08080197 CITY OF CUPERTINO &rS+s
BUILDING DIVISION PERMIT CONTRACTaR INFURMATION�
BwL�M,"?�F -OKGROVE LN TBD — TO BE DETERMINED PERMIT08080197
R'S NAME: PERMIT ISSUE DATE
.:OPNEI.JA BOHLE & WERNER 08/25/2008
NEi+I l l l P A N 71 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: ADD 37 .42 SQ FT TO MASTER BLDG BUILDING
SRP PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION O O O
.�� I bemby of arm that I ma Waned under provisions ofChapter 9 wommenaina ---- --- _— -._ .. ---—.Jbh Description
with Section 9(00)of Division 3.f the Business sib Professions Code,and my license is
>q_ in full to=and efrem5 t�.a 98833
Ucenrt cloyy,�_,-- LTJ �
=p Dam a�f-LLr]9ConO.mor KL,Y CcvfJr
pp7W7W Ty II lI - 'ARCHITECTS DECLARATION
C I understand my plans mall W used as public records
D.V
at
G G Licensed Pmfeui...I
3 OWNER-BUILDER DECLARATION
E 1 herthy affirm Out 1 am exempt tram the ConOamo's License Law for the
p O following reason.(Smtion 7031.5.Bassoons;and Pmfcsmoni Cole:Any city or county
S$ which mGNR3 a Permit in ennLlaet.alis.Improw.demNLih,or repair my structure
iy prior to its kcsuaae.almrequims theapplicmtfar such permit to file.signedwacanum -
w° that he is licensed pursuant to the provisions oftMla
Contractor'sUcemdw(Chapter9 Sq.Ft. Floor Area Valuation
(commencing with gentian7")of Division 3 of the Business and Pmlessions Code)or '
i $ that he at eumpt ....Rears and the basis fon the alleged cxunption Any violation of
Section 7031.5 by arty applicant fora permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than tion hundred dollars(ML P Y YP
I,u ower of the popmy,sir mY eroPlayeea with wagm u thc'vmle eempenution.
wigmoneswon,ands: nnRtumtsnolmmtmnsmortared apply
an an Owner o.
and edywho W code:The Contractor's Liana law dace nal appy 1f an owner sir Required Inspections
properlywho builds orimprotes thereon.and w udatasuch work araffe of through his
own amPlaym•pmWdN Wt s¢n ire Is sold cnu art Tat iateMed m.Rua,fousthe o as It.
builder,the Wilding m i en ovemmt is old within arc yonw comphedon,due ase of
sea.). will Nw tM burden of proving Online did ill Wild or improve for purpose of
tale.).
❑1,as owner of the property.mat exchninly conuaning with Biassed mnomtars to
team rust the project(Sec.7Da4.Badness and Profusions Code:)The Conoacturi U. _
came law does not apply to an owner of property who Wilds or impasses thereon.and
who contracts for such projects with a conuacmr(s)licensed pursuant to the Contractors
License law.
I am exempt undo See .B&PCfar thismaven
Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury oro of the(allowing declarations:
I haw and will maintain a Ceref roof Consent to self-iasurt for Wafters Cmon
pc
talion,as pnwided for by Section 3700 of the I mor Code,for the Performance a the
wort for which this permit is issued.
1 have and will maintain Wacker.Compenuten I...u required by Section
3 of the LaborCodc.fa the performance offe work for which this Permit is issued. '
My Wmkcls Compensation Insoram.eertfm and Polity number art:
Catrier. 5TATE FvN b Policy No.: I'2'�gL 6
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(itis sermon treed no t M cam plated ifflue permit is for one hundred dultars($I W)
of Icer)
1 certify that in the perfomemx of tM work fon which this Permit is hound.l mall not
employ.......in my manrmrm as m became subject to the Workers'Compcnudon
Laws of California.Disc
Applicant
NOTICE TO APPLICANT.IL net making this Certificate of Exemption,you should
become subjen to the Warwes Compensation provisions of the tabor Cade you muss
.J z [mm.ith comply with inch pdvimma or this permit shall be deemed mokcd,
z M CONSTRUCTION LENDING AGENCY
[-�
IMrehyaffirm Nat fort i..cmutroaka leading agcnry fmOeparform.of
Gafes work(sir which this permit Is issued(Sec.3097,Civ.C.)
0..Q114 Lenders Name
z Lenders Address
J O 1 anify fat I have read this application and saw d u the show information is
ly H correct.I agree m comply with all city awd county ordinances and sate laws relating to
.OU Wnstfuand
ildingcoction. hereby mthmiae mprvxtea nuuor this city mcntcrupnn ft
F a .Mee-menticned property for inspctvon purposes
(WC)agree b.a,c.indcmnify and kap hYntlems the City of Cupertion some
to incoiee.,Juria,of ft gramindofthis mhich may in any way acme againstsaid City
C)z APPLt IC
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
CAM
ULATIONS. -
pplie ser m� Re
-roofs
H DOUSMATERIALSDISCLOSURE Type of Roof
applicant sir future Wilding occupmlatort orhandle hrraNmts maetlt e Cuper ire Municipal Cade.Chapter 9.13•and dte Health and Safetyus33(,)7 All roofs shall be inspected prior to any roofing material being installed.
�Naa a Want or future Wildin eau ant u>c If a roof is installed without first obtainin an ins ection,I agree to remove
ror a p egmpmawl m xdas wnlpn g P air con aminants a dehad by the Bay Area Air Quality Management all new materials for inspection. 40
0 No
I hmm read the huaNtot so mrials requirtmmts under Chapter 6,95offe Califm.
Tia Health&Safety Coda,Sections 25505.25533 and 25534.1 undeamod that if the building/ 8�?
does rot currently Mid s trawl that it u my responsibility to mcfy etc tIR'rrpawt of the
rats which sen Wmetpdarw Wumteeeracenieaateufacupm . gna re of Appli Date
6/0 All roof coverings to be Class r or authomxd age Dam g or better