07120238 CITY OF CUPERTINO °
BUILDING DIVISION PERMIT #CONTRACTORxINk'UI.2MATI¢N
O
Bu1LD �DDPs P
STATES DR TBD — TO BE DETERMINED 07120238
R'
05/15/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C=
.OBJ LICENSED CONTRACTORS DECLARATION
i� I hereby affirm Nat 1 am licensednd
touter provuv mmw
iaof Chapter 9(or cinT Job Description
with Section 00(10)of Division 3 of she Business and Profcasium Cade.and my license is 1 STORY SFDWL 3886 ' GARAGE 424 ' -ALL (E) TREES
5R4 ixalsarcia ecL Uc.a SHOWN TO REMAIN, SHALL BE PROTECTED DURING
Dae ARCHIIECTSCon�RATION DEMO,GRADING & CONSTRUCTION OPERATIONS.
y P¢� 1 understand my plans shall be used n public mcards
SyU
g G LiceMed Professional -.
5 OWNER-BUILDER DECLARATION
I Mrehy aftem that 1 am exempt from the Contraclor's License Law for the
C o following mason.(Section 7031.5.Bus utas and Professions Cola:Any City Of County
$ which Coffin.a permit m construct after,improve,dcfaalish.or repair any metum
prior b its iasuance,also requires da,applicant far such permit an file a Signedsusermal
FSC dol he u licensed pumaant to the previaions of we Contractor's lunz Law(chapter 9 Sq.Ft. Floor Area Valuation
�$k-g (cwnmendngwi S=Uw7000)of Divlsion3uftMBudneasaed ProfeWm Coh)w $350000
S`t
that be u exempt Nwefrom and the basis fon IM alleged erempdon.Any violation of
Section 7031.5 by any applicant for a parfait subjects Ne applicant th a QVII penalty of
rot mart Nan It.hundred dolbrs(SMR 36924004Aff Number Occupancy TYPe
0 L u owner of the property.or my mplayw wills wages U their role compensation.
will do Ne worn and Can structure u nal intended of offered fon San,(Sm.704s,Busiace,
and Professions Cade:TM Canmctor's License law does out apply to m owner of Required Inspections
property who holds on impmms Nncon,and wM does such work himself or through his
own employees.provided that such impmsemenu art not ineedee oroRereal foraan,.If.
bavever.the building or improv aunt is said within one year of Compn,Ma de awner-
buiWer will breath.buden a proving that he did nfa Wild on antenna fon purpose of
sale.).
1,as owner of the property.am uelusiwly cornering with licensed contrwmra of
coustvct the project(See 7006.Business and Professions Cade:)The CmU¢m's U.
cense Law does na apply to an owner of property wM Wilds or impmwa thereon.and, .
who
contacts(ar such pro7eets with a contnno(s)licensed purl au of Can contramnfs
s Law.
muempt1Tder Seez2 B&PC for Nis msson
Data —� G
DECLARATION
1 bemby affirm under penalty of perjury,ane of de fallowing dalaeuiwcc
01hawandwRl MAnuinaCertflmmof Coventmself-imumfor Wort sCompen-
astion,as pawiced far by Section 37W of the Lehor Code.for the perfomtmce of the
weak for which this permit u issued
0 1 haw and will maintain Worker's Compewdon Insurwt¢,as rtquimd by Section
37M of the labor Cone,far the performance of Ne wort fon which this permit is issued.
My Worker's Compensation Insmanee Carrier and Policy number ser:
Cartier, Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS' _
COMPENSATION INSURANCE
(Ibis matlen need rot W completed if the permit is far.bondreddo0ats($100)
m leu)
1 Certify TMs in the perfama no at the wart far which this permit is ieue4 l shall not
employ any permnin say re msst9embjectm lh artgn' n
�of California. G
AppRnnt -- O
NOTICE TO APPLltA%1T.If,after making Nu Certificate of Exemption,you should
become Subject to On Waiter's Compensation provisions of the Labor Cede,you muse
O Z forthwith comply with such provisions of this Permit"I Is,damed rewked.
z O CONSTRUCTION LENDING AGENCY
C4
[-t IMr whop duspa Nert isacovSan.307.[ending agency for de Performance of
Ci Le work(w which Nu permit u isswd(Sec.]09'f,Civ.C.)
0 Laadm's Name
Add
=Z li IdeYs Ademss
U O 1 Cavity Nat I Mw rat Nu application and Stan,that the assume information is
I7. cMmcL 1 agree m comply with all city and County ordinances and sum laws relating m
0 building coasuunion.and Mreby ambfulm repremulallm of this city to cner upon the [\�tt(�(/ //
aMw-mutianed property fon inspection purpones
p1, (We)nme m aw,iedcmdfy and loop harmless Le City of CupeNna against
V) m enideLjudcolthseosuandes• "�-.which may in anY's'+Y aCrncaSalvt aid City
V z inconsegance sutler jrmMgo(thu per mit
APPLIC NDERS ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ( ��'
S
— Re-roofs
Si of App HAZARRDOUS MATERIALS DISCLOSURE Doc T
ype of Roof
WIII the applicant or form building eaupmt r 9,1 w haedlc Health
man,rial
fined io 0n,Cuyenine Municipal Coda.t]upser 9.12,and IW Hulth and Safety
.Section 25532(07
DYca PHO All roofs shall be inspected prior to any roofing material being installed.
Will ilm applicant or future building occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ca;hhaT Nous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
0Yw QJNo
I hew mad an hanna mas materials requirements under Chapaw 6.95 of de Califon-
nisHealth&Safety Cade,Sections 25505,25533 and 25536.1 understand Nu if Ne Wilding
does ne�t cCauncndx hq anal Na it u my mspaMibility m mdfy use acuparm of Nc
re4 he f r'�� Signature of Applicant Date
bLwn/seem-.atmriree agent .1 All roof coverings to be Class')q"or better