08060041 CITY OF CUPERTINO x xi„v * w `
BUILDING DIVISION PERMIT ''GONTRAGTORINFURMATIQiN
7•s +,.:
BUILpdS'T'n,ONY HILLS LN TBD — TO BE DETERMINED 08060041
NER'S NAME: - PERMITISSUEDA]E
JOE & RUTH STEVENS 06/05/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHITECTfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONRACfOR'S DECLARATION IOb Description
u 1 Weby affirm that I am licensed under provisions of Chapter 9(commuting P
aces withSaWn70M).fDivisiom3oftheBuimusand N.1cosionsCodgmdmylicenseis FNDTN CRK REPR & FLR DIAPHRM LVLNG N FRNT
<< In full force and
S�_ Li 1.Ce List Is 4'Z� ENTRY/BDRM CRAWL SPC
s,p Dam ARCHrTECTSDDECLARATION MG CONSTRUCTORS & ENGINEERS INC PD BUS LIC 6/5/8
w U I u sn
olormo l my plants ail W used as public ds
recor
to
g o Licensed Professional
5 OWNER-BUILDER DECLARATION
F I hcehy M.Nat 1 am acmpt from the Conuacmr's License Law for the
E O o following mason.(Section 71131.5.saw.and Professions Codc:My city or County
3$ which requires a permit to commucL alter,improve,demolish,or minor any structure
_im prior 0 its issuance,aLw¢quires tM applicant forsuch permit to file a signed statement
FF < that be is licensed pursuant to line provisions of the Contoerar's License Law(Chapter9 Sq.Ft. Floor Area Valuation
Y�$ (commencing with Section 7")of Division 3 M the Business and Professions Cedc)or $7500
- dot Its is comp,therefrom and the basis for rhe zllcgcd c areption Any violation of
Sec6on 7031.5 by any,applicant for a permit subjects the appliconuo a civil penalty Of A,p� Number OGGU anC
rpt mom man five hundred defiant 35930005 .jW p yType-
will do the wart,and the structure u wt intended or offered for sale(Sec.7014,Businw
ted protests..Code:The C muscror's License law does rot apply m an owner of Required Inspections
paper who Wilds nr improves thesan,and whodassuchworkhimrelf m though has
awn employes,provided Nat such impmvemenu are not intended oroRere l(orsale IL
how rvm,Ne Wilding or improvement is sold within ons year of completion,the owor-
Wilder will have the Writes of Moving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am=elusively contracting with Bcem nd convectors be
umrum the poles(See.7144.Bashoss and professions Code:)The Contractor's U. _
emus Law does not apply in an owner of proper who Wilds or improver Merton,and.
who contracts for such projects with a anuscmr(s)licensed powasm as the Convamofs
License law.
❑lamaemptunder See ,B&PCfarthisreawn
net
Data
WORKER'S COMPENSATION DECLARATION
I hereby alrires under penalty of perjury ace of the fallowing declarations:
❑Thaw and will mainuin aCenifiauof Consentloself-insure for WormesCompen.
mite,as provided for by Section 3700 of the labor Code,for the Md...of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insuance,as acquired by Section
37W of the labor Cada.for tht performance ofthe,work for which this permit is issued. '
My Worker CCympgLns�adan�Ivuran(a carrim aM Policy number tie: A.rs
Cartier. �/TWK- PT.s.K!> Policy Na.:�`�^ail-7'-lZ�
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rlltisa mi n rcN rot bo completed if the pemit is formol unded daRms(SIM)
or tun.)
1 comfy that in the performance of the work for which this Permit is moved.I shall nut
crnplr anyperon in sty munerse as m become subject to the Worktra Compensation
Laws of California Dau
Applicant
NOTICE TO APPLICANT:IL afar making this Comfiicam of Eompdam,you should _
become subject to the Worme.Compensation provisions of Ne Labor Code,you most
O forthwith comply with such provisions or this pencil shall be deemed evoked.
'z M CONSTRUCTION LENDING AGENCY
M[-•� IhorwhaRumthu thcmuacd(So,.097.CO. agency for dte perfurmence of
6i Ne work for which Nu permit b issued(Sec.31197,C .C.)
tL1 Q IcnG1s Name
z Lender's Addreas -
V Q 1 cooly that 1 have read this Applicadan and sum that the above information is -
IL.Fconch.l Agra m comply with all city and county aNinaces and sutc laws reading an
.0 U Wilding construction.and hereby suthade repraenutiva of this city in enter upon do
r(Zd above. WDE
j dined proper ford impaction purposes ^ st
1„, y (We)ages to save.indemnify ted keep harmless the City of Cupertino against
h in..itiaConce cats suandeapensfamet.hmay in any way acme against end City
V z in consegvermc of a ting o(this permit.
'-' APPLICAND WILL COMPLY WITH ALL NON-POINT Issued by: DaleSOURCl</T !D$f/ Re-roofs HAZADO Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thee C.po or fMmebuilding acupusammorand to HmIth anmaterial
ss dcBSed Section
the Cupertino MumciWl Codc.Oupter 9.13,and the HW th and Safely
. 0yes 25333(x)?
❑res 0C All roofs shall be inspected prior to any roofing material being installed.
Will the a ream,or future Wilding Occupant tett 1 If a roof is installed without first obtainingan inspection,I agree to remove
Ise e p sou it Qu at Mara whim P
Dov n�u air canaminan�ts�ss Jcfined by the Bay Area Air Quality Management all new materials for inspection
❑Ya b1N^
I have mal the Woodcuts .of,equimentrtu under Chmau6.95oftheCalifar-
niaHulthd:SafctyC ,Sem SU3,35577 amt Z5334.1ummrsmnd thuifthe Wilding
Jos rot currtntiY ha ata l u my home Mlity m ratify the occupant of the
equirtmcna whim rm issaana ter,caifinm a`Occppant{O Signature of Applicant Date
Ownerur aatharimd agar //Date All roof coverings to be Class'W'or better