08080045 CITY OF CUPERTINO :� -naru° 4
BUILDING DIVISION PERMIT C0NT2 '01V IIVI UItMA�ION 's
BUIL 1 G KESS: PERMIT NO. -
�.���� BARRANCA DR CRAFTSMENS GUILD INC 08080045
NER'S NAME: PERMIT ISSUE DATE
10566 S DE ANZA BLVD 08/05/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 366-1000
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION Ib Description
I hereby sly,that I son lisena
l under pmvtsow of CMOP
P.,9(rommecing
i�i with Scction]O(10)ofDivixion3of the Bhhsinev and Professiav Cade,andmylicewcis ADD GARG (12 'X20 ' ) 241SQFT;DOESN'T INCLD RE—RF
^=y infall fomc ane eRr�.a .-) '
Ucawe Class a./
Data Conmecmr
n � ARCHMCTSDKLA ATI
e.< 1 undorsianJ my Plass still be used u pub'1,,cards Vl
a%t; Licensed Professional -
3 OWNER-BUILDER DECLARATION
1 beral y a1Erm the,1 am exempt Tram the Con..es License Law far the
❑O fallowing tenon(section 7031-5,Businas and Professions Codc:Any city of teensy
5$ which mquira a pemiil to constricr altar,improve,demolish,or repair any suaaure
prior to its issuance.also requires the applicant far such permit to rile a signed statement
E that hemlicensed porandtothe provisions ofNeContractor's Lice=Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with section 7000)of Division 5 of the Busicv aM Profediow Cron)or $35000
— that he Is exempl therefrom and the boas for tin illegrd exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
am tame then five hundred dallan ISM 326 010 0 7 .ClY'
❑1,u ownv of th pmporty,a my wplayen with cages u tsev sole wmpewaton,
will do de work and the sw,ture u not insended err oRered fowile(Sc.7014,Busihw..
and Pmfessaw Cade:M Certmet0es License Law does tat apply m an owrer of Required Inspections
properly who builds a The
therron and who does such work himself or through his
awn employees,provided that such improvements are not intended oro@red for We If. -
however.ULA building or improvement Is sold within ane year of completion,the owner.
Wiwor will have to burdent of proving that M did not Wild or improve for propose of
tale.).
❑1.u owner of the prapeny,em exclusively convecting with llCewcti ronvutars to
construct the project(See 70a1,Bwinass sed Prufwsou Cede:)The Conoecmes U.
ewe taw does tat apply m an.of Property who builds of lmprova thereat,and,
who mnuacte fur,uch projects with s ce oracton(s)licnead pursuant in the Ccrome mes
Lice.Isco.
❑l oro exemp,undm Sec. .B&PC fa not reason
mer Dam
WORKER'S COMPENSATION DECLARATION
1 bemby aQrm under pc tad y of perjury aro of the following declarammc
)have and will maintain a CersOam of Comani m mil-Iwum fa Workcra Compen.
vision.u provided for by section 07W of the ubnr Code.for the pedormacc of the
work for which this Permit I,issued.
1 have and will maintain Workers compensation Iwuran¢,as required by Section
5700af the Labor Code,for the performance of the work for which this Permit is lewd.
My Wer a ompem utanc 'ec and Policy nu-m-/ber(er�r/:
Cartier: Policy No.:
CERTIFICATE OF fEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This soctloe heed net b:complcmd if the permit is foram,hundred dollars(SIOU)
or less)
I camfy the,in the performance of tr work for which this permit is listed.l shall m,
employ layperson in any manrmrso u In become subject at the Workus'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,&nor making this Cenificam of Exemption,yeti should
become subject in the workers Compensation provisions of the Labor Cod,you most
.,O forthwith comply with such provisoes mu or permit shall be deemed revoked.
z Fh". CONSTRUCTION LENDING AGE
NCY
I thereby oiren tut Nem is a cowmcunn lending agency
far the,perfamamm M
Cam
> the work for wrath the permit W iuoed(sec.31197,car.CJ
1 Q Lenders Name
5 z li hders Aeamss
U Q 1 certify that l have read this application and sum that the above information is
[kv corrin.l agree to comply with all city and county on irs aces aM stare laws relating to
Wilding cmtsauction,and hemby• osort rtprtsatstives of this city in ortserupon de
above-mentioned pmpeny fa inspection purposes
agree m eve,indemnify and kcP harmless the City of Cupertino against
rA liabilites.judgmc wta oda which may in any way acaoe agsnsttaid City
V z in eonsequen of a ,'hung of permit.
'--' APPLI � STANDS D WILL COMPLY WITH ALL NON-POINT Issued Date
SOUR
Re-roofs
$ignaure pptwnVCo. cta Dam
N DOUSMATERIAL DISCLOSURE Type of Roof
Will dm applicant fuiurebullcingaecup wmrt orlu,wle ha'rardow mamriil
u defined by the Cotten' Municipal Cade,Chapter 9.13,W the Health and safely
.section sssyg(.)] All roofs shall be inspected nor to an roofing material beim
❑r ON. P P Y g being installed.
Will the. Cant or mtw,Wilding occupant am If a roof is installed without first obtainingan inspection,I agree to remove
PP gea Air ca,a desrw which Pe g
emit hvaNnw air cmtamiwnu as dc0ned by the Bay Area Air Quality Managcmcn, all new materials for inspection.
District?
❑Yes 0 N
I have read Nebo mnmmeri aementa rChap Q9 ofthefsliron
ni•Hemth&safe, tow 2550 125534, once ifthe Wiwing
dao no,curet he k that it
I
Signature of Applicant Date
owne,or mthadmd agent D,m' All roof coverings to be Class'7}."or better