04030249 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS PERMIT NO.
WILLIAM HURT 04030249
3740 AT.CAZAR AVF __- _ - --- —. ----- -----
PERMITISSUEDATE
OWNER'S NAME nn!!�1
WILLIAM HURT 7374 AT A7AA AV$__ SANITARY �F.�7ROL NO,
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ARCHITECT/ENGINEER BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+,r0`p LICENSED CONTRACTOR'S DECLARATION Job Description -
juwr I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Zw with Section 70iff afDivision 3 of the Bumnaseod Profcasium Code,and my license is
m full force and effect.
j i License Class Lk.M
SFDWL-2 STORY/LIVING 4699 SQ FT
Z-, Dam Contractor GARAGE 710 SQ . FT.
all ARCHFIEC7'S DECLARATION
1 n&..d my plans shall Mused as public rtmnds
z,U
;a lit Licensed Professional
S OWNER-BUILDER DECLARATION -
I hereby affirm that 1 am exempt form the Contractor's License Law for the
o o following mason.(Section 903 L5,Busness and Prof raom Code:Any city or county
x°m which".ira a puma to consumer.alter,Improve.demni.h,or repair any structure
yam prior in its issuance.also req Wr6 BC applicant for such purml to file a signed statement
t?'<
that W is licensed purammul to fic provisions of the Counselor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
¢'$ (commencing with Section 7")of Drvumn 3 of the Business and Professions Code)or
_
that M is exempt therefrom and the basis for the alleged exemption.Any violation of c—/ S 7 2 0 0 0 0
Section 7031.5 by airy apps ant for a pertait sublet.the applicant as a ervJ penalty of �'
not more than fiw hundred dollars(s500). APNNumber C/ Occupancy Type
❑I,me m rofthepniputy,ormyemploycawimwagaasthensolccampn.Nun. _ J
Will do the work.and the swaum is notmended ararfered for sale(See 70ad,Business .5b /17U11 U
and Professmm Code:The Confiscates License law dace hat apply at an owner of Required Inspection ��`
property who bu occur imprimis Nermn,and who does such work himaeifor through his
awn employxcs,provided that such impmwments art mormlaMW or formed far.1c.IL
however,the building or improvement is sold within one year of completion,One awrmr-
budder will haw the nurdcn of provreg Nat M did not build or improse for purpose of
h as owner of the pmi am caclumvely convicting with licensed comuacmrs m .
o t the eject(Sec.7044,Business and Profesvons Code.)To,Convectors Lt
come,taw does not apply at in owner of property,who Wilds or improws demon,and ,
who contracts for men projects with a eonvaetor(s)hcemed pursuant to the Contractor's
License
I �xe pt under Se .B&P C far Nu restated
`_� WORKERS COMPENSATION DECLARQI�'
4p1 hereby affirm under penalty of perjury one of me following declarations:
haw and will maintain a Cerule of Con at Council sa f-insure fix Warkees Comfort-
as provided for by Section 37M of the tabor Code.far the perlu rn em of the
work for which this prmn is issued.
❑1 haw,and will maintain Worker's Compensation Insurance,as required by Section .
3700.1'the IaWr Code.for the pefarm uce of the work for which this pmnua issued
My Worker's Compensation Insurance carrier and Policy number are:
Came, Policy No '
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
Met secoon need not M completed Ir1M permitur faronc hundred dollars(Stall
or less)
1 ce ofy that in the performance of the work for which this permit is issued.I shall not
employ any,cson in any manner so as in become subject o thc Workers'Compaauon
Laws of California Da•^
Apomem
NOTICE TO APPLICANT:If.after making this Ceniffcam of Esemption,you should
become vinect to the Workers C.I.Notaoon porv.mm of the lannr Cade,you mum
OfoMwoh comply wM men pmv.mm or N.perms shall W dcemcd revoked
Z E;5 CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency lot the performance of
^.G ,7 the work for which this permit is Issued(Sec.3097,Cw.C.)
IV A Lendcr's N,
Z Lcader's Adire"
U O 1 comfy that I have read this application and sum that the anow information is
I2. H correct 1 agree at comply with all city and county ordinances and sum laws relating to
p V budding construction,and hereby authoms,repracrutmca of N¢coy to enter upon thc
flit .love-mcmion s!pmperty for inspccuon purpose.
(We)agree to save.indcmntfy and keep harmless the City of Cupertino against
F' fajl liabrnuu,judgmcn.,ectiv pit cxpnsa whmh may to any sully accrue against said City
U z me ucncc if NC gm got this permit.
'—' AP IC UNDERS A DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
50 E
Re-roofs j
�„ re or nvvlmanueodvaemr p.m
`/ HAZARDOUS MATERIAL 1SCLOSURE-1, Type of Roof
Will the applicant or future budding occupant smrc or handle harsrdous material
as defined by the Cupertino Municipal Code,Chapter 9 12,and the Health and Safely
%"Im,.Sccuon 25532(.)1 All roofs shall be inspected prior to any roofing material being installed.
CYCS No
Will the applicant or future building Occupant use equipment or aem¢a which
If a roof is installed without first obtaining an inspection,I agree to remove
pp 6 P quipmen
iardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes 0 A
er
1 him read the hanoloos materials requirements under Chmacr695 of the Cahfor-
ntaHealth Saf."Ccd Sc cu 255(15.25537 and 25534.1 unJCrs.nd thmifthc building
Joca In 01 'hoc a that u n my mrponviol, m nobly the ice.pnl of the
rcym chmust n ncrtoiss ce ctifiateofoccupancySignamreofApplicant DatC
,- agcm - Date All roof coverings to be Class"B"or better