05120019 (4) CI TY OFCUPERTINO °"?� � « x� •'="f '"�� ` �*? ""'`,:
BUILDING DIVISION PERMIT CONTRCTOTYTNFOTLMAIIIgN
BUILDING ADDRESS: PERMIT 440.0512 0019
1658 JAMES TOWN DR
OWNER'S NAME: PERMIT ISSUE DATE
1 JULIE & MIKE ST. CLAIR 12/05/2005
E: SANITARY NO. CONTROL NO.
ARCHITECDENGINEBR: BURRING PERMIT INFO
BLr ELECT PLO O
X00 LICENSED CONTRACTOR'S DECLARATION Ib Description
(� 1 hereby affirm NOeSCnP
(m
al 1 am licensed under previsions of Chapter 9 mmcncing
with Section 7=)of Division 3 of de Ilmmueand Pe.fessinw Cade end my license Is
I.full fume and. eaa fd 73 KITCHEN REMODEL (NO. ST URE CHANGES)
II99Z Licence Clm 1� Lk.N
Osis�_]_�S��Comrmma OION f`iYM/Ia A/
/ARCHITECTS DECLARATION
rey6G+ I understand my plain shell W used as public rtcnrtls -
�I� Licensed PnResaianelJ�
OWNER-BUILDERexemptDEthe Com oto H VVV/VC"®
ON
I hereby nou.(Here that 11. exempt from the C Protrusions
s e:A License law for the
O o following meson.(Section 7U31.5.Bowness and Ro(rswov Cmla:Any lily ar roomy V
s$ which mqulms a permit m construct,alar,impm e,demalbh,or repair any Wucmic &6,9 $45000
Prior m its issuance.also requires tit applicant fmsuch permit m file asigmd comment
££ Nu heisllmmedpursuant tothe pmviGowofbeConrats'sUmveLaw(Charles 9 Sq.Ft. Floor Area Valuation
Y�$ (commencing with Section 71M(f)of Division 3 of the Business and Professions Code)or
Q
that he Is eumpt therefrom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to civil penalty of r eeupaney Type
oat mart than ftw hundred dollars(5500).
❑I,u owner of the property,m my employees with wage u their sole compensation,
ol
will do the work and the suuemm Is an,Intended or offered rouele(Sec.7044,Business Required Inspections
and Professions Code:The Conuactufs License law does not apply s e ns an Owner of q P
property who builds or i m prose thereon,a nd who does such work himself m through his
own employes,provided that uch improvements are noUnended cautioned foraale.if,
however,the building Or improvement is sold within one year of compleum,The owner.
Wilder will have dw burden of proving that he did not Wild or Improve for purpose of
tele.).
❑1,u owner of the property,am exclusively contracting with licensed canussmn to
construct the pmjca(See.70th,Business and Professions Cade:)The Conuacmr'a U.
come Law does oat apply In an owner of property who Wilds or Improws demon,and
who convects for such projects with a clumu (s)licensed pursuant tutee Conummes
License law. p
[)I am exempt under See b �O���)
3&P C for this rtum
Owner Dau
WORKER'S COMPENSATION DECLARATION
I WrebY all
under penally of perjury ane of the following decimations:ave and will mwntsin.Ccnifteau of Covent to sl6hsue fm Workm'sCmnpu-
n,as provided per by Section 3'r(m of the labor Code.for,the penfomtmm of the
work for which this permit Island.
❑1 haw and will maintain Workers Compensation Women,u nequired by Section
37W of the Labor Coda,for the performance of the work for which this permit is Issued.
My Works s CompevsN�-on bom �nce nuim and Policy number art:
Cartk T(J Policy No,:
CERTIFHC TEOFE EMPT70NFROM WORK
COMPENSATION INSURANCE
(fhb section need notbeconpletedl ifile penult Is fmanc hundred dolum(SIM)
or less)
1 ceN[v that In the performance of the work for which this permit Is issued.10.11 Out
employ any person in any mar7rip u te hcwm�hisu m NEWorkeri Compensation
Laws 0,CWfo Dy� ` 7
Applicant� —-
Nonce APPUCA :Iff,If, thisCnrlifFente oft-ption,you should
become subject m the Workers Compensation provisions of the labor Code.you mow
OZ forthwith comply with such Provisions m this permii ASH be deemed mvkcd.
'Z,..IO CONSTRUCTION LENDING AGENCY '
[-, I hereby ifnrm that Vert is a construction lending agency for the performance of
C> the work for which this permit is Wind(Sm.3097,Civ.C.)
RWi Q• Leder'sName
Z lA=Address .
fJ O 1 certify that 1 Mw mad this pplication and sum Nn the W.information is
ly F COMCL I agree to comply with all city and County ordinances and state laws relating m
QU Wilding emsructlon,and hereby authoden mpreenuaws of this city to enter upon the
W above-memianW property fm ivpecGon purposes
ty, (We)agree to uw,Indemnify and keep harmless the City of Cupenino against
�y IM liabilities,judgments,cavi and expenses which may in any way ammo against said City
U In conegmneo of the granting of this North.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUBGraRE CATIONS
l.Caduree ,�,..c�..�— L—S Date Re-roofs
Sign ort of ApplicaHAZARDO Dau
HAZARDOUS building
ALS DISCLOSURE Type of Roof
WIII tie applicant or futureni Wilding Code.Curt ware or width hvudaw material
as Mfined by tie Cupertino Municipal Chapter 9.1x.and the Heath and Safely
ade.seetion xss3x(.)7 ; All roofs shall be inspected prior to any roofing material being installed.
Yu
Will the applicant or furore Wilding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants u dcaned by the Bay Arca Air Quwity Management all new materials for inspection.
let?
❑sire [jNu
I he. ad to hoard..,meurials requirements under Chapter 6.95ofthe Cwifor-
nixHml"SafetyCode,Secdm M505.25533md25534.IundcntmddwifNe Wilding / Z •— G--��
does not currently how a tenant,Nat It b my numovlbility to notify Ne meupw of the O / .it-�'� �g4f J
trim whk mustW tpdormissuanen.f.Ltrureateofoceepancy. Signature of Applicant Date
k(� "tee
12 -.FV5 All roof coverings to be Class"B"or better
Owner oranhodredagent Doc