05060118 CITY OF CUPERTINO ;� �• e
BUILDING DIVISION PERMIT ;„C ONTRAC°TORINFORMATION '
BUILDING ADDRESS: COUTTOLENC NEFTE PERMITNQ.05060118
OWNER'S NAME: PERMIT ISSUE DATE
JASON SPENCER 2 5
E: SANITARY NO. CONTROL NO.
831) 905-1985
ARCHITECT/ENGINEER: BUILDING PERMITINFO -
BLDGELELT PLUMB MECH
0 t 0 0
LO,p LICENSED CONTRACTOR'S DECLARATION lb Description
<�C 1 thereby N
reby affirm 1 am licensed under Provo
Provisions of Chapter 9(commencing
U with Section 70011)orDivision 3 of line Business and o e i ns Code.and my lie is
i in full farce and effect.
>q= License
to Lim.N O REVISION--TRUSS CAL.
�Fp Dam Cmtmmr t NO NEW PERMIT ISSUED/ORIG. #04110145
-F CTS DECLARATION
¢ I underwnd my plans shall he used as,public records
paU
3 C L7, Limmeed Profcaiunal
s.
3 OWNER-BUILDER DECLARATION
ix I botchy affirm Nal 1 am tromp,from the ccomm o's Litems Law for tine
p 0 Following resumes.(Section 7031.5,Business and Pvfessiov Code:Any city or county
K m which requires a permit in construct,alms,improve,demolish,or repair any structure '
'n-r^ prior to its issuance.also mquires the applicant for such permit to rile aligned statement
Nat he is licensed pursuant to the orwishm;of the Comment's License Lao,chapre,9 Sq. Ft. Floor Area Valuatio$115
,,n Commencing with Section 7")or Division 3 or do,Business and Prmrmilions COR)Or
y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not come than five hundred dollars(55 L 37518016 . 0 0 P Y YP
❑1.ser owner of the proputy,Or my employees with wages as their ole compensation,
will do the work end este stmcmm is not intended or offered for Gale(Sec.70".Business
and Professions Code:The Cunmetor's License law does nor apply m an Owner of Required Inspections
pmper,y who builds orimprews thereon,and who doeaauch work himself orthrough his
Own employees,provided that such improvements are nut intended or offered rorsak.It.
however,tic building car improvement is to within ore year mf completion.Be owne,
builder will bare the burden of proving Nat he did ter build or improv for purpose of
sale.). \
❑I,as owner of the property,am caclusively cmnauting with licensed mnmeors to
construct the not (Sec.7W,Businessand rywh Professions Crede)The COnmcmn, nd \
cense Law docs not apply je an owner of property who builds a impmva thereon,end.
who contracts for such projects with a comm�ortx)licensed purauam to the Cmmmctofs
0 1 a.Law.
❑ am exempt under See. ,B@PC for this mazon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aR'rmunder penalty of perjury ane of Ne following declaaiOM:
P1 haw end will maintain a Cenifneum of Covent m ulf-insum far Worker'sCompcn-
satimn.as provided for by Section 3700 of the labor Code,for the pertmmana of the
work for which this permit is issued.
1 haus and will maintain Workers Comperuatimn Insurance.as required by Section
37W of due Labor Codo.for the performance of one work for which this Permit is issued.
My Worker's Compensation hismance carrier and Policy number an:
Z
Carver. Policy FROM
CERTIFICA O�P170N PROM W00.KERS'
COMPENSATION INSURANCE
Clio section need not bo completed true,Permit is intone hundred dollars(SIM)
or less.)
I certify that in the performance of Ne work for which this permit is iaued,1 shall not
employ anyparean in any manner an a in become subject tO the Workcti Compensation
Laws of California.Date
Apphnm
NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,you should
become subject to the Wmm,'a Compensation previsions of the labor Code,you must
.J Z forthwith comply with such prnvomm;or this Permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[-+� Ihembyalfirm that there is a construction lending agency for the ttrformanco of
Dithe work for which this permit is issued(Sec.3097,Co,C.)
da
Lcn leer's Name
Z)
Z Lender's Address
U 0 1 certify Nat I have mad this application and sate that the above information is
E-' corms.1 agree to comply with all city and county ordinances and state laws relating to
0 U building emnswctimn,and hereby authodm reproomeaves of this city to came upon line
above.menuumd property for inspection purpves,
(We)agree to save,in nify and keep harmless the City of Cupinine,against
H14 hubilina.judgmenu,costs add expenses which may in my way accrue against said City
U Z. APPLICANTeUNDERm Ang S WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE ULA
Re-roofs
Signa: V con <mr Date
H DO USMATERIAISDI CLOSURE Type of Roof
Will pplicmtor Municipal
Code.
c chapter
9mor hagteh e.[%asmaterial
a de.Second
ed the Cupertino Municipal Code.Chapter 9.12,and,he Health and Safety
Code.Sc Yes 25532(e/ All roofs shall be inspected prior to an roofing material beim
Brea pew; P P Y 8 g installed. '
/Will thea Rcmtormtumbuildin ..pool ni If a roof is installed without first obtaining an inspection,I agree to remove
PP B 0 4 Pmem or deviru which g
it haiardnue air comamivnu as dcfincd by the Bay Area Air Quality Management all new materials for inspection.
District?
Q Yes
Ihavc real Ne hmardmr agdals require monde,ChaNk,6.95of0hc Calirm-
his Health k SatelCode.Smu v MY)5.25533 25534.1 understand Na if the building
does not ewrentty hoc a m [m it ig no po ability to notify the occupant of the
mquimmcnss whia cniricam of Occupancy.
_lplf F Signature of Applicant Date
owner r rat n gen, Dnte All roof coverings to be Class"B"or better
CITY OF CUPERTINO ;� �• e
BUILDING DIVISION PERMIT ;„C ONTRAC°TORINFORMATION '
BUILDING ADDRESS: COUTTOLENC NEFTE PERMITNQ.05060118
OWNER'S NAME: PERMIT ISSUE DATE
JASON SPENCER 2 5
E: SANITARY NO. CONTROL NO.
831) 905-1985
ARCHITECT/ENGINEER: BUILDING PERMITINFO -
BLDGELELT PLUMB MECH
0 t 0 0
LO,p LICENSED CONTRACTOR'S DECLARATION lb Description
<�C 1 thereby N
reby affirm 1 am licensed under Provo
Provisions of Chapter 9(commencing
U with Section 70011)orDivision 3 of line Business and o e i ns Code.and my lie is
i in full farce and effect.
>q= License
to Lim.N O REVISION--TRUSS CAL.
�Fp Dam Cmtmmr t NO NEW PERMIT ISSUED/ORIG. #04110145
-F CTS DECLARATION
¢ I underwnd my plans shall he used as,public records
paU
3 C L7, Limmeed Profcaiunal
s.
3 OWNER-BUILDER DECLARATION
ix I botchy affirm Nal 1 am tromp,from the ccomm o's Litems Law for tine
p 0 Following resumes.(Section 7031.5,Business and Pvfessiov Code:Any city or county
K m which requires a permit in construct,alms,improve,demolish,or repair any structure '
'n-r^ prior to its issuance.also mquires the applicant for such permit to rile aligned statement
Nat he is licensed pursuant to the orwishm;of the Comment's License Lao,chapre,9 Sq. Ft. Floor Area Valuatio$115
,,n Commencing with Section 7")or Division 3 or do,Business and Prmrmilions COR)Or
y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not come than five hundred dollars(55 L 37518016 . 0 0 P Y YP
❑1.ser owner of the proputy,Or my employees with wages as their ole compensation,
will do the work end este stmcmm is not intended or offered for Gale(Sec.70".Business
and Professions Code:The Cunmetor's License law does nor apply m an Owner of Required Inspections
pmper,y who builds orimprews thereon,and who doeaauch work himself orthrough his
Own employees,provided that such improvements are nut intended or offered rorsak.It.
however,tic building car improvement is to within ore year mf completion.Be owne,
builder will bare the burden of proving Nat he did ter build or improv for purpose of
sale.). \
❑I,as owner of the property,am caclusively cmnauting with licensed mnmeors to
construct the not (Sec.7W,Businessand rywh Professions Crede)The COnmcmn, nd \
cense Law docs not apply je an owner of property who builds a impmva thereon,end.
who contracts for such projects with a comm�ortx)licensed purauam to the Cmmmctofs
0 1 a.Law.
❑ am exempt under See. ,B@PC for this mazon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aR'rmunder penalty of perjury ane of Ne following declaaiOM:
P1 haw end will maintain a Cenifneum of Covent m ulf-insum far Worker'sCompcn-
satimn.as provided for by Section 3700 of the labor Code,for the pertmmana of the
work for which this permit is issued.
1 haus and will maintain Workers Comperuatimn Insurance.as required by Section
37W of due Labor Codo.for the performance of one work for which this Permit is issued.
My Worker's Compensation hismance carrier and Policy number an:
Z
Carver. Policy FROM
CERTIFICA O�P170N PROM W00.KERS'
COMPENSATION INSURANCE
Clio section need not bo completed true,Permit is intone hundred dollars(SIM)
or less.)
I certify that in the performance of Ne work for which this permit is iaued,1 shall not
employ anyparean in any manner an a in become subject tO the Workcti Compensation
Laws of California.Date
Apphnm
NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,you should
become subject to the Wmm,'a Compensation previsions of the labor Code,you must
.J Z forthwith comply with such prnvomm;or this Permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[-+� Ihembyalfirm that there is a construction lending agency for the ttrformanco of
Dithe work for which this permit is issued(Sec.3097,Co,C.)
da
Lcn leer's Name
Z)
Z Lender's Address
U 0 1 certify Nat I have mad this application and sate that the above information is
E-' corms.1 agree to comply with all city and county ordinances and state laws relating to
0 U building emnswctimn,and hereby authodm reproomeaves of this city to came upon line
above.menuumd property for inspection purpves,
(We)agree to save,in nify and keep harmless the City of Cupinine,against
H14 hubilina.judgmenu,costs add expenses which may in my way accrue against said City
U Z. APPLICANTeUNDERm Ang S WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE ULA
Re-roofs
Signa: V con <mr Date
H DO USMATERIAISDI CLOSURE Type of Roof
Will pplicmtor Municipal
Code.
c chapter
9mor hagteh e.[%asmaterial
a de.Second
ed the Cupertino Municipal Code.Chapter 9.12,and,he Health and Safety
Code.Sc Yes 25532(e/ All roofs shall be inspected prior to an roofing material beim
Brea pew; P P Y 8 g installed. '
/Will thea Rcmtormtumbuildin ..pool ni If a roof is installed without first obtaining an inspection,I agree to remove
PP B 0 4 Pmem or deviru which g
it haiardnue air comamivnu as dcfincd by the Bay Area Air Quality Management all new materials for inspection.
District?
Q Yes
Ihavc real Ne hmardmr agdals require monde,ChaNk,6.95of0hc Calirm-
his Health k SatelCode.Smu v MY)5.25533 25534.1 understand Na if the building
does not ewrentty hoc a m [m it ig no po ability to notify the occupant of the
mquimmcnss whia cniricam of Occupancy.
_lplf F Signature of Applicant Date
owner r rat n gen, Dnte All roof coverings to be Class"B"or better