06120008 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT jUQT091NF012IVIATIQN�:
BUILDING ADDRESS: MARIE-JEANNE & JOEFF DYER PERMITNo.06120008
10
OWNER'S NAME: - PER UT ISSUE DATE
9PRIE-JEANNE & JOEFF DYER 12/12/2006
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
pa LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 thereby affirm that I am li ems d muter provisions of Chapter 9(commencing P
;Tod with section]OfIU)of Division 3 of the Business aM Professions Code.and my license is
?�N in full forte and effect REVISION: ROOF BEAM . CONFIGURATION, SHEARWALL,
,qz oenmCim Customer FOUNDATION TO MATCH EXISTING FOOTING
DTSDEC
ARCN ECTSDECLARATION ORIGINAL PERMIT # 06050091
i
Ym< I understand my pons shall he seed as public records
�U
vi
Licensed Professional
OW NEm momp ER DECLARATION
I Wrtor .(Sinn the 1 1. exempt from Ne Cosiona C's :My c law for Ne
00 fallowing damn.(Saito 703 mean Business and Professluns COO:My city or county
2 m which its Mo a Permit n cnnsvuct,aimc improve,hperthinomi t me.repair any umcmrc
Priormitsisuao purse requires ihcapplicans fm sohpermilsLieca Law
that he is liccmJPursuanuotW Pmvizionsofthe Contractor's Liamlaw(ChaPmr9 Sq.Ft. Floor Area Valuation
(commencing with Section 70(0)of Division 3 of the Business and Foresaw.Code)or $234092
tis, ment he In exempt therefrom and the basis for the alleged exemptims Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Nearly of APN Number Occupancy Type
not mon than firs hundred dallses(55110).
❑i,u owmr of Ne pmpcny,m my employca with wages Noir sole compemdan,
will de thework,and thesvucwre o stinended or offered ftraale(Sec.]Om,Bushes
and Professions Code:The CantrxcmhLs.LiLaw dos roe an
Out apply owner of Required Inspections
property who build,mimprovm thereon,and whodausuchwmk himselforllunugh his
own employers,provided that such improvemsts art tot imerWed conRmW formic If.
however.the Wilding or improvement is mid within one year of completion,the ower-
builder will love the burden of proving that he did rot Wild or improve for purpwe of -
mc.).
Lys,as owner of the propeny,am eaclusivcly contracting with Hared conwtsors b
constrout the project(Sec.]Oda,Business and Professions Code)The,Comncmrs U.
acro Law dos not apply to in owner of property who Wilds or improves thereon,and.
who contracts for such projects with a cantrw.wr(s)licensed pursuant to the Conumtoh
lienor law.
ine
axe/9pnt der Sec .B&PCfm this m`as'on
Dam •t l/"-6
—� WORK SCOMPENSATIONDECI-iia ION \
I hereby alism under pcnilty of perjury one of the following dcdmvians:
❑Thaw aM will milnuin aCeasfiamtf Consenuoself-insert(o Workers Compen- /
seen,as provided for by Section 3700 of to Labor Cade,far Ne performance of the
.on for which This permit is Wood.
0 1 have and will maintain Workces Compensation Insurance,u required by Section
3700.1'Ne labor Code,for Ne performantt ofthe wort for which this permit Is issued.
My Workers Compensation Insurane,artier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlTo season recd nal W compkmd if de permit is formic hundred dollars(SIM)
nr less.)
I certify Nal in the performance of use and fm which this Permit to humid.I shall not
employ any parson in any msncrm csubie`Im Ne Warkers'Campenuu.n
Laws of Cabfomia 03Z
Applicant
NOTICE TO9'IfJ cr making this Certificate of Exemption,you should
become sbjat nt c Workers Compensation provisions of the Lather Cede,you most
Oforthwith comply with such provisions or this Permit shall W deemed noticed.
Z CONSTRUCTION LENDING AGENCY
(•+ I Wrthyalfrm am them is.muti uction coding agchey for the perrurman¢of
a> the work for which No permit is issued(Sec.3097,Civ,C.)
GA Under's Name
z Lenders Add.
J Q 1 Ceniry that 1 have mad Nis application and sum Nat Ne above information is
La. F^ correct.(agree to comply with all city and Worry ordinances and sae laws rtlming t.
QU Wilding construction.and hereby aulh.rine representatives of this city to enter uPnnthe
r W above-memiuned prapeny for inspection purposes.
Pgy (We)agree to save,indemnify and kap harmless the City of Cupertino against
LAY liabilitiesjudgments.cord and eapensa which may in my way sec.against said City
C)z in com aro nce of the graining of this permit.
SOtAPPLIC#NTAPNDERSTANDS AND WILL COMPLY WITII ALL NON-POINT Issued by: Date
_ Lim I �� Re-roofs
5 wof ApplicanuContracmr Dam '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the"pit=,m for=Wilding oaripant store of handle harsrdous material
as defred by tut Cupenino Municipal Code.Chapter 9.13.and the Health and Safety
cele. 0Yes zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yea
Will the applies,or future building ottvpant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Imus ous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection.
Distriaa P
❑Yes t9'br _
I have mail the harsrdsusmaerials requirements under Chapherb.95 ofthe Califor-
nia Health,&SafmyCode,Seew.25515.25533 and 25534.1 undemand Out if the building
dos orocurt r loss a mns�this it u my rtspamihility m mtfY the ocupant of the
dgaidtrty.t, heh,gtartT�m�priortaismaace.faccmfl oraapmhey. Signature of Applicant Date
own rmthmircdalcm p,r-C7 'All roof coverings to be Class "B"or better