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BUILDING DIVISION PERMIT
`�CON.TRACTOR INF,ORM.ATION
BmLDITIQ -gppa
PERMIT N0.
ALMADEN AVE
/ERI'S25NAME.
TBD - TO BE DETERMINED
08060237
WN
PERMIT ISSUE DATE
LNLA OTA
06/27/2008
HONE:
SANITARY NO. CONTROL NO.
ARCHr ER/FNGINEER:
3
BUILDING PERMIT INFO
REMODEL BATHROOM & KITCHEN
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Description
1 bereby affirm that 1 are licensed under provisions of Chapter 9 (commencing
• ^ -- _ __... .-, ,. ,- ^, ..I.Oh
with Section )OlKO of Division 3 of the Budntss and-�JPralessiaw Cade. aM my Ik,•o- u
in full Luna sold cff {j O &CO
IJeense Clay Lk. N
Dale Z contractor C.e.
ARCHt1EC7'S DEC" ION
I mah rsund my plans shall be need as public raortls
Licensed Professional
OWNER - BUILDER DECLARATION
1 hereby aRrm Nat 1 am exempt from the C.nvece.rs License lave for th,
following mason. (Section 7031.5, Business and Professor. Code: Any city err aunty
which ent.ir. a permit m currencies, sher, impose, demolish. er ropeir any structure
-
prim to its issuance. also requires the applicant for such permit 1. Old a signed sutemem
is licensed to the of the Connectors Licenta Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he pursuant provisions
(commencing with Section ] 000) of Division 3 of the Business and Professions Code) Or
that he at concept therefrom and the basis fret the alleged exemption. Any violation of
Section 7031.5 by am applicant for a permit subjects the appikam to a civil penalty of
APN Number
Occu and T e
P Y YP
re more than five hundred dollars (SM.
❑ 1, ss ownv of six popery, or my errployeu with vngu as they sole eompewton,
will do the wort and trestruceum i.mnintended orrffemd forsak(Sao. n .Business
Required Inspections
and Profeamens Code: The Comsemr's Licerve Law dma rot apply to an owmr of
property who buildserimprovea thereon, and whodoessuchworkhimfelfmr through his
ownem.la providedthanrahimprovementsartoatinun ddtlm
is Ref on.(mule r.
builder, the within year of compleefor th
the
heimProvemmce
test e, r use of
builder will have the burden of proving Nat h did ill build or improve for purpose of
have
isle.).
.. .
1, as owmr of the propcny. am exclusively convecting with Hemsed Co.== to
construct the p.j.a (Sec. 7DU, Business and Prefusir. Code:) The Coalescent. Li.
cove saw does ..,apply b an o.txr of pnopcny who builds or imp.ses domem, and
.
who connotes for such projects with a contractor(t) licensed pur.wnl to the GonVaelot's
License Law.
I am exempt under See .B At PC for this reason
Date
Far
WORKER'S COMPENSATION DECLARATION
1 hereby alEm under penalty of perjury one of the following declarations:
Ihawmdw ImeinWnaCe foamof Comenlmsclf- imumforWorker'sC.mpen-
sation, as Provided for by Section 3700 of der Labor Code. fm the performance of the
work for which this pmmi, 4 taloned.
0 1 have anal will mun4ln Worker's Compensation Invunme. as rcquined by Stood.
3700.1' de Lahr Code. for the pcifern.mofthn wort fmwhich this permit is issued,
'
My WarinesssLsll�compew.dem Ilnsurance cartice and Policy Mother are:
�s
55_1 'OG p 77.7/0
-
Carrier. litF Xi4AC 0 Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu stolen need n.thconpletaJ If the permit is forme, hundred dollars (31M)
,
or lest)
1 mroify that in the patfomams of the work for which this permit u issued. l shall not
employ any person in any manner so as to became wbjeet to the Wortui Compc .aeon
Laws of California Data
Applicant
NOTICE TO APPLICANT. IL after mating this CMificam of Eaemptimn, you should
bxnme mbjece m the Worker's Compensation provisia4 of to labor Code, you mnv
foMwilh comply with such provisions or mu permit shall h deemed revoketl.
I
CONSIBUcnON LENDING AGENCY
1 hereby affirm that them us construction lending agency for the performance of
the work for which this permit 4 istmd (See. 3197, Cie, C.)
L,.&ea Name
Lender's Md.
I century that I have read this application and sum thm the above information is
-
mm L I agms to comply with all city and county aWin-.., and s4ta laws misting in
building construction, and hereby authorim repmaentalwa of Nis city in enter upon the
ahw- mentioned Property for inspection purposes.
(We) agree to saw, indemnify and keep homeless ter City of Colander, against
liabilities, judgments. costs and expenses which may in any way attet, against mid City
in corvegance of the}mntin {ref this permit.
APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON
-POINT
SOURCEREGU NS.
Issued by: Date 2 2
Re -roofs
Srgwurc of pplscuVCARDOU Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
�Will the appliance m futurt building accupantsmre m haMle haaerdow material
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ss dE had by the Cupertino Municipal Code. Chapter 9.11. and the Hmhh and Safety
ode. Sdceion 23672(47
❑sea
All roofs shall be inspected prior to an roofing material being
P P Y g g installed.
Will the applicant a future building oaupant me ryuipmml m dcviws which
If a roof is installed without first obtaining an inspection, I agree to remove
coil haeardous air co earroun4 as refined by the Bay Area Air Quality Management
all new materials for inspection.
0 Y.
Ibaverosdthe aAhb w mwta l'mquimmenuun4rCUpmr6.95ofthUifm-
M.Hca, cry ,Scct=nM5.2S533mn534.1umkrsune Jutif NC building
Jos nal camn0 mnsnd Wt ice 4 my nespo.iMiily m notify the amupam of the
myviremc h met 'm t suancc or. Coefcmc of Ocmpanry
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Signature of Applicant Date
�/ %7�
All roof coverings to be Class 'j}" or better
Owner autharixaeagent Dam