05080125 F"C
TY OF CUPERTINO t" xn.r, 'dr
BUILDING mvlsloN PERMIT 4CONT"OT,ORANFQRMATION =<;
o.:.h . '
DING ADDRESS: KELLER CONSTRUCTION PERMITNO.05080125
061 BARNHAR AVE
ERS NAME: PERMIT ISSUE DATE
DAVID B. OLIKER 685 24TH AVE A 09/13/2005
NE:
SANITARY NO. CONTROL NO.
(831) 588-9619
ARCHrrWfrENCINEFR: BUILDING PERMIT'INFO
BLDG ELECT PLUMB MECH
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Jpj LICENSED CONTRACTORS DECLARATION
4 C w' I h cby atrium that I M Ilmrvd Orvkr proc oa Of Ch-Pler 9(ammcnclnl Job Description
t> bulb ralBmnor.I.tm3orftBndnOaandPlmed«raeade.wmylm�t, ADD 341
- and 5 6 z g 3 3 ' (MS BEDRM/BATHRM) &
ce �.m REPLACE FLAT ROOF W/PITCHED ROOF
"C
ARCHITECTS DRATION
e�U I d Y Plans"! raaN
L tr6 lltxvd n.
OWNER-BUILDER DECLARATION FINAL
��
E 1 by nllrm that 1 sm exempt form the CWOrs Linens=law for the L
p 0 folbwin masntu(Saban 71131 ,Busineu ad Pvfesdov Code:Any my m cawuy
$ uMOh rtqubea•permit w cmnroit,alur,Improte,dcmolinh.or mra r any smuaua
_zr Pioro imiswance.aYotcqui=u applL=for WOhpvmltmnkalilydni1Orr=t
< tw le isIkeamPat+�amwu.n l•n.i,tnn,nruK cnn�brsl �w(LbaPwr9 $q.Ft. Floor Area Val a'ki0o00
< tammt anlwNS dm7 Dp)�D �IPn3�d�B�rc.,ar�Pw o inlmtbn oMAY 9— 20UJ
3 dtas he u eaempl tlrie(rorn ad We Gam fa We alkled eaempUort RoyzyWoof
Sesalon703I.5 by atryapplknnfurapermitaubjeem the.Ppliumm.anl pen,ltyd 9N Number Occupancy Type
notmoredw nK wdmd dalau,(swot 37509037 . 00 fA
❑I,aavner eflM pmPrrsy,amy aoplvym wish salsa thetr mle compeaatlan,
W iB do the wart ad the svucvm k out no,rasd oroReted for male(SOO.'IDIt.Bvurca.
ad Pm(eavoru Code Tye Canaan$LiOt"sse law doer m i"PIy m an aorta a Req ?W~
'spat'v'bei builds or Improsa thctmo,and vbo doa.ucL vat himself or tluoabE but
own cmployaa.provkN Nat acrd hoprmeuents ore not Wended aur oRtrd for alo R.
how 'Ne boildinl v Wpm.vnent m mw w ibin ore lar dmmpluim,the owter-
buiwer wap base the bsadrn of pmWn1 hu d dw rot WW a imprme for POToa of
aakJ.
❑L a Ox Kr of the IlroP y.am cadusi c y conmatinl With bcaua,l W mrxY}i b
caturoct the pmjm(Sec 70.4,Busi.ad Prvfeaslov Code:)The Cmtraa ti Li-
cata Taw doas oat apply in a owrcr or prapaty wba hands«impron,,Nerem.cod,
wbo canvaaa far aach pmjeem Wild•tan"Clm(s)paved psuavass b td Csrt.
El l arcam law.
laempt usWa See .BkPCfa Nu m,...
Dare
WORKERS COMPENSATION DECLARATION
\I hueby affirm under penaty,or perjury arc or Ne IdimaitµaecluaHms:
r/ham and v 11 maintain•CeNnab or c..m to alf-ivort for workers Caspcn-
aWan,a Provided for by Section 3'!00 of dtr labor,Code.for the Performena Of the
wort for vbich Wit permit Is wood.
❑1 bate tad wIH maimain Wantons Compcvatlon Ivor .ss rtquircd by Sauan
3'/110 of t4 Labor Code,for Ne pufa rnarOx a the wart for which Nu permil Is i"uOO.
My workersCi.Pt'.tIuo)_ ooicO curia and Porkynum'
art: p
Caller. I� Porky Na: K
CERIIFlC EMPIINFROM WORKERS'
COMPENSATION INSURAN�
mils sccsim red trot dcomPkd if the permit u far o.c budrd lotant(11W)
mless.)
1 certify that In the perfotmana of Nc Work for which this pmnii is issod.I Nall as
anploY any Pr.In any marcr so a to brmtx subpn to the WatOW ComPr.9dri.
laws of California.Due
Appliam
NOTICE TO APPLICANT:If,sfur oukinl this Ccnif=of EaaoPlian,you alouw
became subjm in ft Woh s CoorKmatlnn pvWuav of the labor Code.You ink—
Z romhv ith comply with ouch pra iaiau a thia Pc.I,Nd ra
Nall%dccmvokd.
Z o CONSTRUCTION LENDING AGENCY
[-.gyp+ Ihacby aR Nat Nem Is.mtmoudnn kdlnl.Fray for ft odori.Of
Dd> de wart rue whkh Nis Pamir m ivaed(Sac 3091,civ.C.)
W A UnObes Name
7 z 1<ndces Addrus
U0 I cvHfy that 1 hrK rad W.applkaal.auto sun than the atom bdamariun k
=comet.I ante w comply with all city ad county ordo.na..nd sore Wer m1atink a
0 GdldinE ta^nnu'non,tato bembyauNoritt repruw
enha d Jtw is city enlapo
un de
U abovc.m.Oorcd Proptny fa inspc oo puryosca
ty, Wj (Wt)time to an,idamdfy and leap barrolas Oe City of CepeNtm.laitut
lay Vl IlablllliOi jad5menm.cosm.d eapensa which may I.tiny v+Y.muc.l.lvl said City
U In mnsequata of Ne lrvNnl M this permit I�
'-" APPLICANT UNDERSTANDS AND WI COMPLY WITHTI
A .NON-POINT Issued by: Date a f
SOURC EG ATTOKI
Re-roofs
silo fAppllaHAZA DO �I
HA].SRDOUSMATERIALS
lnuita W RE 'J�Of ROOF
tB the O Cup ret a(atom ban I Co oaupapt nate a Iudk hsvrdaus!Sdvy
a tkntd by Nc CupeNco Mutdelpl Cot.Chapnr 9.11,W th linith ad 5a(ay
.sedon 155324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea dno
Will tin applk.nt or funnc bulwlnl aavpam ore egWPntml a Whim If a roof is installed without firs[obtaining an inspection,I agree to remove
�ata„m air cantamwma a that d by ft Bay Ata Air Quality M.auTOOm all new materials for inspection.
0y. KN-
IMG mad de hamdwsmanriam nOu'uctrcom umkrCMptai95 aftd Glifor. �/
nuliolN&SafayCatk,Srcilav15505.u533au Z531.1umlcw irdc Wilding
WZ
dm cot carted rum•rerun.than It u my m4portsibilRY w oadfY tfr oaupuu of de
mgu4c ms .9 pri i.amnaar.ctrdreucor $i ture of Applicant Date
°S All roof coverings to be Class"B"or better
Ow author'ved.Ecco Dan
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