05060220 CITY OF CUPERTINO �rr`° rr�y.�.' ��. x• ^yy��f' �i ' r
BUILDING DIVISION PER-14VAN°la �®ll"TNL'��.
4 h?. t••r�vy§ 1,.,,ns.t �C. h!•:U`s, X�'; ,;,9�1,t ,m,q,?i
BUILDING ADDRESS: PERMIT NO.0 5 060220
ER-S NAMEIF : PERMITI55UEDATE
JOHN & JUDY BRUZUS ' 07/20/2005
PHONE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PlE LUMB MnECH
o l� I
a0o LICENSED CON7RACIDR'SDECLARATION Job Des t
i� I hereby a)ofI that l am Oaosed under provisions of Chapter 9(Commercial M
with Sectionhereby afri that I am licec Businder pr Professions Code.hapten 9(Comcenm it
inmBfmc mdeffet. INTERIOR REMODEL (MSTR
LicDam ❑aa �.g 2ND BATH/ADD SKY LIT TUB
eC0
Dam.ARCHITECTS DECLARATION
y H l undersand my plans shall he used at public records AUGIll G I O 2006`U
D t7 N
G Licensed Pmfeaiamal
�3 Oat I am exempt I DECLARATION
�I I oma .('Sero that 1 t. exempt from Use Canunetart License taw for the in U
0 0 follwhich ng requires.permit
703 ambr,Business and pr ve.de loth h,or Any Cm of Ucauty =
$ which its u a a permh W cdri the alae Improve,demolish,m repair any idemcm
_Zy
prior Wisemsedp,rsu requite the inion o for such Permit LRleasigned wmment
FpG thmheiact.1wiJpSectiotmthe ofDiviomofthe ConratummulPreeLaw(Chapter ode)., Sq.Ft.Floor Area Valu$fE6000
3$ that M is UMPLtSeNomasand O basis for
of allegedr.
Professions Code)of
al Nu he u esempl tlrcmlmm and dw bard for circ alleged csempnt to Any violation of
not
7Omliemyreddapplicant far(M),iuubjcctstheapplicanttoadultpenalty of APNNumOccupancy Type
not more Nan Bw hundred dollen(SSW\ 35603030 . 00
I,laowner of the property,ter my employees with wageala their sole eompenlation.
will do she work,and theswcmm is not intended or offered for sale(Sao.1014,Business Required Inspections
lad Pmfmadom Code:The CaWri onlaLicense Law does not apply to an owner of q P
property who builds or Impmvea thereon,and who docs aah work himself ter through his
own employees,provided Out such improvements We not Intended oroRcrad for late.If,
however,Ne building or Improvement Is sold within oa year of cnmptetim,the owner.
builder will haw the burden of proving that he did not Wild or improve for Puryae of '
sale.
J.u owner of the property cting am exclusively eonoawith licensed con W
nuecio
conmrom the project(Sec.7044,Business and Profeasions Cade:)The Convector's U.
cense Law does not apply to an owner of property who Wilds or imprnwa themoe,and,
who contracts for such projeea with a convector(s)licensed pursuant to dm Convector,
License Law,
❑I am..atop,under Be, ,B@P Cf rthis moon
a,,— bhA ,Tz PS7auza)S' Data 20 O .
WORKER'S COMPENSATION DECLARATION
I Wmby affirm under penalty of perjury as of the following dalasatiom:
❑I haw and will maintain t Certificate of Consent to selGloaum fa Workers Cooper.
lattice.a Provided for by Section 3700 of the labor Code.for the performance of Or
work for which this permit is issued.
❑1 haw and will maintain Walkers Compensation Insurance•as required by Section
3700.1 the Labor Code•for the performance of the work for which Nis permit Is Issued.
My Worker's Compensation Insurance artier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ThLssemlon need not be completed If th Permit is foray hundred dollars($Im)
or lets.)
1 certify that in the performance of the work for which this Permit is issued,I shall not
employanype n reny manarw t eco ervpfaclto the Warken'Compematian
Lawsof r Oa
Applicant % _
NOTICE TO PLICANT:If,a er mak' this CenlOcate of Exemption,you should
become tab W me Worker's Compensation provislans of the labor Code,you must
z.forthwith c ply with such provisions or this permll shall be deemed revoked.
ti O CONSTRUCTION LENDING AGENCY
[•n I hereby affirm mat mem iuconssuctinn lending agenry for the ua<
perfurmof
r6 ate+ the work for which this permit It Issued(so.3097,Cl,C.)
WWE
4ndcr'a Nemc
]2 Landers Address
U 0 1 certify that 1 haw read this application and ser¢that the above Information Is
W P COMM l gnat to comply with all city and county ordinances and sera laws mhting to
0 r.) building convection,and hereby sumorim miumsentativea of this city to cater upon the
W above-mentioned property for inspection purplas
FL (We-)egme to lave,indemnify and keep harmless the City of Cupertino against
r.a rn liabilidu•judgmenu•casts and eapentes which may In my way aceme against slid City
U 'acomeCe OERSTdngofmitpeW'LLCOMPLYWITHALLNONPOINT Issued by: Date 0—
R E U S
7 U Re-roofs
Sign of mAppliamVCom"Cunrate
HAZARDOUS MATERI DISCLOSURE Type of Roof
Will the applicant or future building occupant nom or handle hvsrdous material
u de ocd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
oda.Section 155324)? �/a All roofs shall be inspected prior to any roofing material being installed.
❑Yes fd N
Will the applicant or future Wilding occupant use equipment er devima which If a roof is installed without first obtaining an inspection,I agree to remove
emit horardeal air cmnaminanis dcgned by the Bay Area Air Quality Management all new materials for inspection.
District?
0es Nu
I have read the hasardousmncrials requirements under .Chap¢r6.95ofrhe Califon
nia &SafciyCade,Sccdom35505,25533.d25534.1uW&n.dmetifmc hillding
J not a mlly how s tenon at It 4 my raponsibiliy to notify circ aeupant of de
ire wh' et pct muissuamceofl CeniOeateof sap x Signature of Applicant Date
0w her or authorimd agent Do(7 d� All roof coverings to be Class"B" or better