08090185 CITY OF CUPERTINO
BUILDING DIVISION PERMIT mzqRANFORMATTQN-_�
BUILDIN8 ADDRESS PERMr`NO.
1 474 RAMPART AVE TBD TO BE DETERMINED 08090185
41VCR"NAME FEIRMrr ISSUE DAM
AT116INE SUN 10/14/2008
PHONE: SANrARY NO. COMROL NO.
ARCH=fENGINEER�. BUILDING PERMU INFO
PLUMB MISCH
Z, LICENSED CONTRACTOR'S DECLARArION
I hemby Mm Out I an licensed under proviaints of Chapau 9(communist, Job Description
with Section,7")of Division 3 offilan Business adi Profissimas Coca.ad my license us ADD 197 ' EXTEN(E) LIVING RM & MASTER BEDROOM
in full foren am effecIi.
.Z"o
LicaosmClas—Lic.0 TOWARD
Dat.Contractor
ARCHr7ECrS DECLARA�ON FRONT OF OF 4 ' -5" . ADD PORCH.
I unalcomadi my Plans shall he bad as public onourols
Licensed Prorcesminal
OWNER-BUIUNERDECLARAMON
M I lacm1by&from that I an,campt from the Commator's Ucconso Law for the
COD folloaring,mean.(Section 7113".Business ad ftications Codc:Any city Or County
es
ff. which recounts.Permit an consatmct�Mon.improvo.dOmolim,Or mpmr my structure
on prior in its issuance.also oxiuin,;the Applimmu for such permit to file a signed suationcrut
0� Oat k is licensed pormoun,to the Provisions of the Contractor's Lice=Law(Chapuo 9 Sq.Ft. Floor Area Valuation
1— (commencing with Secdon 7C(lay)of Division 3 of ft Runinear and Picrecoom Cedle)or $25000
5 that he is exempt thadfrom ad One basis for the allcipul exemption.Any violation of
Section 7031.5 by any applicant for.Permit subjects the applicant to a civil penalty of
wo,...0.five hundred dollars(SM 3 6 9 2 5 011 ANbl Number Occupancy Type
0 1,U�of�pmpcny.mmympl�wi�wgmu�kmit�pe=don,
willfttkwrk.wdft��nGtinW.kdor.ff�r...k(S�.7�.B�neas
ad prefessime,Code:Thn Cuumachon's Licerm Law dean not apply in in coner or Required Inspections
propertywho builds orisip. vilicidoessuchmak libeaself.,thadaugh has
Own employees. radded deal men improvements am not inandicil or offered for side,If.
however.due buildiin:or improvessicart is mid within neve year of compledon.me nomen,
Inelmer will have the bunden of paving Oat lic did at bald or Improver for purpose of
salc.�
0 1.as moves of ft property an exclusively commaefing with dratual Obbirmhem W
construcat the pobjca(Sec.7044.Business ad Professions Code:)'flIc Counneson's U.
emse Law does not apply to a contain of property who builds,or improwat therecon.and.
who contrats for such projeciat with a contractor(s)licensed pursuant be On Committees
Licesson Law.
ptundessec. ..B&PCIwOusession
d PA , - C— Dan
into cand U WORIEll'S CUMFENSAM7fs DECLARATION
I hereby�Orm under Penalty of injury orc ofthe following dediandow.
C3
as pro�idlbcd for by Section 37M a th.Labor Code.far On performance of the
weris for which cars Permit is Liman.
M I have mail will maintain Worlon's Compensation because.as nopmed by Section
3700.f dic Laor Codc.for the perform...fthe work for which this nmu I.aumL
My wm�s Compensation locursome,cafficur mal Policy number me:
cadw._Policy No.:
CEIMFICATE OF EXEMMON MOM WORKERS'
COMPENSArION INSURANCE
(This scetion bad notbaccompleund Ifthe pcoult U[wow hundred oollaz(SIM)
or Ic.)
I cacrtif�ths,I.the perform....f thec woria for which On,Permit is Issued.I Andl ma
employ any person in my manner a as to become abject In ft Workers Compensation
Laws of ifad
NOMCE TO ApprfATIf.after makirfilihs Cmfiflcauc of Exemption,you should
0
becomes fo a Com,cousidom provisions of the Labor Codc.you must
z forthwith comply with such provision;m this ptrrnk shut hic decrood revolmd.
z CONMUCTION LENDING AGENCY
1 hereby afflms dua them is a connotation lending agency for the Performance of
due woric for which this permit is issued(Sm.3097,Ch,C.)
Lenders N.
z Lenders Addrecas
U 0 1 caunIfy Oat I have ound this implication ad mum thin On move informaus,is
C) building cmanxturt.ad looethyadmos,refunemmadves.fthis city to cous.,im ft
Llmn-mentioned property for inspection purposes
(We)agree to save.imicrunify ad lacep issonless;the City of Cupertino against
i,i itabilimet,judgments,costs and expenses which may in my way accone Midnat said City
U Z in Criumbeconce Of doe,Soosint Of LOS permit.
APPLICANT UNDERS'TANDS AND WILL COMPLY WITH ALL NON-POIW Issued by: Date
SOUrE RtOar[ONS.
I� (=q -� Re-roofs
Signsine OrAppli VC..tmm.r I Dan
17 AZABDOUS MArEIUALS DISCLOSURE Type of Roof
rL�byftCupenimMunicipICodC.Ch&pMt9.]ZmdftH��mdS&fcty
he.Stettin 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
0y. [�W_
If a roof is installed without first obtaining an inspection,I agree to remove
W311 On aplicart or future building dKeeUPIOL use CqUipount or dc,u.which
emit bacardous air contaminants as dcrined by the Bay Ama Air Quality ManiScrocrin all new materials for inspection.
District?
0y.
I have madl the laboardlows monamnals undenrChapmr6,95 ofthe Cadifor-
.I.Hialth&S.1mCumi Sectiona 25505,25533 ma25534.I..&.d tentifft bulklial
,toni out currently hun a 1cosm.mans it is my responsibility or nodify th,occupern of be
requirtmints Th MM t9=I prior In VON==Of A Certificate Of0c - Signature of Applicant Date
Dow All roof coverings to be Class'W'or better
1,-7 L::::, -7 R(4
Owner or mOvM,,cd.*t