05090229 (5) CITY OF CUPERTINO ` `° "`�''
BUILDING DIVISION PERINT C0NTRACTf1RYIN,EQRM ,�.0
BUILDING ADDRESS: PERMIT NO.055090229 ,
422 CARNOUSTIE CT
WeR'S NAME: PERMIT LSSUE DATE
JOHN & JUDY BRUZUS 09/30/2005
PHONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITEC(ENGINEER:
BLDG 0 ELECT o PLUMB MECH
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30o LICENSED CONTRACTOR'SDECLARATION Job Description
yd I hemby amrm Net I+m licensed under Provisions of Chapter 9(commencing
with SCCIIan 7W0)of Division 3 of the Bminessand Professions Code.and my license Is
n'1 mmll0rceaadeit REVISION--ENLARG 2ND BATH/MOVING
ucen a use.x
� e Dam _- n canBum( NO STRUCTURAL WALL
D 9 F_
ARCHITECTS NO NEW PERMIT ISSUED/ORIG. #05060220
y< I undersand my Pena shall be used as public retards
Is KKKKoU licm.dPmfesuonal -
OW NER-BUILDER DECLARATION
1 hereby olYrm Thal 1 am exempt from Ne Convector's License Law for the
p D following mason.(Section 713I.S.Business and Prefetsions Code:Any city or county
$ which requires a permit or construct.alma Improve,demolish.0r retain my awcmm^ prior to in issuance,alsomqulma the applicant for arch permit to lie a signed sutementValuation
p G
that Is is Handed pursuant to Me provialonanfMeCommittees�Jmnselaw(Chapter9 Sq.Ft.Floor Area d.
y $ (commencing with Section 70D0)ofDivision 3ofdie Businessand ProfessionsCade)Or $0
that ho is_ ion or
Section 7031.5 by any applicant for A permit Subjects r She Ne appled icant n•civil Penalty of
am mare Stuart five hundred dollars(M). APN Number Occupancy Type
❑1,as owner orthe property,w my employee with wages u their sole compensation,
will as Newarl the structure is not intended mattered(araale(Sax.7044.Business Required Inspections
and Professions Code:The Commiserates License Law don not apply n an owner of q P
pm<rty who builds orimprowa thereon.and whodonsuchwwkhimselfor Waugh his
own employees,provided that such improvements am notimended oraRerW for Bale.It.
however,Ne building or Improwmem is sold within ora year of completion.the owner-
builder will have Ne burden of proving that he did and Wild in improve for pualu ss of
sale.).
❑1,or owner of the property,am exclusively convecting with Bernard coovecnrs to .
convect the project(Sec.70",Business and Profrasiom Cotler)The Comnonr's L6
mw
coe ladose ata apply n an owner of property who buil"or improve thereon,and,
who contracts for such fortuitous with a com motors)licensed puouam in the Conuadoh n.
L.icans law.
I am exempt under See. ,B&PC far this wan
Data
WORKER'S COMPENSATION DECLARATION
1.hereby Man under penally of perjury oro of the following declarations:
I Ismand will manusoa CeNOnteof Contenttose161nsum fw WQd esCompan-
wlan,u provided fm by Section 3100 of the labor Cade.(er W performance of the
wank for which this permit is issued.
❑1 have and will maintain Workch COmPenaatlan Inawance.as required by Section
37W of the Inbar Coda for the performance of Ne wank for which this permit is issued.
My Worker's Compensation II Unna carrier and Policy number em:
Calver. fA Policy Na:
CER TEOFEXi!MPIIONPROMWORKERS
COMPENSATION INSURANCE
(This+etion rad notal completed If the permit is reform hundred Alan($1010
' or less.) '
1 certify Net In the Performance of the work for which this permit is issued,l shall nut
employ any person In any manncran ss to become subject in the Wwkmr+'Compenaatim
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,a0e,making this Cediftate of&.pOan,you should
become subject to the Wark er's Compensation provisions or Ne Labs,CtMa you must
O •forthwith comply with such pianissimos or this permit shall be lamed rewkad.
y CONSTRUCTION LENDING AGENCY
I hereby af0rm that there In construction lending agency rat the pertormwmc of
g!s t7 the work for which this permit It issued(Sec.3097,Civ.C.)
W Q Lemices Name
D. Under's Address
V Q I really that I have red this application and sue Net the show information i,
W U mama 1 agree to comply with all city and county ordinances and sus laws misting to
O building convection,and hereby summbe representatives of this city to enter upon Ne
W above-mentioned property(or inspection purposes
fytt ow (Wit)agree in save,indemnify and kap harmless the City of Caperton Against
f..�cA Ilabilitiu,uudgmcnu,costs and expemes which may in any way ascot against saidCity
J in consequence of the granting of this permit
'••' APPLI ANf UNDER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
50 QE GULATI
Re-roofs
gliplalueteol'Apriticaroicammator Dan 'Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will Ne applicant wfutua Wilding occupant stow or handle ha'rudon menrel
:r it by do CupeNno Municipal Cede.Chaper 9.11,and the Health and Safety
We. Oyu 2563x(+)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yn o
Will the applicant or ranm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
..It hvaamoa Sir comarrinans as defined by the Bay Arca Air Qaallty Manegemmt all new materials for inspection.
DirricO
❑Yes
1 have mail Ore harsNaus materiels requirement under Chapter 6.95 ort the Califor.
nia Health A,Safety Car,Sccdana 25505,25533 and 15534.1 unrmtaM than true Wilding
does a ntiy how a nn Naz it is my responsibility us rally the oa.p.i of Ne
re 1rc Ch main dpdunuissuanceahCCNOcanof mp'"ry' SignatureofApplicant Date
All roof coverings to be Class "B" or better
wnmr ur+uthaAvnd agcm Data
CITY OF CUPERTINO
1 Of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # : 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 357160014.00
DATE ISSUED. . . . . . . : 03/07/2006
RECEIPT #. . . . . . . . . : 33486
REFERENCE ID # . . . : 06030032
SITE ADDRESS . . . . . : 10031 CARMONA COURT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CARTER, NANCY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : XM HAGAN
CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108
COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC
ADDRESS . . . . . . . . . . : 702 S. DANIEL WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 260-1260
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4,000.00 104.76 0.00 104.76 0.00
BSEISMICRE VALUATION 4,000.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 105.26 0.00 105.26 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 105.26 AMEX
TOTAL RECEIPT 105.26
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