06080122 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA TOIL INFO,RMN 19
BUILDING ADDRESS: ANTIQUE TERMITE & PEST PERMITND.06080122
10371 CHERRYTREE LA
0.'S NAME: PERMIT ISSUE DATE
STEVE SCHECK 1913 STONE AV
PHONE: SANITARY NO. CONTROL N0.
(408) 995-6300
ARCHITECVENGINEER: BUILDING PERMIT INFO
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PLUMB
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Top LICENSED CONTRACTOR'S DECLARATION lob Description
1 bumby affirm deet I am licensed under provisions of Chapter 9(commencing
wide Secdon 70110)of DlWsion 3 of Ne Business;and Professiuw Cade.and my Ikotas it
in full(=a and effee I REMOVE AND REPLACE 6" MUD-SILL, 30 LIN. FT. 2X6
License Class_j,J—_Lie.♦
Dam ®—.meg it CamMaf JOIST.
q �T�CTS DECLARA ON
i a< i understand my platy shall he used Is public Words
iy
'o Licensed Professional
t OWNER-BUILDER DECLARATION
i0 Fp I lasso .firm that 1 1. exempt fern dte Cantron Co e:My c Lew for the
O O fallowing massa permit
cooaa.Buttes,and Improve.
de seas Code: of airy or county
$(4i which mquima•penult re ca the elm(impmsu deermitt w repair ed swmum
prior Wslcened issuance,alsodeeapplkmo for Conpermit Wicessigned statement
Chap=9 Valuat$d 000
< that helslkensed purwawwthe provisions of the ConwcWr's License law(Ch.poer9 Sq.Ft.Floor Area
(commencing with Section 7000)of Division Sof the Businessand Proreulnm Cndcl or
v Net he 13 exempt Wemfmm and the basis for the alleged eaempdon.Any viol.tion or
Section 7031.7 by any applkant for a permit Subjects the applicant W a civil penalty of "Number Occupancy Type
Our mom than Ova hundred dolWa ISM 333053 . 00
❑I,u twos of the proputy,n my employes wW wages u then sole compewadun, ,
will&the work and the Muctum is let boosted or offered estate(Sec.7044,Beaia•.. ITbd IIISpCCt1o115
and Pmfesslow Calc The ContruWrs Lianas Law dos not apply W an owner of s s
property who builds Or improves thereon,andwho duessuchmil,hinwifor through his ' : •g•.yam
owncmployces,provided that Inch Imprmemenu arc not intended oroffered for We,if.
however,thebuilding oimprovement4hat within oleyou Or mprove farcm,me owner- 18,1/ tis
buildu wW lova an,burden of proving that k did let bulb m Improve for Purpose of
ule.l.
❑I,as Owner of the property,am exclusively corseting wide licemed mntruWn W
consume(the project(Sec.7044,Business and Predications;Code:)The CotrecWls U. MEMO
„�� f� j,','.�
who law tow not apply W an owner of property who beads orimprow thereon.and. [ICY Ij �(py
whaeonwdoes nottahplyea with oweeanmmorty who
Wil punwntWden Ganrn.Md (tvVyrt�jl/I '�7\'Vfl kll`\.CIJ/9
Licanse Law.
❑Iamuemptunde Sec .B@PCfwthis--
Data
WORKER'S COMPENSATION DECLARATION
I hereby ITOmt under penalty of perjury one of the following detiva0ans:
I have and will maintain a CesrOcete of Consent toself-Invert fw Wmk<s'aCampcn-
sation,as provided for by Section 7700 of the tabor,Code.for the Performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worldes Compensation hounnce,as required by Section
3700 of the tabu,Cade,for the performance of the work for which this Permit is issued.
My Warker's Compe ads nsunnc vier and Policy number are
Grtier.
Policy No d 401516
CE TIFICATE OF %EMP170NFROMWORKERS
COMPENSATION INSURANCE
This vection need Sutbecomplewd If ole permit is fmane hundred dollars(3100)
or leas.)
I mnify that In the performance of th work for which this permit is Wood.1 shall not
employ any person In any mowrso Is m become wbjen to dee Worker•Compmutio ,
U.of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this CeniOcaw of Exemption.You should
become Subject W the Workefs Compensation provisions of the Tabor Cade,you most
.J O forthwith comply with such provisions or this Permit shall be doomed revoked.
,z CONSTRUCTION LENDING AGENCY
[—t14 (hereby affnm that them Is.construction lending agency for the Performance of
IY> the work for which tlda permit isissued(Sec.3097.Civ.C.)
14Q 1 coddes Name
7 Z Iendress
ets Add
U C) I cenify the,I have read this application and sum that the eWvc information it
LL Fcorrect.I agree to comply with all city and county ordinances and aur Iowa relating W
V building construction,and hereby esthome representatives of this city to enter upon the
GU above-mentioned pmperty for impeNon purposes.
(We)agree to saw.indemnify and keep hatless the City of Cupertino agairm
.F.(A liabilides.judgments.cwu andexpeww which may in my way aeric agaiu,said City
V Z in consequmm of the granting of this permit. /
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date — G
SOURCE REGUL� 6kL
/]'IONS. �t & 9-17—X
Re-roofs
Signa u e off Applicanl/ConUrwito Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant O forum building occupantsmm or handle ha'rasdow material
defined by the Cupertino Municipal Code.Chapter 9.11•and be Health and Safety
Section 15531()? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant m future building occupant us,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit henvdow air cmrsmidenu as de0md by ton Bay Area Air Quality Management all new materials for inspection.
Duria?
❑Yes 0N
1 have mad the Paramour materials requirement under Chapter 6.95 of the Captor.
nia Healthar SefctyCWc,Seedow25505.25533 and 25534.1 un&mwd Naif the building
dna not currently have a tenant,this it is my responsibility W Purify de Oaupant of the
requiremcnu whkh mullh Ipd W ranee a Is Cerdfeate ar a70Signature of Applicant Date
7 UG All roof coverings to be Class "B”or better
Owner or mthm.d agent Dam