06040102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ..lCCdN"TI2AG' ORINFURMATION
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BUILDING ADDRESS: ' ATLAS REMODELING COMPANY I ITCMIT NO.06040102
10166 CAROL LEE DR
' ER'S NAME: PERMIT ISSUE OATH
CHOTANI 685 KINGS ROW UNIT D 06/3,S/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 293-2617
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT O PLO MO
1�6
LICENSED coNTRAcoRSDECLARATION Job Description
1 homey affirm Nn 1 am provisions Of under provof Chapter 9(Commencing
with Section 7")of Division 3 ofthc Business and PlefcssWns Code.end my Ikcnm 4
=z L(.Il�fanuandeffen n u g yve $ ADD 839 ' -2ND STORY-2 BEDRM/2 BATH-MAIN PANEL
in D;m F+ass conma,r �, ' UPGRADE-MAJOR REMODEL 2 , 989 /WINDOWS, PLMBG, BEDR
3 ARCHf1EC1'3 DECLARATION r
1 ndersunJ my plans alWI he need an public meords
;Q LWcrgPmfcaional
OWNER-BUILDER mDECLARATION
I hereby alirm Not 11. exempt from Ne Cssions CoLicense: Law for me
p o which requires
e mama.(Section 71mem Business and Professions Cod':Any city or coumy
S_ which its Wo a penis m airs,the alter,hnpmw,dpermit,nr rtpairmyg ed mount
—Z pro',
prior wslicumna,dso mgolrca the applicant for rmhpermitw Nmenn A Signed ant Va Ai513998
E€G theho ending wit Pursuant to the of Division
of citeo Business Liar Law(Chaptor9 Sq.Ft. Floor Area
s; (commencing pt Smdam 7fand the
basis for
or that
alleged
exeand pton.Anyavi Code)ser
� ren he is ewmPt thert(tom afM Ne bais for Ne ailryed eumpdmv Any Wo4dan of ppmN b
Section 7031.5 by any applicant for a permit subjccu the applicant to a civil penalty of 316 2 3 N uTO .r 0 0 Occupancy'I�pe
test mom than Ave hundred dollars(5500).
1,a owner of me property,W my employees with wages as Nes sole=Perdae,
will do the work and the wuctum is Out inmvdW o offered for age(Sec.7044,Budnev Required Inspections
and Prefesdom de:CaThis, mhect
Co'S License Law des mot apply M an mvmr of q P
property who bul IM ser improves m aga m,and who does such work himself ter through his
awn employes,provided that gam improvemaua am nut intended or offered For$ale U.
however,the building or improvement is sold within ane year of Compiegne,the awner-
bullder will have the burden of proving that he did net build or Improve for purpose of
sale.).
❑1,as owner of the propenY,em eselmlvelY canbKl{ng with Ilesca d conuanou in
construct the project(Sec.7044.Business and Pmfadons Code:)The Contractors Li.
cove Law does nal apply to an owner of property who builds or Improves demon,and
who commme for such projeeu with.C.Mactorm)licensed Nmunt to the Contractors
License Law.
❑1 am aempt under See B A P C for this mown
6� Dam 6::rF'4
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pefjmy one of the fallowing declaradoe
l](have and will maintain aCorusate of Corm to self-ingenfmWorkersCmepen-
aging,a provided for by Section 3700 a the Labor Cade.for W pmformaae of this
wwerk,for xhich this permit I.isued.
[TI hese and will mdntdo Wormes CompemNon lauranct,as resulted by Section
3700 of the labor Code,for the performance of Ne wort fa which this permit is Itaed.
My Worker.CoTtedgqan Insurance artier and Policy number am:
Carver. Sf'n f-f Cuau� Polity No. a23K-ddaj(fy.yatr
CEiT FICA�EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlan need nothecanpleted Bthe permit 4 form hundred donam(SIM)
or less)
I amity that In the performance of the wart fm which this permit is issued.l shall Out
employ any pawn In any mamxrw u u becama sol�iect to du Warketa'ComPartion
Laws of Califom)a.Dam �0
Applicant_(. , " �_
NOTICE TO APPLICANT:IL slur making m4 Certificate of Esompdon,you should
become subject 0 the Workers Compergon providoa of the Labor Code.You must
.,O forthwith comply with mch prove=or this permit shall be domed naked.
zCONSTRUCTION LENDING AGENCY
y
f~ 1Muchyellirm that Nem is a construction Wading agency for Om pmformana of
rti > me work for which 444 PCrmil4 issued(See 3097,Civ.C.)
N] Q Lender's Name
} Z Lenders Address _
U O 1 comfy that 1 have roof Nis application and sum that the above hnfamation 4
Cama 1 agree to comply with all city and county ominanca and sum laws mlating Le
�U Wilding conswction,aM hemby authorim representatives of Nis city to enter upon tiro
W ahove-mentioned igmyty far h o ccuon purl gas.
gy (We)agree to aro.indemnify and lump hamlea tie City of Cupertino agaiat
rFr fA
liabilities.judgments.cats and expenus which may in any my memo a{alat said City
U Z in consequence of tie gumdng of this permit. Date Y
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: S_�O 6
SOUggccee REGULATIONS.
Yf/
4_110 Z Re-roofs
Signatr of ApplianlMonuano Dam
HAZARDOUSRoof
HAZARDOUS MATERIALS DISCLOSURE ']P
Will dm applicant or future building acupemmuc ter handle hw1dom material
as defend by the Cupertino Municipal Code.Chapter 9.13,and me Halth and Safety
k.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes y no
Will mo applicant orf When
building occupant use equipment or devices which If a roof IS installed without first obtaining an inspection,I agree to remove
..It WsOrdoa It conuminanu as dewed by me Bay Ama Air Quality Managcmcmt all new materials for inspection.
District?
❑Ya cl�o'
I have mad ft Imamaasmaterials requirements underChapur6.95 ofd:Cgifof-
nisHealth&Safety Cade.Sectimts 25305.25533 find 25534.1 undersand"ifte building
goes rot currently haw a teanL Lou it is my rorpo omilhty 0 notify tic occupant of the
requlmments which mug be my� . r w 4eaame of.comfmau of OcCOPLmCY, Signature of Applicant Date
G % X�~ �' S"�� All roof coverings to be Class"B"or better
Owner ar anthon'ad agent Dau