04070070 CITY OF CUPE =CONTRACTOR INFORMATION:�
BUILDING DIVISION SION PERMIT ,
BUILDING ADDRESS PERMIT NO
04070070
OWNER'S NAME. PERMIT ISSUE DATE
ANN& THOMAS TRANKTIR —_—__ — _ _ 9'7 /7a fl rla
NE: SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n O p` LICENSED CONTRACTOR'S DECLARATION O O O
w I hereby affirm that 1 am liconud unde proviziom or Chapter 9(commexmg Job Description /�
Z withSmti g1U)ofDivision3ofNCBUSina ProfcasiamCodwandmylmcnsen Al
'^<N in full fn d effect' (c� -7 ////e�e�
;�z License Lw.M��O.51 REPALCE DECK �/�j
z Dale �- w ComrsctoPy -x�'PKICy"0A5r' CONTRACTOR: ENERGY CONSTRUCTION "���l1
ARCHRECI'S DECI.1q'0 0NN /'/v /\
I understand my plans shall he used as purl m records "v !C 7)
JyU \J
C Licensed Professional Z00Q
3 OWNER-BUILDER DECLARATION Sr
aY I hereby al0rm that 1 am exempt from do Conuxctor's Liecnm Law for the
O O fallowing moan.(Scedon 7In1.5.Busman and Profession CMG:Any city or roomy L
-.9 which aywres a From to eonshour,alter,impmm.demolish.or rePart any.ammum �LLT
Nii Prior 0 its issuance.also mgmmsthe applcant for such permit to file a signed staemcm
z< thnMislicensedpursuantto thepmvrs.o osoftheContractor s Licxnselaw(Chapter9 Sq.Ft. Floor Area Valu$tipo600
AFC (commencing with Scedon 7 000)of Division 3 of the Business and Profcsstom Code)or '7
$ that he is exempt Nciefrom and the bens for the alleged exemption.Any violation of t
Section 7031.5 by any applicant for a permit subjects the applicant to a maul Penally os APN Number Occupancy Type
not roam m fire.e hundred dollars($500). P Y YP
0 1.as owneafde proputy,mmy employee with wageethetr nom compensatron, � 35709028 . 00 r
Will do the wart,and the structure snot Intended.,offered forsale(Sec.7004,Business; -
.it Professions Cads:The Contractors Lice-.-taw does Iron apply ro an owner of Required Inspections
progeny w ho bu ilds or improves thereon,and who does such work hnmsel f or through his
own employees,provided Nat such improsements art natimeMed oroRered fors ile,If.
however,me budding or tmpmwrocia is said whin one year of complcuon,the owner-
budder will lusts the burden of pm.ing mat M did act build or improve for purpose of
sale.).
C)I.as wmer of the property,em exclusively contracting with licensed conmctors to
construct me project(Sec.700,1,Business and Pmfessom Cade')The Concacmr's Li.
cane taw does not apply in an owner of property who builds or improves thereon,and
who contorts for such projects with a cormactons)licensed pursuant to the Contractor's
License Law.
O 1 am exempt under Sec ,B k P C far mu mason
Owner law
WORKER'S COMPENSATION DECLAR.ZION
1 hereby aflino under Penalty of penury one of the following declaration:
hose and wdI mamum a Ccruficam of COnscm m selGmaum for Workers Compan-
.non.as provided for by Section 37M of Oa Lobar code,for tha performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as recanted by Section
3700 of the Lobar Code,far me padmirm nce of the work for which ths perms is Issued.
My Workds Compensation Instance tamer and Policy number are:
comer STATE FU M0 Policy, ZZ I'C)UZZ S S S
CERTIFICATE OF E%EMP IONFR?WORKERS'
COMPENSATION INS NJ
(This section need not W completed If the Permit is formte hundred dollars(SIM)
or lee)
I ceni(y mm m the ite,i munec of the work fn which ths perms s mucd.I shall nth t
employ any Ferran in any manner an m in become subject to the Workari Compensation I
Laws of California.D n-
ApPlian
NOTICE DO APPLICANT:If.afmr making this Cmdrilate of Exempt'.,you should
Wcome subject in the Workers Compensation provmons of the Labor CMG,you most
.J O forOwnth comply with such provision or ms Permit shall be deemed revoked
'Z'P N CONSTRUCTION LENDING AGENCY
I hereby affirm that cone is a confinement lending agency fur the Performance of
S' the work for which this permit is Issued(Sec.3W7,Civ,C.)
LU Q Larder's Nam, _
z Landers Address
V Q 1 certify that I base read this application and sum that the about information is I
U. correct I since ro comply with all city and county ordinances and sou laws relating he t
L)U budding conawcuon,and hereby authonec repmaamtamea of MS City to enter upon the
alrovcmemloned property for infractor,purposes
F y (We)Agree to saw.Indemnify and keep har alron tha City of Cupeni0a&&Lost
(n Ii11 i�s mcnu.cossandespcnsen which may in anywayaceruc agamstsmd City
f,z in can goenec o granting of ms Permit.
^ APP CANT fas RSTANDS AND WILL COMPLY WITH ALL NON-POINT : ISSUed by' Dale
50 CE REONS. J� /]y
Re-roofs
ontram or \J Data /
(/ HAZARDOUS MATERIALS DISCLOSURE 'Type Of Roof
will the applicant or future Wilding Occupant store or handle hazardous memos]
as defined by thc Cupertino Munlnpal Cade.Chapter 9 Rend the Health and Safety
% ❑Seeman Cade.Scea 25532(a)+ All roofs shall be inspected prior to any roofing material being installed.
Yea �Na
Will the applicant or future budding Occupant vac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
h laodous ae..mamma.as dc0acd by the Bay Area Aa Grainy Management all new materials for inspection.
con?
❑Yes
1 have read the hasardouustruuaerials rtyuimmcnu under Chapnr6.95 of the Cabfor-
maHcauh&Sit Iy sum 25585,33533 and 25534.1 understand murtthc WIWmg
does notcu dyhave mamamat0n553 and 2553.1 la Mtifydoraddebref IM
mgmm ch metpnorto lsmaneeofaCemfieauofOeupmcy. Signature of Applicant Date
Owner or All roof coverings to be Class "B"or better
authoved a�t�,
Dam