08090164 CITY OF CUPERTINO
BUILDING DIVISION PERMIT -=CONTI2AC�,.TOIt INEO�RM�ATI,O1V � .
BUILDI1NGPEESS: PERMIT NO.
07t5V CASTINE AVE PRUDHON BUILDERS 08090164
HER'S NAME: PERMIT ISSUE DATE
ASKOUNIS PAUL L AND FRANCESCO 1096 NORFOLK DR 09/24/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC/ENOiNEER: BUILDING PERMIT INFO
REMODEL 135 SQ FT MASTER BLDG ELECT PLUMB MECH
O O O O
trop LICENSED CONTRACTOR'S DECLARATION
�uC I thorebymb700)of Nal1amIkmnsedumksproviaicnsofChapuY(mmmencing Job Description
ZW wiNSection]1111U)of DivHion3aflk Buainus and Prafcaions Code.admylicense is
in full fora and ecc.,
j Z License a.. Lic.N — 7T6 j�
G
Comramor sa —a.- ! al%6Ya
££7W ARCHITECTS DECLARATION �
Q W U I undersand my plans shall k used as puhlic records
a o In Licensed Professional
3 OWNER-BUILDER DECLARATION
1 krcby all that 1 son exempt form the Contractor's License Law far the
00 following mason.(Section 7031.5.Business and Professions Cade:Any city or county
3+� which requires a permit to convect.Almr.improve,demolish.or minor any shuctum
prior 0 its issuance.also requires the applicant fmsech permit to fk.signedsummem
< Nis licensed purvunt to tk provisions of the Contractor's have Law(Chapter 9 Sq.Ft.Floor Area Valuation
ES
at'-O sa k(commencing with Section]000)nf DivioonJnf NC Buainmsand Prakuions Cadc)Or
that k
Care 9,themfmo and dm basis fm the alleged eaempUm.Any violatim of
Section 7031.5 by any applicant for a permit subjects tk applicant to a civil Penalty of APN Number - Occupancy Type
not more Nan five Wanted dollen(S-IM P y yp
❑1,a owner of the property,m my employers withwage m their mk compenndon,
MB Pr thewale.Code:
ire Crekme.Licensor awdofmale(Sec.]061,Bosinm
and Prolamin.W Coda:Tire ves trectors Li•..... ons aces set appy lf,n caner is Required In$peCtlOHs
property wyebuildsmimpossathfinpowowho
..suchwork doll
his
awncer.the iprgor ithatsuchimprovemmttart notimo amd ofCmannered the ower.
however.the Wilding burden
improvement within one old ofimproe(or the owe of
Wd1dR MO have uk bunom of paring that k did mu Wild m improv for purpose of
sok.).
El 1,u Owner of the property.am"elusively contracting with licensed cvntrams to
eensrmt the project(See.7064.Bushmen and Professions Code:)The Conmetori U.
come Law docs set apply to an owner of property who builds or improves Nermn,and
who contracts for such projects with aeomranm(s)licensed pursuant to the Contractor'.
License Law.
❑lamesemptunder See ,BkPCfmthitmarn
u Dam
WORKER'S COMPENSATION DECLARATION
I hereby affim under penalty,of perjury am of the following dmismadom:
❑I h.ve and wRI.6mam.Certifiexm of Comma On.lf howen run WmkeesCompen-
.It..a provided far by Second 3700 of on,Labor Code,for the perf.m.of the
wort far which this Permit is issuM.
❑1 have and will maintain Workers Compensation Imuran",a required by Section
370(l.f Ne labor Code,fm the terformares.f the work for which this permit is isom- '
My Workers Comns Ins; "seer and Poli,number am:
Carrier. Pali,No.:
C EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mor;ametion need ml on completed U the permit is for am hued doll.tS 100)
or 1"s)
1"O fro that in the performance of dm work for which this Permit is Wood.I shall not
employ any person in my manner an as to became subjmt to Ne Warms Compensation -
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,alter making this Cenonam of Exemption,yon should
became subject to Ne Workers Compnsotion provision a one Lsbm Code you mum
.,O forthwith comply with such provisions m Chia Permit shall k deemed corked.
Z CONSTRUCnON LENDING AGENCY
[-+ I hereby afam that Nem is•carmroctim lendingal far the parfomme,of
ani > the work fm whim this Permit is issad(Sec.3097.Civ.C.)
0 Lender,Name
7 z Leaders Addams
U Q I ecnofy that 1 have mad this application and sum that the,bows infumamon is
,sn L 1'gra b comply with all city"county anointment and men laws relating to
C) builim cgsuuctiorkrd hereby smhorise representatives of Nis city to enter upnn uk
0. akve-mcnoomd imp and fm inspection imposes
(we)agree to ave,indemnify and kap harmless the City of Cupertino against
ti r'/3 liabilities,Consequence or
Cards ad expspommi ch may in any way saxm against said Clry
V z in PLICA nee ofthegrantingof Nu permit.
APPLICANT UNDER DS
ZD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE ULATI
�A�
SignaRe-roofs
Tmm afAppb an r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future Wilding occupmmme or handle haardons material
a dc0md by the Calamine Municipal Cade.Claim,9.12,and the Health and SafetIr y
❑v
.Se Oon re.
All roofs shall be inspected prior to any roofing material being installed.
` ban
Will the applicant or I sere building ecmpmt use cyuipmmt ser dcvicrs which If a roof is installed without first obtaining an inspection,I agree to remove
emit huarmor air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Duvict? LLL���
Ely. ®Nu
I ban real the heard, ma<riaHmWimmcwumkrChapwG97oftheCaiifor-
nuH"INhSafmyCaM,Scniom25505.2533.ndZ534.1undcnundthaifdm building
Jou set cumndY have a cm: t u my responsibility to mtifY the oecupat of Ne
rtyuirtmcnuw muslk me orto' uvea ofd Cenifw"of Occupancy.
^ �^ Signature of Applicant Date
Owner of meagent Dom All roof coverings to be Class'W'or better