07050009 CITY OF CUPERTINOBUILDING DIVISION PERMIT z CCSNTRACT�R INF�OItMATI( ,N
BUILDING ADDRESS: PERMITNO. '
10889 BARRANCA DR TBD — TO BE DETERMINED 07050009
OWNER'S NAME: PERMIT ISSUE DATE
THOMAS MAIER & ELIZABETH - 01/03/2008
PHONEIVt,"r SANITARY NO. CONTROL NO.
(Alk-
CHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EISCT PLUMB MECH
0 0 0 0
o p LICENSED CONTRACTOR'S DECLARATION
1 hereby arrirm that 1 un licensed unJer provisions of Chapter 9(rommencin{ Job Description
with Section70M).MiAshm 3ofine Bushes;aid Profeuiun.Cma.Mdmyllmostis ADDITION/REMODEL
n O% in full immanent effect.
License Clna Lic.0 ADD SPACE TO LIVING/DINING ROOM, CLOSET, REMODEL
1 Dam
ARCHITECTS DECLARATION BATHROOMS, KITCHEN AND CLOSET
1 undersand my Plans shall he used an public records
DIFUa
y O G Ucammd professional
5 OWNER-BUILDER DECLARATION
I I hereby aRrm Net I am exempt from the Contra or's License law for the
COO following matin.(Section 7031.3,Business and Professions,Code:My city or county
$ which requims a Permit to mosvo:L ahs,arrive,dcmuluh,or repolr My atrocture
_Z} Pram to itshouaM0.also,lequlm3 the applicant for such Permit b rile,signed WNmem
pp mar he it licensed pursuant to me provisions of do Corrector's UccueLaw(Charter 9 Sq.Ft. Floor Area Valuation
Y�$ (co urnmel {with Salion 7")of Division 3 of the Busm.and Proresslou Cock)or $216536
Q ..
that he is exempt therefrom and the basis for the alleged exemption.Any violNon of
Section 7031.5 by any applicant for a permit objects the applicant to a civil Penalty of Number Occupancy Type
tit mom than five hundred dollars(5308), 3 2 6 010 0 9 A
❑1,no ofthepa.ny,mmyemploycuwithn{eautireuulccompenudon,
wllldo me wart,and ftsncium moot Intended oroQemd forsam(See.70N,Bminw
and Prorenmru Code:the Contractors License Law does not apply to M owner of Required Inspections
property who bui Ids or im proves mesion,and who does such work himsel f or through his '
own employms,provided thetueh improvements art not imended oroRermi for sale It,
however,me building or Improvement is sold within one year of completion.the owner.
builder will low the burden of proving that W did net build or Improve for purpose of
uta).
p'"se owner of the property am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Predictions Code)The Comractots U.
roue law dors not apply to an owner of property who builds or improves themon,and
who contracts for such prejecLL with a commmor(s)licensed Forecast to the Contractors
License Law.
❑I empt under B&P C for this masod
Datal j ,��
WORKER MPENSALO TION DECLARATION
1 berth,affirm under penalty a(perjury one of the following deelarWou:
I have and will maintain a Card04mu of Co..,I.self-Warm for Wmi eraCompen-
n,se provided for
by Section 37M of the Labor Cade,for the performa� ft
of
r(or which this Permit is issued.
❑I have and will maintain Worker's Compmust IOun=,as aspired by Schon
3700 of the Labor Code,for the perforeemceaf the work for which this permit is issued.
My Worker.Compensation Insurance carrier and Policy number art:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
trials need.1 becompinN Iflhe permit Is fora.hundred dollars(SIM)
or len.)
I cerdfy mot In the Performance of the work for which this permit is W.d,I Mail.t
employ any penin in any mameru anbeen ub'ectto tic Wmken'Coun momm
Laws of C4Wmr a.Man
Applinnt C -
NOTICE TO APP CAM:If,a r matin{this CeniRa¢of Faer,num.you should t
become subject to the Workces Can.nsadon provisions of IM labor Code.you must m
.J 0 forthwith with comply with such provasioor mu Permit shall be deemed revealed..'�-m 55 CONsTRucnoN LENDING AGENCY
[-r IMuchy&Mm mat then la a construction lending agency,far the performance,of
IX> the work for which mb Permit i issued(Sec.Som,Civ,Q .
tj tenders Name
::D z Lender's Addrev
(„)Q 1¢oily that I have rod this pplication and MoM that me above Information is
[g.^. caned I gree to comply with all city and county ordinances am sum tan mluing to
Q LS.'J' Wilding convection,and hereby Mondrian mpccomaum of vis city to enter upon me
W ahovo-memi.ed property for Inspection purposes.
(We)agree to save,indemnify rad keep homeless the City of Cupeni.agdnst
rr IA liabilities,judgments,costs and expenses which may in any ray ame against said City
f,)7 inconeq.nce o(me SruOngofmitpermit.
•^• APPLICANT UNDE0. NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATIONS.
��^ t13��� Re-roofs
Signature of ApplimVConuac Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sum orhMdm harammu mauri&)
U deOned by the Cuperti.Municipal Code.Chapter 9.13.and the Health and Safety
Coals.Section 25532(.)7)7
Cl 1 All roofs shall be inspected prior to any roofing material being installed.
('ns,
Will me applicant or future budding=open,trto equipment or denim which If a roof is installed without first obtaining an inspection,.I agree to remove
It haxardnu air cmuminants a defi.d by one Bay Area Air Quality Maogeorent all new materials for inspection.
We,?
❑Yrs M<
I have mal the hvardous materials requirements under Chapur 6.95 of the Cali(or.
in Health&SarmyCode,Sections 75505.35533 sed 25534.1 understand that lfthe building
notcimenI It aumacL dist It u my ma.mwitty the=
lbituy In tty upset of me
Won
mu .1to Issuance OfaCertificate orOccoParou Signature of Applicant Date
Owner or aumariantlagent D,m' All roof coverings to be Class"B"or better