08010073 Ci
OF CUPERTINO
ILDING DIVISION PERMITCO1V.�CRt1CTQR'�I1�T+'UItMAIOL�IC. ,
BUG OGRESS: PERMIT NO.
�57 CRAIG CT TBD — TO BE DETERMINED 08010073
OWNER'S NAME: PERMIT ISSUE DATE
03/19/2008
NE: SANITARY NO. CONTROL NO.
ARCHI'IECTfENGINEER: BUILDING PERMIT INPO
GRD FLR ADDITION 648 ' —FAMILY BLDG ELECT PLUMB MECH
O O O
goo LICENSED CONTRACTORS DECLARATION ' „_.dab Description
I tereeY affim tulam ll¢rmed under prowions tef Chapmr9(nmmcncing -'^-_ �_^^^•• ^•• ^^••
�i wit Secdon 70M)ofDiviuon 3 ofnK Encloses and Prof essb Code andmy Ike=u
^<�� in full fora and effm QQ ,
? ? Llanse Clan Lle.g
3 Dan:
:CUBA ARCHITECT'S DLARA
I underatanJ my plw ahtll k used u public rtarda '
ted Licensed Prohaitenal -
5y OWNER-BUILDER DECLARATION
1 hereby offices tat 1exempt from to Covin Co License Lew for to
D O followimason.ason.(Section 71131.1.
5.Busiest and Profession Code:Any city or county
S$ which rtqulres a Permit m construct.allot,improve,demallah,or repair my structure
iy prior to its issumou.alto require,dc,pplieam for each Permit to file a signed seeumem
< Wet he si licensed pursuant to du pmvinmu of to Correctors Liam Isw(Gaper 9 Sq.Ft.Floor Area Valuation
9 (eammmci,wit Sacdon 7000)ofDivision 3 of t,Buslnnsand Profusion Code)or
tat k ren
is aaamp, nefrom and to bassi for to alleged exemphor.Any Wasitin of
Section 7031.5 by Lay applicant for a permit,ubjccu to applicant to a civil penalty of APN Number Occupancy Type
tat moa tau five hundred dollars ISM '
❑1.0 owner ofdie pmpcty,or my employee,who wage as their sole cmnpereader,
rid Pedmr�u dams Codda;TIV C nnctors License Lawdodoes ret appply in an owner of Required Inspections
propertywho builds or improves,thereon,and who doesschwodthimalf or trough his
man mnployorn,provided tnsech improvements are not intseded oroRered forale.IL
bowever,to building or Improvement is sold whom on year of nmpiedon,to owmr- y
Builder will have to burden of proving Mut he did lit build or Improve for purpose of
ole.).
%Les awcer of to Property sm exclusively oonraming who named an at cton to
cormosen to project(Saw.7044,Busbnn,ed Profesaloru Code:)The Cnuacwrt Lt.
amu Taw does not apply M an owner of property who Milds or improves tureen.and.
wk coastalf2,ach projewit, anrclurls)llcammd pmm
snt to Me Cnucdofs
License L-
01
a❑I am exempt under .B R P C for this reason
Owner Dam
WORKER'S COMPENSATIO BC1.ARAMON
1 hereby aflin under penalty of perjury,am of to following declandmu:
have and will maintain a CadOats of Cement to self-inure for Workeh Compen-
suln,as provided for by Section 3700 of Mo Labor Code,for to peNommce of to
were for which tis permit is Maned.
❑1 have and will maintain Workers Compensation Inamorata,an required by Senin
3700 of to Labor Code,for tr performance of to work forwhich to Permit u lased.
My Workers Come matin hu2um��e�e uAct and Policy number am.
Carrier. AAMML Policy NOM WO ENS'
C Fl ATTEE OF S PILON FROM E ERS
COMPENSATION INSURANCE
fThsi seNn need net be completed if tic permit is foram,hundred de len($100)
or leu)
I ceMfY rfonarco of to work for which this p ,u issued.I shall not
employ any person m crauubecomosubjectote Wmken'Compemater
Laws of California.own;
Applicmt \
N(DICETO APPISANT:IL aftermaking tut Trunate of amorphous you should
become subject to the Workers Compnemdn provision of to latter Code,you mow '
O fordwit comply wit a ch Provision of tis permit shall is,deemed Invoked.
r CONSIBUCnON LFNDINGAGENCY
(-r I hereby affirm to them tea construction lending agency for to perfnnana of
to work for which this Permit M Mason(Sce.3097,Civ.C.)
0 Lenders Name
Z) z Lenders Address
U e I certify that 1 have mad thin application and sou that Me above infomater is
ly E comm.I agree m comply with all city W county ordinances and seem laws relating u
0 -' building cenmucdon,lid hereby autarlm representatives of to city in rotor upon the
[17 above-mentioned property for inspection purpmol.
(Wr)agree to ave.Indemnify and keep hammy Me City of Cupertino agalm,
ray rrAA Iimilldes,judgmenu.cmuandexpemrs whichreq in any way..against mid City
in of Me
of
V�-+
APPLICANT ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by:• Date
9DDRCE gEGfL ;). . —
_se.fA � cji}est Re-roofs
Si{nuua of ApplioHAZARRDO Dau
HAZARDOUS INATERIALSDISCLOSURE Type of Roof
Will to applicant m future ko
u CupertinoCupertinoaovpa,atore or handle aldom maarial
defirod by to CupMunicipal
^I CCodChaptere.Chapter
to
Chapter 9.11.and Health amf Safety
Cada.Section 155324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye, o
.� Will to applicn,or arum killing occupant use equipment of devices which
If a roof is installed without first obtaining an inspection,I agree to remove
h,vsrdnm air commune as denied by to Bay Ara Air Quality Manage... all new materials for inspection.
c,7
❑Yes tyro
I have cowl to pandas,\\materials mnimmenu under Chapter 6.95oft,Califm-
' ria H.It&Safely Cad-Scvau15303,25533 uW25534.1 undcwAW tstifdebLiiding
dor m,Currently Nes a meant,tat it u my responsibility in Miry Me occupant of do
n9uiremucs which must kme 'or to issuance of,CcnnrAu,of ecmrpsery. Signature Of Applicant Date
%—t —1
Owner Dam. All roof coverings to be Class'%¢"or better