01060055 (2) CI BUDI GDPERNO
DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10908 VIA SORENTO 01060055
OWNER'S NAME: APPLICATION SUB DATE
• CITATION HOMES 06/11/2001
PHONE: SANITARY NO. CONTROL NO.
O O Z ARCHITECTAiNGINEER: BUILDING PERMIT INFO
toy BLDG ELE PLUMB MECH
U
Z 6 L.J
Z 8 v=i LICENSED CONTRACfOR's DECLARATION Job Description ell
O Z_G 1 hereby alTrm that 1 am licensed under provisions of Chapter 9(commencing
0, ;ar with Section7000)of Division 3 ofthe Business and Professions Code.and my license
arc m f 'n full force and effey�
-mza uannc�la.a. r� Le.x SE -Syd RE ROUTE IRRIGATION AND STREET LIGHT WIRI
w3 aJ' a b-rF o f Contractor rsildeat
H a. ARCHITECT'S DECLARATION
gI understood my plans shall be used as public records
u p O Licensed Pmfessiowl
c R OWNER-BUILDER DECLARATION
ac
I hereby aRrm that 1 am exempt from the Comoro Co :Any c Lew for the
h?a following Business and Professions Code:Anycity or county
IXC winch aquina a permit re nmsnuct,aline improve,demolish.t file
repair any sauaurc
c. Barhisslcnsedpltsaam to die Posh nsof[be Conpermit tnfleasi.aedsmtnnent. .. ._
coon toucan¢)puhntmn,70M)lvvidmuaf rhe Ce13u,m'a deems law(CWmcr9 .r a .ks, . Floor Area, A $100)Oluatiou
orthatfeisewiiheudan,]mandte basisoafeallegdeaaandl'rp Any
ewe) (.'(l". . 3,r•,t� ± ..t .. . . .e ,. •y, • :I';�
or that He is emmbr zany applicant
and the pentruor the allege)exemption.Any violation
Of Seniors]03n five hundred
for aperminubjensNmpPlimm toacivil penalty
of not mute than aye M1andrcd dmlat,usoo). 316 Il�Fpm�q .. . Occupancy Type
❑L as owner of the property,or my employees with wages as their sole compemation,
will do'the work,and the structure is not innnded'or offend for sale(Sec:]bu, - -
t Business and Professions Code:The Contractor's License law docs not apply to an 304 - ROUGH ELK%TV*_]J(1V!IPFctions r�•'
owner of property Who Wilds or improves themon,and who does such work himself
- rthroughhisownemployees.providedthatsuchimprovementsarenetintendedor _.._. 501 _-._FINAL _ELECTRICAL ENERGY
offered for sale:If,however.tie building or improvement is sold within one year of
completion.the towner-builder will have the burden ofpmving that he did rot Wildor 505 — FINAL ELECTRICAL
improve for purpose of sale.).
.._.. --'---. _,6;
._ _. _.. ...—_._.. .
_ Ol.as owncrof thcrn _._ _...... ------ .. .. .. .. .... ... ._. - ._ -__..
pmpv y em exclusively d Pmming n,Code:)
h comocnn m - -
License
constrain the,rosea(Sec.]13x4.Business and any whores Cwe:)The improves
Contractor'snrsecar
Law does not apply man owner of a cony who Wilds ix improves t.to the
O ucaser ,License L men projects with.a contractors)liccnud.purxuant.m the
01 am exempt under Scc. .Bffi PCfonhis reason
Owner Date
WORKER'S COMPENSATION DECLARATION j
1 hereby affirm under penalty or Perjury one of the•following deelandinna:"
❑ 1 have and will'mainnin'a Certificate of Consent to teff insnn for Worker's
Compensation, as provided for by.Section 3IDB of the Labor Cade, for the
_ performmae of the work for which this permit is issued.
❑1 have and will maintain Worker a Compensation Insurance,as reyuimid by Section
3] dof the Latin Code,for he performance of the work for which this permit is
sue .My Work ce,Compensation Insurance artier and Policy maqriber me:
arriersf4:�, (�yave� 's Policy NO:-�7/ "-17 •tt. . .. .. .-. .. _ ._. ._.__. . .. ..__.__ ....
'CER_TIFICA'IOi N OF EXEMPTION FROM.IVORKERS' : - 't- 1 ''�l t[, a1• .t
COMPENSATION INSURANCE'
(This action need not W completed if the permit is for am hundred dollar '"" '
(SILO)or less.) ,
f eerufy)hom'In be 11fi romme,of the work for which,,,r unit is issued,1
shall not employ any person in any manner so as to become subject to the Workers '
Compensation Laws of California,Date
-'Applicant ' _r .. .. - ..
I NO1 ICE'rO APPLICANT.IL after making this Certificate of Exemption,you should - s
come subea n sthe Wbrker s Compro
pensation visions of the Labor Code,you most
C O befan as i Ili comply with such provisions or this permit shall W deemed revoked.
'N •'^ ` 'r CONSTRUCTION LENDING AGENCY "
"'. ''I Hereby offimt that thele a conshootio s lending agency for the perfannance
� s
ti of the wok for which ffik,coni,is issues(Sec.309].Civ.C.)
Lender's Name. . ...... ........ . . _ ...L. ,... - . . _.. _ _ . ....- -
;;;I+Z Lender's Address'
L.) 1 certify than 1 home mad this application and state that the above information is'
R+F. correct.1 agree n comply with all city and county ordinance.,and state laws relating
to building conswction,and hereby authorize mpnxematisea ofthis city to enter upon
�s_;4 the above-mentians•J property for inspection purposes ,
. .�,i
P. (We)agree to save,indemnify and keep hotmlees the City of Cupenino against
Nliabilities,judgments.costs and espenseV-1...h may in;my way uceme auun,i said
V,Z City inconsequence of rhe gmnan,of this permit.
APPLICANTINDERSTANDS'AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
-O/
- SOURCE ULATIO y•
tL_ !! . _
signature or Apphoeam/CoertM1mr "." Dale Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
vs Jcfin ill applicant or fume Wilding Occupant aorc or handle Aazardous material' Type Of Roof -._.... .. ....._.., ._ _ .: . .._.,._.,. _
y the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(It �' ..r �'. [1 i.+ '•
✓.� a .�.� � .�.-
❑vee o No : All roofs..shall be-inspectedrior_to.any.roo5ng material being installed..
• r wroth applicant future building Occupant use equipment or device, which If a roof is installed without f rst obtaining an inspection;I agree to remove
en
sir rd cot w defined h,tM1 Bay A'rc A Qu'1'ty Mamg•memI
D t' t all new materials for inspection. Applicant understands and will comply with
' ores ❑Nn' - all non-point source regulations. -
I have read the hazardous materials re,mrsomnts under Chaptec6.95 of the
Ca1ifomi6 Health&Safety Cad,.Sections 25505,25533 and 25534.1 understand that .
if the Wilding does not currently base a tenant,that it Is mvrresponsibil'ity to notify the
u '
upant of the requirements which most be met prior to issuance of a Cenificam of
aP'onQ 6 Signature of Applicant Date _
�/
All f coverings to be Class"B" or better
�ri�neem . Dae . roocogs ,
. _ . .: . .. .. -
OFFICE ..._ _ .. .
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