06050174 CITY OFCUPERTINO
BUILDING DIVISION PERMIT �ONT'RCTCIKINI+CIz ATION G
.. 4x2` rw r&,�d, t
BUILDING ADDRESS: ' MARK CUNHA' S PAVING µ PERMrT NO.06050174
20846 GARDEN GATE D
ER's NAME: PERMIT[SUE
YAN 2491 OTTAWA WAY 06/14/2006
PHONE: SANTIARY NO. CONTROL N0.
(408) 866-0945
ARCHITECTIENGINEER: BUILDING PERMIT INFO
B Cr PLUMB MECH
t� 0
sapLICENSED CONTRACTOR'S DECLARATION IO D tri
ed c�
JIM affhm that I am Hived under pmvW m of Chapter 9(mmmcneing -.
with Sution 700D)of DM.Ion 3 afthe Bualn=and Profmi..,C.d.,.d my licenw is
in full folie and affect b HOUSE DEMO
= Llee.rc e Lie.» JUL to, 2006
0-q Dox A !;1 Contractor k-ev,,t rtG .
7W ARCHITECTS DECLARATION
I uadsan
enJ mY Plans shell bu used u public mcnNs
Ztt;s U Ip{ IrJII FptT� ���,\�\\)VPJII
LiacnseJ Pmfcasionel
OWNER-BUILDER onDECLARATION
qy 1 Mrern.(Tvm that 11. exempt stun the Contractors I:Aay c taw for tad
`p o fallowing sores a permit
i to construct.
her.and Pmfeai.n Code:Any city armoury
$ which requires reeonaudee daroodism,fie a sig stracture 9000
_Z Sex prior i is issuance.inu entW require,the applicant for each permit Na a siLoeJ ssaxmem
iothubusmnsedpursoan7000)ofDiviomaflbuCausinestUarueLaw
onsCodta9 Sq.Ft. Floor Area Valuation
�$
(commencing alaeas with Section tang basis
r at me al a ad exeandmpt Profession Code)or
Net he s 31.5 b mmefmm and me aper ser the Woad exemption.W My violation of
Out a 7than by sry applicant fa a penult subjects the applicant R a civil pensby of r Occupancy Type
rent mart Than Ow hundRd dollars($300).
❑I,as owner of thm property.Or my employees with wages u their sole compensation,
win do thc war,and the svuctus,is not intended or offend for mic(See.70 N.Buslaex Required Inspections
and Professions Cade:The Cmdreames License law don. 1 apply m ns an Owner of q P
property who builds or im proves thnean,and who does such work himself or through his
own employees,provided mss such Improvements aro notin emled aroQemd fn ear.B.
however,the building or Improvement is said within arc yea of completion.the ower,
builder will baw the burden of proving that M did not build a improve for purpose of
saleJ.
❑1.as owner of the property am exclusively cormacdng with licensed contractors;to
convect the projen(Sea 7044.Business and Profesalmes Cade:)The Canaactora Li-
cemm law docs not apply m an owner of property who builds a improv meRm,and,
who contracts for such pmjecs with a comeactor(s)licensed pursuant to the Commodes
License law.
❑I me exempt under See .8&P C for this teason
Data
WORKER'S COMPENSATION DECLARATION
I hereby of im under penalty of perjury on of the following melaration:
I haw vd will msinuin a CeniOmx of Conem w tel(-imuR fn WarkereCampen-
:der.as provided fn by Section 3700 a due Labor Cada for m.performance of am
work for which this permit is Issued.
I Than and will maintain Workers Compensation Insurance,as required by Section
3700 of me Labor Cade.far me pmforwe ce of me work fn which this permits lased.
My Worker' Co pe o0lrtpmrytcc tori sad Policy number aro:
Camer. n.vMi »S0. No.:
C 7E F ON FROM RKE S'
COMPENSATION INSURANCE
(Thssemlon dead etbucodepated If m.permit Moron hunmeddollars($100)
or les,.)
I cenify that in the performance of the work for which this permit is issued,I shall nm
employ any person in my mannered as m became abject in tie Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you slmuld
human abject an the Workers Compcosation provisions of the Labor Code you masa
O farmwith comply with such provisions or this permit shill W dmmad revoked.
CONSMUCfION LENDING AGENCY
(•r I henry amen the them r a constmadmm leading sane'for the performucc of
ani the work far which this permit is land(Sm.3087,Ch,C.)
Wry Q LenMh Name
.7. z Leaders Addm••
U Q 1 certify that I have RW this application and sate mat the show infam.uun is
W r correct.l qme to empty with all city and county ordinsnm and we laws mhung m
0 building construction,and hereby authorise mpresmstiva of this city to enter upon the
W above-mentioned property for inspection purposes.
L3, (We)agree to saw,indemnify and keep harmless the City of Cupenino against
rex Ilabilitieafthignumm,coau red dammed,which may In any wwy.ceme against said City
(„)7 in consequence of the gnndng of this permit.
�7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 670 Date
SOU REGULATIONS.
Oby O S
A �3 Re-roofs
Signatum of Applianuconuanar Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Futuro building accupatsoR or handle hvudaus material
as defined by the Cupeniao Municipal Code,Chapter 9.13,and the Health ad Safety
.Section 25333(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yeo
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Imamans airconumuunts as defined by the Bay Area Air Quality Management all new materials for inspection.
Dlnrict7
Mae )(Nu
I hew read the haarMmsmaterials requirements undcrChaPterd.95 of the Califar
nsH"I"Safmycode.5miaa23303,35533 and 255th,1 understand mmifdx building
does not currently haw a tent,that,It r my responsibility an amity the occupant of the
requirements which mus be met pdarm issuance afar Ccnlncam of Dccuprcy. Signature of Applicant Date
hz a O 6 f r 3 �0 6 All roof coverings to be Class"B"or better
Owner or authansed aam Dam