08080185 CITY OF CUPERTINO xar%=s�5svt.�a -�+rzkz:xi.tc -
BUILDING DIVISION PERMIT p C�NTRACTQ;R I„Nk'O�RMATIO,N
RUILOINO RRDRESS: PERMIT NO.
!.i(S.5 / CR I:CKE'I' I-I:I:LI, RD RICARDO REMODEL 08080185
R'S NAME: FERMrr ISSUE DATE
AtNYA R.LCE 4111 WILL ROGERS DR. 08/25/2008
NE: - SANITARY NO. CONTROL NO.
ARCHrTECT/ENGINEER: BUILDING PERMIT INFO
REMODEL: INSTALL SKYLIGHT & 'BLDG ELECT PLUMB MECH
0 0 0 0
o$ LICENSED coNrnncroR's DECLARATION ^• Job-Description
4 C 1 hucby affirm Nall,m linnsed umkr provisions of Chapin 9(rnmm acing '^ ^` —••^-••^^^ ^•
t� with section 7M),of Division 3 of NC Business and Profession Cade.and my licenscu
j iin ran torte and eRat fy 13/0 Y 3
Lkens Class /�
=� Da¢ ConraWe PIC or 'P LW oetr(
pp ARCHDECrS DECLARATION
W U 1 undemand my plan Nall W used as public nxords
a
nal
O Licensed hereby .
3 OWNER-exempt fr m do,CoATION ,
O I hereby
a(Sce
that 1 1. camps from Ne Canuamh License Law for Ba
HO fallowing recon(Salon 7031.5.Bualcocs and Re.dab ll Code:Any oily or county
$ which m9uims n permit re matin,altar.impmsu h Permit
t fie a sig any awetum
_i y tat W its l ecsuaae,also requires Ibe inions o foe such permit W files Lad(Chapter
p€0 NaznculiccnW pursuant to Nc of Division
ixon of dx ConuxbYsli¢mrcrAw(C Cod.)
Sq.Ft.Floor Area Valuation
(coy Was M is exemng pt Section s ad of Divis for of al Busaged essantl Ptoon.Any
Crdc)or
y�$
Was ba u exempt them(rom and tW buss far the dkgW eampuam Any vWlauon of
Section 7031.5 by ah,applinnt for.permit subject/the applicant a a civil penalty of APN Number Occupancy Type
not mart Nan firo hundred dnlWs(MM).
❑L u owner of 1M preperry,a my wplayera with wgn ss Ne'v sok compcwtin,
will do the warts and Ne atrtmwm a at intended,L w does
t ow.
of
and Pmfetian Cam:7h Canhe e..Dane Law don oat apply W a awns of Required Inspections
pro,ary .peowiimpot such improvements
mexauenwot nimselrer through bM
ownver.the
Wilding
pr suchimproromattartnot intendedeofoara@red roe Owner.
howews,Ne building u den Of Proving
Old within one Wild
of completion,the owar-
W ilda will baro the Wrenn of treeing Nu K did rot MOW o improv for puepoa of
uk.).
❑1.as owns of the property an exclusively contratung with Honed contractors to
contract the pmjen(Sec 7014,Business a,Pmfnalon Cam:)The Conuacmrs Li-
.Law does not apply al an Owner of property who Wild]us improve thereon.ad.
who..tram for such pm)eas with a conuacmr(a)licensed phrases in the ContrseWrs
❑I am exempt under See .B&PC for this mune
Dat
WORKER'S COMPENSATION DECLARATION
I bamby aPrm under penalty of perjury We of Ne fallowing decimation:
1 hart and will maintain a Curtifca s or Conten to OIf-court fee Workers Compcn- .
one,u provided for by Section 3100 or Ne labor Com.for the performance of dw
work,for which this permit is issued.
N
rI 1 have ad win maintain Workers Compensation Innatce,as required by Section
311.f the labor Code.for Ne performance of the work far which this permit is Issued.
My Workers Compensadom insurance cartiu anal Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fruits memo need scribe completed if the Permit is farmne hundred dollar(SIM)
or less)
1 certify Nut in the performance of the wok for which this Permit is issued,l shill no
employ any person in my maarc, u Wbecomeabjat Wtho ricers,Compensate
Laws of Caliromia.Date -
Applicat A n X14 d•O�
NOTICE TO APPLICANT:If,afcr making NM CemifE¢mNun you
cate of shoo,
become subject W rise WaharS Compeouom prevision of de Labor Code,you most
.JO forthwith comply with such provision or Nu permit ahall W deemed mvokcd.
CONSTRUCTION LENDING AGENCY
[-ate I Wrehy alum that tberb is a construction lending agcay,in,tho peRomancnhf
aw�. the work roar which this Permit M issued(Ser.3097,Civ.C.)
114 Q Landers Naw
.7. z Lenders Address
U Q I certify that I base mad this application and scat Nat the show information is
D, corttr4.1 ayme W comply with all city and countyoNinaanand sus laws relating W
� Wilding cmeameian,and barebytuthodm representatives of Nu city Wnlef upon use
W
atharve-qumdoned farinpallon purpo
ses
gy (We)agree to Ow,indemnify ad kap hatmwss the City of Cupertino agalnt
fn inconsequent or dw rah ad efthin which maYM NY w,yamue against hid City
V z in consequence of thegrating Ofthis Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION
91V_11 Re-roofs
Signetoe of ApylicantrCmUselmr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Eby
applinnt o future Wilding aaupal sWro or baMw bassoon manurial
carm
fad by de Cupertino Mwiripal Code.Clupue 9.12,and de HnIN ad Safety
. 0y.25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yue Na
If a roof is installed without first obtaining an inspection,I
Wall the applical or future Wilding Occupant tax equipment or devices which g agree to remove P
It haallon air comminution;u mficod by Ute Bay Area Air Quality Ma agcmenl all new materials for inspection.
Dia a? 1 /
Dyes VN.
1 have real Nc hand=materials requirements under Clu N6.95oftheCalifon-
nixHcaiN&Safety Code,Section 25505.25553 ad 25534.1 unmuund Natirde Wilding
don Out currently haw a renal has is 4 my responsibility W county the occupant of eve
requiremenu whph�"muss W nut poorµissuance of a Counfma¢of lkapary.
�yM ,�— dB ZS 08 Signature of Applicant Date
Owner a annoagent DOW All roof coverings to be Class'%¢”or better