08040118 CITY OF CUPERTINO
BUILDING DIVISION PERMIT `f}1'aRAG�T(}R.II ''bXtMA" If7N ?=
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UIL�TS"gUZINGW00D AVE WYANDT DAVID A P080ERMIT40118
NER'S NAME: PERbBT ISSUE DATE
WYANDT DAVID A 19827 COLBY CT 04/16/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHRECTIENG(NEER: BUILDING PERMIT INFO
BLDGO 3 ELECT PLUM MECH
LICENSED CONTRACTOR'S DECLARATION - Job Description
ec
I hemby er,.Nut 1 um Imemed under pmWsions of Cbapmr 9(mmmencing p
with Stion 7IX111)of0ivWon3of Na BusinmudPmfcuium Cado,andmylimnsets WNDW RPLCMNT,WTRPIPE CHNGOUT T CPPR,NW
m in full fans and effect
Ll z— Lima.Class tic.fr FURNC&RELOCT
Sh,
Dow Contractor
ARCHITECTS DECLARATION
Q 1 undmatand my plans Nell W used as public records
7.0
yah UccnseJ Professional
OWNER-BUILDER DECLARATION
+� E 1 hereby a?rm
that 1 am exempt from the Contracture License Law for the
Z O o fallowing mason.(Saman 7113 1.5.Bushes,and Professions Cat:Any city or county
$ which mqu(rca a permit to mnmrmt,a@r,improve,dsmollxh,or mptir any Immune
'.z prim at its issuance,also requires the applicant rat Such Permit M rile a signed aufemcnt
that he is limmnd pursuanuo the provisions of the Contactors Limmc law Chapter Sq.Ft.Floor Area Valuation
$ (commencing with Somme 7000)of Division 3ofdoBusiness and Profcuions Code)or 10000
— Nat be is exempt therefrom and!Ne basis far the alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant as a civil penalty of 7az,{Number Occupancy
tot mom Nan five hmdmd dollar(g5W). 36920019�VTyPe
❑1,u .of tier Property,or my emPloyem with wages as thebmle eompensgalm,
will do the work,and Nesbuctum is rot Intended or Offered female(5m,7044,Bususm
and Profmaioor Code:The COnussnors Lixense Law does ant apply to an Owner of Required Inspections
pmpeny who Wildaarimproves thaseon,and who dmssuch work himselfmlNough his
awn employee,provided that such improvements are,not intended ora@rod fmsale.If.
however,the building or Improvement is sold within and year of compleuan,the Owner.
build.will have the burden of proving Nat he did tot build or improve for propose of
ask.)
0
I.u awrcr of the property,am exclusively contracting with Bmneed mnuaaom in
common the pmjem(Sec.7014,Business and PmfeWom Cade:)The Commoner U.
cense Law does not pply to an owner of Property who builds or improves themon,and,
who Walmcu for such pmjccu with a conwnm(s)licensed pursuant m Ne Contractor's
License Law.
❑Ism ex5�\InlId Oder a B&Pcf //Nh�ia moon
� TIO V D
WOR SCM SA O�1 N DECLARATION
I hereby affirm under penalty of perjury oro of the following declared onar
❑I ham end will maintain•Caruil m e of Conserv toself-insure fa Worker's Camped-
Mian,u provided for by Suction 37000f ale t.bm Code,far the porfarmenm of the
wort for which this permit is issued.
❑I have and will maintain Worker's Compensation lasmanm,as required by Section
37M of Ne Labor Code,for the performance of th s wart for which this permit is lament.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Polity No,: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Drisseaion reed mthecomple cd If the Fernit is fmaxe hundred doltara($100)
or leu)
I mnify Nat In the perfamanm a NG o Ito which this permit is Wood.I.hail not
employ any person in my menneraedp brep to the Workers CompensNon
Law!of Califomie�pa X111
Applicant /I yrI— f�ii.—� C
NOTICE TOAP .If,ife ma�dngv nificm of Exemption,you should
become subject m the Worked Compensation provisions of the Labor Codc,you mm
.J O fonhwith comply with such pravOmm,or this permit Nred re
all be decevoked.
'Z y CONSTRUCTION LENDING AGENCY
E-r l hhrehy affirm Nat Nem is a convection loading agency for One performance of
C the work fm which this permit I.issued(Sec.3097,Civ.C.)
W Lender.Nurse
z tenders Add.
U 0 1 certify that I have mad this application anal sum that Ne above information ie
W Eve mrmn.1 Mroe m comply with all city and county milim nce!and sum laws mlaung in
.QU building consuuctian.and hereby mthoriu representatives of Nis city to enter upon the
W shove-menudgro property for expenses Purpowhich ms
ry (We)agree to save,indemnify and Imp harmless the City of Cupenina against
r.y fA Itconanitano of
commd expenses which may in my my xecruc again.said City
U z A APPLICANT
of Ne granting of Nis o WIit,I. ,COMPf/Vy�yYyY f1.l�jtf/� yv5f (�,
SOURC RE UNDERST NDS No WILL
- WITH Issued fs Date —/_ 7—"Y
SOURCE REGULA N
Re-roofs
Sgnuum of Appliean onmemr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(mum building ocmpmtat9,1 ser handle haMdaas material
u OeOSa by tie Cupertino Municipal Cam,Chapter 9,11,roti Ne HcaiN roti Safety
.0Yes 35533(x)7 aw-� All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or fumes building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
calk haurdnm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dal —/
❑Yes Cryo
1 have mad the ha ndou.materials re poiroments under Chapter 6.95 of the Cables-
niaHcaW @Safety Cad.Sacdam35505.35533ad35534.im@mondthuifthe building
does net currently have a renm4 Nu It is my m osechilby to notify the occupant of Ne
rcyvire c m Wmatpno�u ofacent"""OO/P Signature of Applicant Date
� �_1 ��� All roof coverings to be Class'W'or better
Owner or authorizedagent D