05070108 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION ::.
BUILDING ADDRESS: GENE NORRIS ABELLA PERMITNO05070108
808 S RTANRY All
OWNER'S NAME: PERMIT ISSUE DATE
GENE NORRIS 'ABELLA 18402 ALCALA 71 08 /10/200S
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
io0 LICENSED CONTRACTOR'S DECLARATION JbDescription
u C 1 hereby affirm that 1 am li¢n¢d ounder provisions of Chapter 9(commencing
t� with Section 70(016 IDivision3ofd¢Business;and Pmfmma Codc.md mylimmem is
+�a imm11rnrmandeffect. ADDITION 305 ' -MASTERBEDRM/DINING NOOK/RELOCATE
j K License ClaraLk.p
;�, Dat Ompramor KITCHEN-REMODEL 88 ' KITCHEN/BATHROOM
ARCHITECTS DECLARATION
I< 1 understand my plans shall tm mud as public.emrds
us
sG� Licensed Pndessom.1
OWNER-BUILDER DECLARATION
<I 1 xrthy atTrm thaI I em exempt from the Contractor,Lieenu Law for me
O O following mason.(Section IID 1.5,Business and Profusions Code:Any city or county
�,w which,squints a permit Inc mower,aIle,,improve,demolish,or.,air any ntmcm e
pniorm its issuance.also myuiru the applicant for such permit m file a signed au.ment
thasW is licensed putmommNc provision of the Contractor's License Lsw(ChaPier9 Sq.FL Floor Area Valuation
yl-$ (commencing with Section 7000)of Division 3oftheBusinessand professions Code)or $74248
that x at exempt tMmfmm and We basis for the alleged exemption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not mo.man five hundred dollars(1500).
I'm owner prime property,or my employees with wages as their role compensation,
will do rework and theswnure is not intended or offend formic(Sec.7014,Business
and Pmrecsimu Code:The Conuacwra Linctus Law docs nor apply an an owner of Required Inspections
property who Guilds or impmms drawn,and who does such work himself or through his
own employees,provided that such improvements arc not inmmded oraRered formic.If,
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for pumpote of
r Q•1,as owrcr of the progeny,am uelusively moaning with Iia sed mnuacbrs to
commum the project(Sec.7014.Business and Professions Code)The Conuumr's Li
cone law docs not apply as an owner of property who Wilds or improves menton.and
who contr$LaK
ist licensed pursuant m the Contractor's
Lkmtse❑lamc .B&PCT this reason
Owner Date Mb�ION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
nam and will maintain a Certificate of Content m ul6insum for WorkcYsComp an-
on,u provided for by Seniors 3700 of the,labor Code,firs the perfmonance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 o(ft labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Deet section treed nn,W c.mplc.d Rise Icman is froom hundred dollars(5100)
mlus)
1 certify than inarfprm-@9l�ec of me work for which this permit is isucd.I shall nut
employ anypc ray'IyPln9t_SpIa�IV be�Ine subject the Workcrs'Compensadon
Laws o(CalIR, aur III Vit((// //,G "
Applicant nA-(
NOTICE TO AP CANT If,arm,Making that Cmificauc of Exemption,you should
sectors subject in the Worker's Compensation provisions of the tabor Code,you most
.Jz forthwith comply with such provisions or Nis permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[•+� IW.by affirm that then isacmtsuucimn lendingagcuy for the perfurmanst of
a me..,it fur which mu permit is issued(Sec.3099,Co.C.)
U3 1<ndcrs Name
CL. Lender's Add.,
D z
V O 1 modify that 1 have read his application and sum that the above information Is
correct 1 agree to comply with all city and county ordinances and sum laws miming to
p V Wilding construction,and hereby authorim repretenutits of this city to court upon the
above-rocroord property for ins ection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
HN liabilities,judgment,costs and expenses which may in any way accrue against said City
U z in consequence of the granting of this permit.
APP NT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EGUL ryDNS. rl
/ t t )6'KIr y1 0j It"ilv Re-roofs
u
t Signac er Appli auanm
nt'ConD c a
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applianl or to,=Wilding aaupant store or handle humorous material
as dcfincd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Coda Section 15531(a)7 All roofs shall be inspected nor to an roofing material beim installed.
❑Yea Np P P Y g g
Will the appRemt or future building ampanl use muopment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
f� hanamm a air contaminants u defined by the Bay Arta Air Quality Management all new materials for inspection.
3Vict7
0 y Nu
I have read the huarma mebrialsrtyui ancomunder Chapmr6.95m17the Califon
ria Hr�althksafelyCodc.Scctioru25M5.M533 and 25534.1 and pmadi thatirme Wilding
Joy rdr eurrcntly Tasc a ten my it t my resporuihility b mufy de oauPant of me
iremmt whi ustx I m issuance of,Ceorfcaw of Occupancy Signature of Applicant Date
,yrs, t F• l o O$
owner pt autbort dawn am All roof coverings to be Class"B"or better