05060011 CITY OF CUPERTINO �',"^"
BUILDING DIVISION PERMIT O1�IT1tA6111,
awt 'Sv
BUILDING ADDRESS: PERMIT NO,
0 MUKABTKSE AVE PERMIT 14118 DATE
NE: SANITARY NO 31 21I9*01.NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O
CF I hereby tlIl
LICENSED IN SED CONACR'v ofTLTepmr 9(commencing
.IOb Description
%4 with Seetim7ftfn)of Divbion3olt I am Ule Busmen and Profcssimn Code.and my licem Is
j w in full forte and effect.
az ucenwcln, Lle,11 SFDWL-ONE STORY-2 , 115 ' LIVING-441 ' GARAGE
Dam Conbacmf
ARCHITECTS DECLARATION SANITARY IS SUNNYVALE ' S JURISDICTION
C lunderstand myplans shall neused sspublic mCards DEMO LTR SIGNED 5/15/06-NO INSPECTIONS UNTIL DE
�U
`]t; Licensed Prufnssional
a3 OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contr,ctor,License Law for the
j o following mason.(Second 7031.S,Business and Prefael,m Code:Any city Or county
16! which mquim a permit to eomema elms Improve,demolish.or mpalr my,outturn
e� pdorhe in immune,also MquirestM applicant forwch permit to file a signed sutemem Valuation
C c that he a liamed password to dm pmvidom of the Con month limve Law(Chapter 9 Sq.Ft. Floor Area
-$ (commencing with Session 71)00)a Division 3 of the Bud=end professions Cadcl or
T— are he is exempt dtemfmm and the basis for the alleged exemption Any violadan of
Sebum 7031.5 by arty applicant for a peanh subjects the applicant m a Civil presby of APN Number Occup
Arwe
mat mart than five hundud dollar,ISM
Q 1,u.of the property,or my employee wish sage u thW wlc=pl.dm.
windothework,andthe,wnumi,mtmtendedwaReedfassle(SW.7034,BudnsssRe aired Inspections
and Professions;Code The Cmrr,cmfs Limtw e lem Law data apply an awry of 3 7 5 2 6 0 5 6 . 0 0 q ns P
property who halos,or im pose,nem.,and wed does we h work himself or through his
over employees,provided dol such impmwmenss am am intended-Offered fmsd H,
however,she building ver improvement is sold within onsSear or WdPadam.the owner-
builder win haw the burden of proving nw he did om build or improve for purpose of
sa—le.).
[fit,as owner Of dm prop:rrY•am eaclusivcly cote aging with licensed conoMon to
concoct the pmject(Sec.70N,Business and Profesd ed Cnde)Tie Commences U.
.cmc law doe nm apply to we owner of property who Wilde or improves them.,and,
who contracts for such projects with a anlrwraRs)Ransed punam to IW Commoner
Lben,e Law.
Ellam Martin de a. .B alk P C far this mason
Owner ✓ Dam M31 O
PIRKER'S COMPENSATION DECLARATION
I thereby affirm under penalty of prjury atm of the following declamdotsc
have and will mdmdn.CeNOam of Consent to self-insum far WmImesCampn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
wort fm which this Perth is issued.
El 1 have and win maintain Wasives Compensation Insunna,as required by Season
3700 of the Labor Cade,for the perfafmuee of the work forwhich this permit m bsnsd.
My Wartime.Campaaak.bromm a ardor W Policy number see:
Cards: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPFNSA71ON INSURANCE
(Ihls wmim need nor W catnpleted n we permit is formehu urns]donan($100)
or lest)
1=Wry tom in den pdormanee of we work for which this permit b issmd,I doll not
..ploy anyperwn In anYmmncrw m b' r the Wodmfs'Campematim
Laws of Califomin.times �
Applicuu�� '
N came s7On in theAhT:1,after Comma 5thiseminate of Exemption. you
become h comp y the WorkeroCompmtiod em iL ma of the lahm Coke you muss
,7, forthwith comply with such provisions or this permit sell W damcd mwknd.
Q
CONSTRUCTION LENDING AGENCY
1 Wmby sabon that were is a coasrrmOnn lending agency for the performance of
due work for which this permit Is issued(Sec.3097,Civ,C.)
QLender.Name
Z Lander's Address
Q 1 cegree that I empty
mad this city
and county
and sum deal cite zWve information b
builds I,Fa m comply here hereby city and canary alainmma and sum rows r upont e
aimm-gcotioned ro and forImpaction Purposes, of this city menmrupn cite
slave-I%)Afire property far impnian keep et
(We)qma to cows Indemnify and hap hay In
the City of Cupertino id City
y liabiline,)ndgmcnm,emu and expenses which they In anY ray wctne against said City
1 Z in consequent of the frmdng of this Permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.(( t /
��---� Z: /3! I o Re-roofs ��—
SlgnnumofApplianvcmuwtm Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will de appliam or future building oceupmtmom or handle heafdoes mamrid
as dented by tie Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Code.Season 255374)7 All roofs shall be inspected prior to any roofing material being installed.
ElYen tr�
Will dm epplicml or future Wilding asupm sew equipment or devices whish
If a roof is installed without first obtaining an inspection,I agree to remove
OIL hnamnm air comm onm donned by see Bay Arta Air Quality Management all new materials for inspection.
Dimict7
El Ycs Nu
I new mad the hazardous materials requlmmenmunder Chaper6.95 of the Califao
M41fealth BSarmyCoM,Sect1am75505,25533 and75534.I undcr,mad thin(ne building
Lima not cu nay haw o enant mu it la my mapGm hi[ity m nudfY the ceeupant of Ne
requite en which mon et pear amu ce of a Ce tiflam of Occupmcy.
°f � � o Signature of Applicant ate
own.nr n Ueda em All roof coverings to be Class"B"or better
Dam