for which this permit is issued.
My WorkeYe Compensation Iantrance carrier and Policy number are:
Canter. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbs.,I.n need not be compleurd if de permit 4 for one hundred dollars($100)
lir las)
I certify that in the performance Of to work for which this permit is issued.l shall not
cmployan noaid yman so beams eject to de Wmkee'Compengauon
Lawaof Callfo
Appliam
NOTICE TO APP CANT:I,• er :Ing oCeniOcam of Exempt n,you should
with comply with such pro
mbjcm m the Woheb Cm i nsadon provisions of the labor Cade,you must
,J2—;, visioes m this permit Nail be demand revoked.
.Za CONSMUCDON LENDING AGENCY
't•w ry-i 1 hereby Wilon ter den is.construction lending.gemY for me performance of
Ni > the wart for which Nia permit Is issued(Sm.3037,Civ.C.)
W Q Lender's None
z Lenders Aaamu - !/
V Q I ceni(y Net I have rad Weapplicationand noun and sum Nn the saw
t m information is
0 cuffed.1 agree m comply with all city and county atmimscus and atsta lama elating t
building comwdion.ark hereby auNorimmoses. ves of this city menmr upon Nc
W above-mcmioned property fm ermily a purposes.
gL caju.greemum,indemnify ad trap hay less1.An Ne Ciryof,Cuperfi
agarmne.goat
h incoi..quee of tocoatsand expemeemit. may in any wayacrncegalalasid City
U'L A PLICA nee of UNDERSTgrarmhq;ANDS
or A permit.
APPLICANT UNDERSTANDS A WILL OMPLY WITH ALL NON-POINT Issued by: Da
Tally
SOUR EGUL ONS,
Re-roofs
k,
Wrote Of llc On \Due
OUS MATERIALS DISCLOSURE Type of Roof
Will dma iant m future Wilding occupant mom m handle harudom maicriai _
as defined by the Cupertino Municipal Cone,Chapter 9.12.ami the HUIN and Safety
Code.Section 2ss3x(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑tam KN.
Will Nn:applicant or furore building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
it he ardnm air conuminanu u unlined by Ne Bay Ann Air Quality Management all new materials for inspection.
District?
❑Yea `X No
I have read the ham dnus materialsrcquiements under Chapter&95ofsixCalirm-
aiafSalN&Safety Coca,Seen.25505,25533 and 75534.1 undcnund Nat iftc building
dma not currently hnm.ma t,thm I mY mNonsaility m notify the amount of the
require which¢ bemetpd ilium McckOcmcaf upanry' Signature of Applicant Date
owt r euNomed cot V Dam All roof coverings to be Class "B"or better