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CITY OF CUPERTINOXO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
22345 CARTA BLANCA ST
ER'S NAME:
PERMIT ISSUE DAIS
CUTLER GREGORY M AND MAI H
04/04/2006
PHONE:
SANITARY NO. CONTROL NO.
ARCHIIECIfENGINEER:
BUILDING PERMIT INFO
BO EO PLUMB MEOCH
.
LICENSED CONRACfOWS DECLARATION
Job Description
Oe$GrIP
1 hereby affirm Nat 1 am licensed under previsions of Chapter 9 (commencing
with Section 70QMR ofDiviaion 3 of the Business and Profession, Code. and my license is
CONSTRUCTING A SHED IN REAR YARD - 10X16
in full fore and effect.
License Class LIC. N
PER MANUFACTURER SPECS
Dale Contractor
ARCHITECT'S DECLARATION
1 understand my plana shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Connectors License Law far the
following reason. (Section 7COIS, Business and Profusions Code: Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any muetum
prior to its IuummC. also requires the applicant for such permit in rite a signed summent
Ft. Floor Area
Valualpao
Net he is lmen,ed pursuant to the provisions of the Comrmmr's Ucense Law (Chapter 9
Sq.
(commencing with Section 7000) of Division 3 of the Business sod Profeuiaw Code) or
that hu is exempt Motorman and the basis for me alleged exemption. Any vlalaian of
pp yyyy 1 y,Occupancy
�7—�
Type
ype
SCNwt 7031.5 by any applicant far a Permit Nbjem the applicant In a CMI PCMIty of
not mom dun five hundred dollars (5501))
3L�'1' 3 V 0 0
1, u owner of the properly, or my employees with wages u their rete compensation,
e
Required Inspections
will doda, work. and Ove .WpaRl. our intended arofferedI.ands (Sm.70N.BusirmL
emes Code: The Contravene, License law does not apply an owner of
and PContravene,m
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prepay who build, Or impmvea menton, and who does awh work himxelf or through his
own employws, provided met ateh Improvements an Moh m mad ¢offered fwsale. If,
'
however, the building or improvement is mid within ow year of completion, the owed.
builder will have the burden of proving ma he did not build or Improve fn, purpose of
ask.).
1, as owner of the properly. am exclusively contracting with licensed Common to
o street the pmject (Sec. 7044, Business and Profession Code:) The Contractor's U.
LCNe taw does not apply in in aWna of property who balm. of ImpmMa momm, and,
.he CenLaCm for such PlojecLL with a Ca11V9emKa) Ilwnmd Pursuant in IIIC Canllmle(a
License law.
❑lam tie tuncm See .Bit PCIfushomman
nn, Dam G
WORKER'S COMPENSATION DECLARATION
/
1 hereby in. under penalty of perjury one of the following dowlaredom:
❑ I ban and will maintain aCeNOate MConrent no xelf-insure fn, Womer'SCwnpen-
nation. as provided for by Section 3700 of the labor Code, for me peAowance of the
work for which this permit Is issued.
❑ 1 have and will maintain Workers Compensation broadcast as required by Section
3700 order labor Code. In, me performance of the work for which this permit is Issued.
My Worker's Compensation Werance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This auction wed not uncompleted Kind permit isforone hundirddoll n ($100)
or mss.)
1 certify that in the performance of lite work for which this permit is issued, l Nall nn,
employ any pan in mymon" sad o sy19t to OR Workers' ComPemMmn
w
La we of California. Dam
-
NOTICE APPLICANT' If, site making this Cisionsaof of Exemption, you
N
ushould
come subject me Wwh a m
bwome subject provisions 1)I me labor Code, you mtsa
provisions
forthwith comply with such previsinm w rob permit shall be dared rewtsd.
y this permit
CONSTRUCTION LENDING AGENCY
1 hereby alarm that there is a contraction lending agency for the performance of
me work fn, which rola posit is issued (Sec. 3097, Civ, C.)
Lender's Name
,
Lever. Admeem
1 certify that I haw mad this application and sum that the shove information Is
connect. ) agree to comply with all city and county ordinances and sum laws rcisdng to
Wilding construction, and hereby sudmin mmol stirs of this city to cram upon the
shout -mentioned property for inspection purposes.
(We) agree to an, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and expenses which may N my way aKNe agaiml said City
in consegwnce of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date — 4-0t'
SOURCE REGUTA ONS.
Re -roofs �t
tA�/A,�06
am
Signature of _ppliesHAZARDO Oft6
HAZARDOUS MATERIALS
Type of Roof
pantamDISCLOSURE
Will thea, building occupant uarocar amaterial
Cupertrfactum
2.andte Health
as defined the Cupertino Municipal Cade. Chapter 9.13. mtl the Health and Safety
. Sceban 2563x(.)?
io
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All roofs shall be inspected prior to any roofing material being installed.
_
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building ta equipment or devices which
occupant u
emit hevardnua air contaminantaas defined by the Bay Area Air Quality Man IACMCM
all new materials for inspection.
DiSIML?
❑Yus ro
I have mad the haurdousmacrialarequiremenu underChapter6.95ofthe Califor-
nis Head" Safwy Cods, Sccticn,25305,25533 and 25534. I urdcnurd mal fila Wilding
dais not currently haw • mnant, that it is my respouibifty to notify the aecupant of da
Rquimmcytl hien reset)_ prier some ofaCemficam�eu ry
Signature of Applicant Date
All roof coverings to be Class "B" or better
Tk
Owner
or Llhe agent am