Loading...
05060220 (3) CITY OF CUPERTINO1 BUILDING DIVISION PERMITbCOIR'AGTQRAINFO„RMATI©1 BUILDING ADDRESS: PERMIT N0.05060220 VS*11422 CARNOTIRTIE CT JOHN R'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITECUBNGINEER: BUILDING PERMIT INFO BO EO PLUMB MECH O 306 LICENSED CONTRACTOR'S DECLARATION Job Description I bereby&(Ilam Nam at 1 licensed under previsions of Chapter 9(com mencing .T� with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full farm adeffeeL INTERIOR REMODEL (MSTR BATH/CLOSET) g�Z Licene Clua Lie.# �1- Dam Connector 2ND BATH/ADD SKYLIT TUBS oil ARCHITECTS DECLARATION if 1 understand my plans shall be reed as public records 3 Znd Licemed Prereu)onal �3OWNER•BUII.DER DECLARATION Z I hereby affirm that I am exempt from the Contractor's License Law for the pS Off, follawing mean.(Section 7W 1.5,Business and Profusion,Code:My city or county which requiru a peanit to memories.altar,improw,demolish.or repair any sWetum y� prior to its lelYNCe.also mgUix3 use applicant for such permit in file a signed muta tion < that he is licensed pursuant in the provision of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valu;t06000 ,2F$ (commencing with Section 7000)of Division 3 of the Business and Profusion,Canon)or d that he is exempt therefrom and the basis for dm alleged exemption.My Nolmion of Scotian 7031.5 by say applicant far a permit Subjects the applicant to a dell penalty of APN Number Occas e not mom then Rw hundred dollars(55001. Occupancy Type Iuawnuefft m 35603030 . 00 C1P PutY•mmY emPlayeu with mgesu theh ale tompenuton, wllldo dm work,ad the Someone Is not Intended orenered for&alo(Sm.7W.Business Re UIr I anpropertymfudom Code:The ComrumYs Lianas taw doss trot apply in in owner of q property who Wildsorimpmwa themen,and whodoessuch warkhimelforthrough his ppp eo own employees,provided that such improvemmume not Intended oroRered formic.If, hmvewe the Wilding or improwment is mid within arm Sem of compledm.the aweeo- qU builder will lure dust burden of proving that he did not Wild or Improve for purpose of /1(/G fg� talc y V 9nsy 1.as owner of the Sec.7property,S.,Business uand eanbeting with:)TheCmnuamn . ®Ae� `this massaat the project(Sec.n an werofand Professions Code)The datemrt W �T�r1Q wate taw tau not apply u an owner of property who sed F or alto th Corton,red, 4 Lica.contracts for ouch projects with acontranor(U I)coned punuantwthe ConvadoYe VVV Lkeae Law. ❑lam exempt undo See. .BdPCf this rtaun .�badu T B7zu�S Date � o WORKERS COMPENSATION DECLARATION ir 1 hereby afRrm under Penalty of perjury one of the following declarsdons: ❑shave and will maintain a CeNOnuof Conant m sof-Insure for Wmh ,Compcm sa ka,u provided for by Section 3700 of the labor Code far the pedmmana of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,u required by Section 3700 of the Vhor Code.far the performenm or the work for which this permit is blued, My Workers Compensation Insunnco carrier end Policy number am: Caner. Policy No.: CERTIFICATE OF EXEM MON FROM WORKERS COMPENSATION INSURANCE CM13 eNan nerd nothecomplawd if the permit is forone hundred doll&&(5100) or leu.) I Unify than.In the perrormaree of 1W work for which this permit is issued,l mail not tmany PPlayt a' mm ymnerm t Cm 5,newie Worhere Cnmpmeadon L&ws0l a Avpueant NOTICE TO PLICANT:IL a cr mak' this Cmillcata of Examples,you should become nth t to Ibe Worker's Cornpeuadon provisions of the Labor Code,you must .JO forthwith ply with such provident w this permit shall W domed.1ted. Z CONSTRUCTION LENDING AGENCY Ihanny Sun.that then Us extraction lending agency for the perfmmanecof the work for which this Permit IS issued(Sm.3097,Civ.C.) ❑ Lender's Name Z Z Landers Address U O 1 coolly that 1 Mm read ibis application and sou that the Show information is torten I agree as comply with all city and county mdinaees and suss 11"missing to C)SV' building convection,and hereby sudoriarepmsenutiws of this city u enter upon the W ahow.mcmimad property for Inspection Puryaas gy (We)agree 0 haw,indemnify and keep handed,the City of Cuper ins against y liabilities,abilities,judgments,costs had expenses which may in my way acerae against Said City ()zU Intone m Swung of this permit. APPL DERST ^-' A DERST WILL COMPLY WITH ALL NONPOINT Issued by: Date R U S -7/a;06 Re-roofs Riga ler or ApplicanJConuacmrate HAZARDOUS MATER) DISCLOSURE Type of Roof Will de appiicmt or forum building omupmt seem or handle huardous material do and by Ce Cupertino Municipal Code.Chapter 9.13,and the Health end Safety .Section 25531(x)7All roofs shall be inspected prior to any roofing material being installed. ❑Yu td Nu Will the applicant or future building aavpsm ace equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove earth hnmdnus air conuminamsfired by the Bay Area Air Quality Management all new materials for inspection. ` Dian:17 ❑Yes Nu I haw mad the baramnus maerids rcquircmcna under Chapter 695 of the Califon nu jr4 B SafmyCede,Sections 25505,15533 and 3553/.l mdeatmd thin if to building MO., my hew a tanto at it Is my mepomihility ta notlly the occupenl of thevein etpn muauecaraCnnc..ofa r Signature of Applicant Date All roof coverin s to be Class"B" or better arizedegent D g