08050095 CITY OF CUPERTINO '�•' �"r a-> "`gym'•' `' -
13UILDINO DIVISION PERMIT 'ICONTRAOTR
PERMIT N0.
BLULD1Nq,aj7pR AUBURN DR AMERICAN BRANDS 08050095
l y'SbllbME PERMIT ISSUE DATE
DF BLOIS CHARLES E TRUSTEE 1029 BLOSSOM HILL RD STt 3 05/23/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 265-8000
ARCHrfECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
moZ, LICENSED CONTRACTOR'S DECLARATION - Job Description
w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
with Sectio.]000)afDiAnon JofN B"neumd PrafcuwnsCaded my brasxis CONSTRICT 240SQ PATIO ENCLOSURE @REAR OF HOME
m rull forte and dfeca
eq_ Liccnxclasi Lla.g� AMERICAN BRANDS CONSTRUCTION RENEWED BUS LIC
H p Dam tormRCNnECI-S DECLAR IO 5/12/8
Cay 7W 1 understand my plans Nall be used as public Mo rda
J6U
g Licensed Pmfesdonal
5 OWNER-BUILDER DECLARATION
I hereby affirm that I am eumpt from the Conuactoes License Law far tW
p O following reason.(Section]OJ 1.5,Business and Profession Code:Any city or county
e S ff which requires a permit to ceramum.alter,improve.dcm.liaM1,or repur any..ream
L i j prior m its its..0.round.the applicant formch permit m file a signed statement
pzs, that he islicenmdpursuantmNeprovisionofthe CommuneWcntxLaw(chapter9 Sq.Ft. Floor Area Valuation
YF (commencing with Section III00)nf Division J.fthe Business and Profession Code)., 20000
y 3 thu h ucarmpt therefrom and the basis for tha alleged a osi doe.My violation of
a
Slim]OJId by,a0'applicant for a Permit mbjccu the applicant to a civil penalty of Number OCCU
ml more than Tres hundred dollars($503). 31635023 . Occupancy Type
I,as owner of the property.u,my employes with wages as Nair ani comp action,
will da the wort and she urlKlme is not intended or offend in
for sale(Sce.]Ota,Busess
and Profeauans Code The Cmmwmrs License Law don owe
mt apply m an r of Required Inspections
property who Wilds orimprows mhermn,and who dues such work M1imselforthmugb his
own employers,provided that such impmwmenn are not intended ar fFerW Initial.IL
however.the building or improwmem u said within one yew of completron.the owner-
Wilder w•iB have the burel of proving that he did not Wild a impure for purpose of
sal.).
1,as owner of the property am nelumly contracting with licensed conmaemn m
commoner the pm)ect(Sec.7061.Buuseu and Professions Code:)M Cmu atchas U- _
cense Law docs or apply as an.of property who Wilds or improves therm.,and,
who contracts for such projects with a conmmmr(s)licensed pursuant to use Conmanor's
Licene taw.
oer"amptunder See .BAPCIorthisreaxn
as Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Not under penalty of perjury one of the following declnimucc
,haw and willmainby Section
37W of ConsentmCoca.farrfesWorkmanCompco-
w als f r whit ided for tri Section J]00 of the Later Code,far the performance of the
wart for which this permit is issued
❑Lues and will maintain Worker's Compensation last .u requited by Section
3700 ofdm Labor Code.far the perfmmance ofthe work for which this permit is Issued. '
My Worlers Commands.huu///r'ma ewrior and polity,nu bre>R:
Cartier. �,L L � POIIry Na.: Z 70"
CERT, CATS OF IXE MON FROM WORKERS'
COMPENSATION INSURANCE
rlBisxctim reed ant W completed lith permit is forme hundred dollars($100)
or less.)
I«nify that in the performance of dm work for which this Permit u heard.l that nor
employ any person in my manner an u an become subject to the Worker'Compenstian
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,error making thus Ccrtir,.w of E cmp,mr.you should
become subject m the Workc's Comprnadon provisions,of the Latter Cade you moa
.J0forthwithfawith comply with a co
such hosannor this .it mail W dmd.1ted.
'Zy CONSTRUCTION LENDING AGENCY
C > the workhemityfor iaf0rm Nem is a construction,lsndi.g.pre,ran the performauf
an .
Permit is issued(See 3(19],civ.C)
rT7 Q Lenders Name
z Lenders Address
U O 1 artily Nat I haw mad this appliction and sum thrt the wmM information u
i,, E' "reset I ogres m comply with all city and county ordinancesW state law,relaung m
C) Wilding eonsuucuon,and hereby aushorim mpmx.tauws of this city to en=upon the
W a1mve-mentioned property for inspection purposes
gy, (Wju agreejudgments,
to saw,indemnify and kecp may
in m the City of against said
against
Fes Z WbilitietJWgmeute,cas ti eapenuamay in any way arcane agalnlseid City
U vZ incomeq crUND jnnu.gof this permit.
SOURC�fT UND):RSTANDs AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC EGUL ONS.
AaYli 0 /231 2 -� Re-roofs
Srgnuu of HAZARDOUS MATERIALS DISCLOSURE DT— Type of Roof /�-
WIl,th applicant or future Wilding orcup ora ore or handle bwud.m material
Med by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safcry
.
Section zsszz(.)? All roofs shall be inspected nor to an roofing material bei. installed.
EI Y. {j No P P Y g $
Will the, secant or future building occupant ante If a roof is installed without first obtaining an inspection,I agree to remove
pp geyuipmem or rlvies which g
emit hmndnu air cmtamimnta u dcliacd by the Bay Am,Air Quality Management all new materials for inspection. '
District?
❑Yes t N.
I have rtvl the hwardous materials rtquiremnenb under Chapter 6.95 fthe
. Caior
o nit He-thksn,C �,;
u nM5.25533 and 25531.l understand!that J the Wilding
I Mhwtea y Lthitismy.ouhilitymmdfythouantofth
mgaimhict
*or
'faanaor.Certificate araapanry Signature of Applicant Date
ownnerm ath cd,grnt DamAll roof coverings to be Class'%¢"or better