01050003 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10180 CAMINO VISTA DR. 01050003
OWNER'S NAME: APPLICATION SUB DATE
MALKA NAGEL 05/01/2001
T� is
ONE: SANITARY NO. CONTROL NO.
uCHITECT/ENGINEER: BUILDING PERMIT INFO
z .DG ELECT PL IB ECH
Pi
LICENSED CONTRACTOR'S DECLARATION
ZI hereby tfi m that i am licensed ander provisions n g Job Description
o i r a pr��s,ons or Chapter 9 aommrndn
FvthSection]O0p)ofDivision3ofsheBusinessandPmfosionsCudeandmylicense NEW SINGLE FAMILY HOUSE.
<ymrmuomeanaerr«t. 3633 SQ. FT. LIVING SPACE,
z zce
ccnseClass Lic,p0e ARCHITECT'S DECLARATION 496 SQ. FT. GARAGE .
= 1 understand my plans shall he aveJ as public records
dZ O O Licensed Professional
o OWNER BUILDER DECLARATION
1 hereby affirm that 1 ma exempt firm the Contractor's License Law for he
following mason.(Section 7031.5,Business and Profrs lam,Code:Any city or county
IM which recurs,a permit to conaruct.alter.improve,demolish,or repab any structure
u� Priort t e also 9 :theapp! ant for.such permits fl 'g dstatement -
e, hot he is licensed p a ,to the prossairsesof,hcContra Liven. la (Chapter9 Sq.-sFI. Floor Area , --_- _-_- - -
r s.,. • nation
(commencing< gwtptthe ra)B)orD'aiisorfinelegedi ai re loans Code) •��1't ; ,. •.,N i.I, { �'.\i �(}' $3638H
or Nm he is exempt themfmm ander,far..roo for the alleged eeempuon.Any violation "�
--of Secnot ann 703 1.5 iv any applicant fora500)rt subjects the applicam to r civil penahy Occupancy Type
l
of not mom Than five handrtd dollars(S50o). 34 2�LP�L Alnrel�r n'N:'. � ,.
°I,as owner of the property,or my employees with wages as their sale compensation, ll V
willdo he work,andthe.amemre isnot Intended or offered-Far'safe'(Sce.']Wa,'
'-Business and Professions Code:The Contractor's License law docs not apply to an 305 - FRAME Required Inspections—It "
owner of property Who bui Ws or improves thereon,and who dos such work himself
or through his own employees.pmvmed tot such improvements aye not intended or ... 307 - INSULATIONcompletion.
-offered f f It:however,the building p merit n la.. edwithin not year lir
iampltn@eo nor-bald it[have theburden lProvingthat h did not build or 601 — ROOF TEAR OFF
mprove for purpose of<ale.'. 602 — ROOF PLYWOOD NAIL _
— — _. — ---
glLmnwnrroit - pct. -an Tarr s 'slit - a ...0 mratn 603 — ROOF BATTENS
onstmn the p r (s nd obla s.,on.C,ds:)The Crmmemrs r oo .. ..
. c .'lie. '
License Law oe all yi woe fpmpenywhobaim.orimpmae thereon. 604 — ROOF IN—PROGRESS
and.who a ¢ sac rets III crn,.et.N,) licensed.pursuant.to the. __..... ....___..____... _._ .-_ .. ....__ __.._.___.__. .-__... .._
Contra h 'tens w ---
%? °Ir _<a to , c ' ',B&P C for trNmeon
_ - o erD,e Lf U
0 K ' Oh SATI E RATION
1 hereby affirm ua r pewhy of perjury ane of the following declarations:- �r 1I
ti{, ° I have roil will mumbut a CeniGcate of�Consrntt6 self-imam for Workers ��0�110a"kltd�®
_ Compersetion, as provided for by Section 3703 of the Labor Code, for the
performance of the work for.which this permit,is issued.V
°Ice '. dti will maim W kers Ccarraponori Inxumner,as required by secdun JUN 2 4 2002
- _ 37M of the Labor code.for the Perfordwnce of the work for which this Permit is
issaed.My Worker's Compensation Insurance cabrier rod Policy number am: t
BUILDING.
•
Cart,c. .I. Vt,t ;'' Poli y\o. r .r ^ ' s . L r, t st
Y „CERTIFICATION OF EXEMPTIONFROM WORKERS'" _ , -' -
_ COMPENSATION.INSURANCE m`,' '�`V,f
..._....._ .. -",ice, ---- -"--
•r rfhts,at need not he coirletcd if the - I,-
--- --
O fl' -
(SI(X))or le".) P permit is far one hundred dollars
1 tfymiin' h pen - 'e, work for hhthrial ,,t
shall r employ any person n any mann<r w us to.eco nc su.Ject n,the Workers t •^ (` t ",.rq s '
Compcnsmiun Laws of Callrornia.Date
.APPlicdni_. ..f .....
rNONCE TO APPLICANT.
' if, rs making CertificateofE pt
should
Z .eco subject othe
Work Compensation provisions h L. C d you mace
r.irthw honply hprovisions r this permit shlllh<JccmeJ evoked,� �_ .. --,- - . -
CONS(RUCTION LENDING AGENCY
_
a I h
of th for R th r th- cn t et on lend ng igen y f th p rfanname a t
Gz7 r - k for which this permit is issued(Sec 3119].Civ.C 1
Lender's Namethapl have rtaJ this appli<atmn and zm-the the above informaion is
E! .wrrea.I agree to comply with all city and county ordinances and ante laws relating
:�:f) •mbuildingcmumtse aandh ehy ori-rep -mmives of city to enter upon
.the,hove.menti. pope or coon mi -
"ts;0. (W'e)- sox ,de ' and y of Cupertino again.,
Z
. liabilities.' d encs,av a pens Lal ch nnay in y way?cerae again¢said
V Z City i' nx acne e¢ ling of s mitt. ¢
,APP. A. -0N aTA, S'AN P 'COsI _ K'ITH ALI _\PO Issued b l "'ZC/ 0
- - so• cF Fc' � oN .� Y4()� c Date /
ijpamre m App moan, a1on,' "'s " at Re-roofs
r ' RIALS DIsCLOg UR
pP a dam t .lice alert a - orcrial . Type of Rdel d b ah C H n no MUS hll Cad Ch ps 9 12 lid th H hh rN safety YpK 11 thea I cant hu na.Code S t o 353J./of i . -
.All-roofs.shall.be inspected prior.to_any_roofing.material-being installed.___-.._
Lauth applicant ;'` building ocu p 'useequipmentrdevices whcn: If a roof is Ibstalle,d'diithom first obtamifig an inspectton,II'agree to remove
emir hazardous a to lints a,d edb he Ba,Area Air Quality Mw t
D t`, all new materials for inspection. Applicant understands and will comply with
`al 'non-point sourceregulahons I ..-.,t :.:;;y
I have' the and s a coals pt' rent,.nJ nChapter h95 of the
Calicorm 1 &S YC c tions"so 533 and 21111.lunderstood that
dthel, n res cu le a tenon at islt my resp sibiltry to notify sae . . ..
.ecu _of r, m t ch must et prior to
popeits read Cenificrt<of '
,. �L G/
Signature of Applicant. Date
own<r or atnori=e,agent spam All roof coverings to be Class"B" Dr better
' ' OFFICE