04090036 �`
BUILDING DIVISION PERMIT INCON "CTORINF.ORMATION &�
Pa 5,::3 A.>x
RUILDINGADDRESS: TOENISKOETTER & BREEDING It CRMITN04090036
0455 BANDLEY DR
OWNER'S NAME: PERMIT ISSUE DATE
CUPERTINO—BROWN INVESTMENT 1960 THE ALAMEDA #20 10/20/2004
NE: SANITARY NO. CONTROL NO.
(408) 246-3691
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
L� 0
20o LICENSED CONTRACTOR'S DECLARATION
F❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
iW with Section 7000)of Division 3 of the Business and Professions Code.and my license is
imfull tome and effect. REVISION--FL CHANGE FOR 3 CLASSRMS
O z License ClassLie#
i�'c Dam Contractor NO NEW PERMIT ISSUED/ORIG. #04040178
o .WyARCHITECTS DECLARATION
?w< 1 understand my plans shall he used as p.hire records
u.;i, Llccmxd Podt,a...mal
3 OWNER-BUILDER DECLARATION
a l7 1 hereby afford that 1 am exempt from the Contractors Liecrx Law for the
00 following mason.(section 7031.5,Business and Professions Code:Any city or,mory
x m which requires a enot in construe,alter,improve,demolish,or repair any structure
v—H prict iB issuance.also require the applicant for such permit to File a signed statement
!'2a that he is licensed pursuanothe Provisions of the Contractor'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation $0
C, tt
(commencing with Section 7000)of Division 3 of the B uziness and Professions Code)or
a 3
that he is exempt therefrom and tM basis for tW alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
net.. than fire hundred dmura(s50R). 32633102 . 00 P Y YP
D I.as owner of the pmpcny,or my andoi with wages as their sole compensation,
will do the work,and Ne structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property wh.birlds or improves Neeson,end whodocs such work himself or through his
tun employees,provided that such improvements are nut intended oroRered for sale.It,
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of Cr
sale.).
't.as owner of the progeny,am cz[Imivdy contracting with licensed convacmrs m as
onsuva the project lSec.7044,Business and Professions Cade:)'ITe Contractor's Li ,
c.nse law docs not apply to an owner.f property who builds cr improves thereon,and Y
who sopa Imusudl projectn with a eonmactods)licensed pursuant to the Convactor'.i
LiCenae law. Q
Or..
1am exempt under$ec. I B&P C for th s recon
ORK R'S COMPENSATION DELLA N
1 hereby affirm under Penalty of Perjury one of the fallowing declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Comp,n-
ation,M provided for by Section 3700 of the labor Code,for the perfmmanm of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
377 of the labor Code,for the performance of Be work for which this permit is issued.
My Workers Compensation Insurance prier and Policy number am:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WOR K ERS'
COMPENSATION INSURANCE
(this section nccd not W cmnplctd if ole permit is for one hundred dollars(3100)
m kss.)
1 certify that in the porfmmucc of the work for which this Permit is issued.I shall not
employ any person in any manner an as or become subject to the WorkersCompensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject m the Workers Compensation provisions of the labor Code,you must
.,2, forthwith comply with such provisions or this permit shall W deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
Pl hereby affirm that there is a construction lending agency for the Performance of
d' the work fur which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Nam.
2 Lender's Address
U O I certify that 1 have read this application and stem that N.above inumalion is
fy F Correct.I agree m comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorim representatives or Nis city to enter upon the
above-mentioned pmNrly for inspection purposes.
H y (We)agree m save,idcmnify and keep hurmless the City or Cupenin0 against ,{
fq liabilities,judgments.costs and capcmos which may in any way accrue against said City �p
V Z in consequence of the granting of this Permit, t
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG ATI S.
2Re-roofs
a�tgnawrc ofA p canVC.nlracmr ^Da'— l�r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wildmg occupant amt.or handl,hm odmix motorial
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Cdc.Section 25532(¢)? All roofs shall be inspected prior to an roofing material being installed.
El Year 1t'YN. P P Y g
Will the applicant or(future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haeardous air contaminants re defined by the Bay Area Air Quality Management all new materials for inspection.
evict?
❑Yeses
I have mad the havadousmamriuls requiremens under Chapter 6.95 of the Califoo-
pie Hcahh&Surety Code.SCCuous 25505.25533 and'M5 ,I umkrsmtd thatifuc building
does not Currently ham a tenant.that it is my responsibility to nodty the occupant or me
mqulr. entswmCnmusn.mt ti,trmmaenamacemfe.w.r/oyapaney. Signature of Applicant Date
ems/,///y � O C All roof coverings to be Class "B" or better
Owner—`or x>•ithRr,.c/J apehi 4 Dam