05040013C
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CITY OF CUPERTINO
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C`ONT'ReC'�OR IN'O1ilV,iATIO1V,,h
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT N0.
05040013
E ME:
PERMITISSUBDATB
SANITARY Al OL NO.
ARCHITECT/BNOINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby film IMI 1 Nm limned under pmvWons of Chapter 9 (commencing
With Section 70lk1) of Division 3 afthe Budneu and Profession, Crile, ed my license I.
Lifull
e lm Cums effect. tae.{
ADD 332' (BEDRM/BATH/CLOSET)
Deck Cumncier
ARCHITECTS DECLARATION
I understand my plan shall M used As public records
Licensed Prurwinnal
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt (rum IM Camroctors License Law far [be
following reason. (Section 7031.5, Business and professions Code: Any city or county
which requires a permit In convect, alar. Improve, demolish, or repair any simerum
poor to in lauaneo, also requires IM applicant for Such permit to Ne ulgned statement
License Law 9
Sq. Ft. Floor Area
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that he Is located pursuant to the provisions of the Contractor', (Chapter
(commencing with Section 7000) of Division 3 of the Business and Pmf xedons Code) of
dol he I, exempt tlamfrom Nd the, bub for the alleged exemption. Any violation of
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CCUaraC
Occupancy 1YPe
Section 7031.5 by arty applicant for N Permit Subjects the applicant o . civil penalty of
not man dun five hundred dollan({500).
I,unwrcr of the propns,y.amy employcu with mguutheir sole Compewtion,
Required Inspections
will do the work, and dere Su actum Is not intended nanend raraale(Sec. 7044. Business
and Profession, Code: The Convactors Liana law does not apply to en owner of
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property who bac ilds m improves thereon, and who dm, ..h work himself., Iluouth his
own employees, provided that such Improvements Am not intended oroRerd for ale. IL
however, the building or Improvement is said within one year of completion, the owner.
builder will have the harden of proving that M did not build or Improve for purpose of
tal�u
owner of the Properly, am exclusively contracting with licensed eonlraekra Io
construct the project (Sec. 70th, Business and Professions Code:) The Convector's Li.
cans Law does not apply m an owner of property who bullda or Improves desmon, And.
who contra for such pmjccm with a eonlr.elar(O licensed pursuant to the, Contncloe,
Leena raw.
❑lam exempt er Jly. . B A P C for this restart
owner / Deck 22 d
WOR M NO ATION
' IMreby derpeml fps uryoneof following declarations:
D I havennd will maintain. Cenificare of Conant to self-on,um for Worlmes Coarsen.
action, u provided for by Section 3700 of the labor Code, for the performance of the
work for which this Permit is issued.
D 1 have and will maintain Worker', Compensation Insurance, As required by Section
37M of the labor Code, far the performance or the work for which this permit I, Issued.
My Workers Compensation [noun= carrier And Policy number art:
Center: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
(Thasecllm acd nor beComplewl if the permit is futane hundred dallace (SIM)
or less.)
1 cenify that In the performance of the work rot which this permit It laud, i Nell nm
-
moploy any persom manymancr an u to become mbjeclfo the Wohen' Compensation
Laws of California. DazC
Applicant Li 4 Q {O
NOTICE TO APPLICAIQT. IL after making Ills Chaellricate of Exemption, you should
become subject to IM Worker's Compeosallon provisions of the Tabor Code, you mol
forthwith Comply with such provisions or Ibis ponall,h ill he deemed revoked.
CONSTRUCTION.iscLENDINOAOBNCY
1Aor lending.) InnM perfmmemc or
thi Nn thea b•ted(S
which .3
Nr. doh (tar which This permit h bifid (sus. 71197, CIv, C.)
Lender's Nurse
Lendcr'a Address
1 1 Certify that 1 have red this application and sok that the Nixon aformulon is
' corns 1 atfea to empty with all city and county on inance,and sum laws crating to
Wilding const union, and hereby audamia rep mmultirea of this city to enter Open But
ahovnmemioned property for inapection purposes.
-
(We) agree to ave, indemnify and kap harmless the City of Cupertino against
j Ilabllidn,judgmenu, casts and expense, which may In any wry.cane against said City
in consequence of the floating of this permit.
i APPLICANT DERSTANDS WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR L TIO
Re -roofs
Roof '
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sl are fir can corer cmr Dole
H AR ons MA II S DISCLOSURE
Type of
c applinn rf urebuildin upam torcorhedkhuudousmateoal
A defined by IM Cupefund unicipal Code, Chapter 9.11, and the Health ad Safety
Cok, Section 75531(.)7�/
[:]y" V.
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 of future building occum nl use equipment or devices, which
call haeArdous air comaminso_ts defined by the Bay Area Air Quality Management
all new materials for inspection.
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D Yet {irvO
I have read tik huaNws materiels requirements under Chapmr 6.95 ofde Califor.
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nia HcalthkSatcly Coc.S,d.u15505,25533sod15534.1umantandlhuifthc building
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dm, not cement y h nen n II' my :ponohlllly to notify the naupml of the
rCgalnmCnn "n all CI r 1 Ca f.L'Cf11ECamaf panCy.
lir. t Date
-f12--2 0�
roof coven gs to be Class "B" or better
ownefaf stn la Date