05120105 CITY OF CUPERTINO =
BUILDING DIVISION PERMIT CONTRe� ORINFORMATION
BUILDING ADDRESS: CASEY CONSTRUCTION SOUSA ENTMa05120105
10862 BROOKWELL DR
ER'S NAME: PERMIT ISSUE DATE
GEROGE SOUSA / HANS RECHE CHE1118 VALLEY QUAIL CIRCL 02 08/2006
NE: SANITARY NO. CONTROL NO.
(408) 997-6515
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT. PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION Job Descriptionvd(y I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Basims and Profusion,Code,and my Iicame is
mfuEfhemandeTeL ADD 5421 & REMODEL 158 '
Z Lluvc Clam IX.a 7 33 d
g- Dam �canmewreavreur—mei ! 1/3/06 SANITARY THRU SUNNYVALE.
ARCHITECTS DECfARA ION
I understood my plans abaft W used as public¢ands
=v� Lmcmed Professional
OW NRR-BUILDER DECLARATION
a I hereby salon that 1 em exempt from the Chnuanors License law for the
Z p O following reason.(Section 7031.5,Business and Prefessiuv Cade:My city or county
ISE! which requires a parmit the canstrua.alter,haproe,dcmolW,or mpair any structure
_Zy prior to its issue=.also requires the applicant forsuch permit n file.signed matemant
p G
that he u licensed Persimmon the Provisions of the Contmanes Uann Law(Chapter 9 Sq.Ft.Floor Area Val
yzC (commencing with Seaton 7000)of Division 3 of the Business and Pmfessiam Cmk)or
3 S That he Is attempt therefrom and the basis for the alleged exemption.My violadan of ppN N be
Section 7051.5 by any applicant fm a permit subjects thn e applicant a civil penally or 3 6 9 21��7 0 0 Occupancy IYPe
om
not mthan five hundred dollars(5500).
❑1,as Owner of du property,or my employ¢with wages as then sole compensation,
will do the work,and the awcture m not mended or attend for sale(Soc.7044.Busies Required fns actions
and Profession,Code:The Conuaaors Dame Taw don at apply n an hemes of q P
property who builds coo improve thaehn,aha who does such work himsel f ar through his
own employes,provided thatauch Improvements ere none nded oroffcred fm Woe If.
however.the building or improvement Is sold within am year of ampleda•the ower.
Wilder will have she burden of proving that he did ant Wild or improve for purpose of
ulo,).
❑1,u orvner of the property,am mo lunvely...0 uaing wish licensed contncmrs to
consumer the project(&e.7049,Baines and Por a lam Code:)The Counselors U.
came law dean not pply se an awaer of property who Wilds or improves thereon.and
who contacts for such mojac;with a contactm(s)Ilaned pursuant In the Characters
LIcctsx Law.
O lamemorptunder Sec .B@PCfmminreason
er Dau
WORKER'S COMPENSATION DECLARATION
I hereby alOrm under penalty of perjury am of the following declarations: '
❑1 haw end wEl mainuin aCeNfiamof Covent itself-imam fm Workers Compal.
talon,n provided for by Seaton 5700 of the labor Code.fur der pmformance of the
work for which this permit Is issued.
I have and will maintain Workers Compensation Insurance,a mquimd by Scalan
3700 of the labor Cade,for the perfor came of the work forwhich this permit pa intend.
My Workers Compensation Instar¢ a crier and Policy number am:
Caner: Ce,..D PolicyNr:i2.q'—('b2 7C1¢
CE0.77 EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(nu sada used nolmcompkud ifthe permit is form hundred dollars(SIM)
or teas)
I certify Not in the performance of the work for which this permit is issued.I Mall not
employ any person In any manner an M to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,Nmr making this CcAOam of Esemplion,you should
become subject in the Workers Compensation provisions of the Labor Code.you mum
.J O foMwith comply with such provisions or this permit Nall In,dared revoked.
Z► CONSTRUCTION LENDING AGENCY
(ti I hereby artium mal mon It.arsonatinn lemdingageucy far de perform.of
!Y 7 the wart fur which this permit ts issued(Sec.3097,CW.C.)
fl)Q Lenders thane
a z Lenders Address
V 0 I certify that I have read this application and sun that the above information Is
Li. eaumel.I agree n comply with all city and county ordinances and sus laws relating n
O building construction,and hereby authorise representatives ofthis city to enter upon to
[51 ahovc-mentioned Property fm inspection purposes
f3, (We)agree in use.indemnify and kap harmless the City of Cupertino against
In Ilabilidu,luitruns.costs and eaperues which may in any my sarue against said City Js/
U In consequence of the graving of this Permit.
APPLICANT UNDER AND1�ILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULA S.
— . _ff a Re-roofs
Signatum of Applicanuconuacnr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant team orhandle haallous material
so de0md by me Cupertino Muntcipal Code.Chapter 9.12.and de Health and Safety
Scares 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya z".
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
aril bmardous air conumine es as dc0ncd by the Bay Arca Air Quality M...Career all new materials for inspection.
Dinia7
❑Inns 1su
I have rind the handmnsmauaials requirements underChepw&95of the Califon
nu HawaSafetycadc,Swdmu25505.25557am12553e.IundcrsuMdn Enc budding
does not currently have a tens mat it h M. Hilly n notify me occepal of me
re �'`fmntswhicItman Torun' ran faccm0canofOccu Signature of Applicant Date
Owns Z ea All roof coverings to be Class"B"or better 3
Owner Or amhon7al gai Don