06080043CITY OF CUPERTINO
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BUILDING DIVISION PERMIT ;:eco
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BUILDING ADDRESS:
10731 WUNDERT.TCH DR
JORGE SOLORIO
PERMrrNo.06080043
R'S NAME:
4
PERMIT ISSUE DATE
JORGE SOLORIO
/071/2
PHONE:
SANITARY N0. CONTROL N0.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BO EO PLO MEOCH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hcreby affirm that I am licensed under provisions or Chapter 9 (cemmencing
with Section 7") of Division 3 of dm Busincctand Professions Code.and my litems, u
In roll (me and effect.
REPAIR PLUMBING, ELECTRICAL AND INSULATION WALL
Llate eel"° COM
Dam Lk.0 r
NON STRUCTURAL
ARCHITECCS DECLARATION
1 amomm�d my prim. °hall ns, used as public records
Liccnscd Pmrcasional
OWNER -BUILDER DECLARATION
I hereby af0rm Nm I am exempt Isom the Cants.dn's License Law for the
following reason. (Section 7031.5, Bus mss and Psofmsiuns Code: Any city or county
which requires a permit to commmel, alter, hnprove, demolish, or ¢pair MY {immure
poor m its ismance,aan requiter, the applicant for such Permit m rile a signed mowoont
License law 9
Sq. Ft. Floor Area
Valu $iSm 0 0 0
Nat he is Iiccmed fromantl0 de provisions of dm Contractor's (Chapter
(commencing with Secuon 700M of Division 3 of the Business and Proressio. Code) at
that he ts exempt tnetefrom and the bub for the alleged ammption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally of
not more than Eve hundred dollen ($500).
37529002.00
❑ I,. owneroftne property,amyemploycea with wage°. ducirmkcompensnlon,
Required Inspections
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will do the work. and me sWctme ts net intended aaffered for seam (sec. 7044, Business
and Prorcesions Cade: The Cmtrmmr'r, Liana law dons rot apply m an ewxr m
property whe Wildr,aimprovesthemon,and wodoessuch work himself. through his
..
we employees. Provided did such improvements tie sotimended offered for ole. If.
however, be Wilding a Improvement 13 mid within oro year of completion, the owner -
Wilder will have the bu em of proving out ns, did em Wild or improve for purpose of
.le.).
❑ 1. a Owmr of the propmy, am smledvoly conusotin{ with licensed counectan m
construct the pmjca (Sec. 7044. Business and Protections Code:) Tim Commodes L(-
-
came law does not apply 0 in Owner of Property who Wilda or improv. person, and
who contracts for such pmjecta with a contucmr(s) licensed pendant m the Conmenor's
License Law.
I amu pt under See ,B&PC for thio mason
r Date,„
. .
ORK • 5 COMPENSATION DECLARATION
1 re. lb aRm under penalty of perjury ate of de following declaraWns:
❑ Imam and will maintain a CartiOcam of Consent m self-insum for Workers Compmn
sation, as provided for by Section 3700 of ass IaWr Code, for ase performance of the
work for which this permit b issued.
❑ 1 have and will maintain Worker's Compemalion Insurance, as mquimd by Section
3700 of the Ube, Code, for Ne performance of the work for which this permit is Issued.
My Worker's Compensation Insurance carrier and Policy number me:
Carder, Policy No.:
,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
(russectim heed mtbecaurpleted lithe Permit b Imam hundred doll. (5100)
or less)
I certify that in the performance Or dm work for which this Permit b issued. I shall not
employ any person in any man in tbecome subject to the Workers' Compensation
Laws of Calif rola Dam PAIL
,,,,,,Co., B A fl O
NOTICE TO APPLI NT: If, after making this CeniOcaw of Exemption, you should
become subject m the Worker's Compensation provisions of me lour Cade, you most
forthwith comply wit such provisions or this permit shall he domed revoked.
CONSTRUCTION LENDING AGENCY
y
I hereby affirm there t comrending ageecy for de Performance of
,
wort for which this Permit ls Wsued (Sec.39, Civ. C.)
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Nadreas
Lendcr°
landeM1Address
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Q I mnify that I have read this application and sum Nat me Move information b
torten. I agree to comply with all city and county ordinances and state Paws relating er
U building convection, and hereby aumorne representadics of this city to enter upon the
above is,Judged propc for peNon purposes.
(Ws,) .;me to sive, indemnify and keep harmless the City of Cupertino against
esmit. may in any wayaccmc against said City
liabilities,Judgmentsetom and expenses
costs
of this
I.A PLIC NTT DERSTA got this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
50 RCEREGUL Oh S.
Re -roofs
Type of Roof
eau of Applian Contractor Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fumm Wilding ocmpanlaore or handle h.amons material
deBmd by the Caper im Municipal Code. Chapter 9.13, and the Health and Safety
Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yea (AN.
If a roof is installed without first obtaining an inspection, l agree to remove
Will he applicant ser future Wilding Occupant use equipment or devices which
cmll h.ardous air contaminants. dclined by the Bay Atm Air Quality Management
all new materials for inspection.
District?
❑Yes 55No
I have mal the haa.duus materials requiremsms under Chapter 6.95 Ofase Califon
nu Health & Safety Code. Section, 25505,25533 and 25534.1 understand and fare balding
dao not curmntly hese a sonans, asst It is my msponabilb, he nodfy be occupant of the
require emuwhkhmaa me o 1samance Ofa Ccrufeamof currency.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owTaradvmduen, Date