08060119BUILDING DIVISION PERNM
TINO RD
AMCON SUN ROOMS
OWNER'S NAME.
SUNNY VIEW LUTHERAN HOME 23358 CLAWITER RD
ARCHrfECTIENGINEFR:
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commmncing
with Section 7000) al Divislon 3 of the Business and Professioru Code, and my license is
in full force and effort
licorrm Class aLr. o
Pile O Contractor
ARCHrrECCS DECLAZA71ON
1 urAcrstsrd my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from t)hc Contractors License Law for the
following r aso . (Section 70313, Business and Professions Code: Any city m county
which requires a permit to construct, alter, hnpmvr, demolish, or repair my nrucmro
prior b its issuance, also requires the applicant for such permit to fie a signed stamment
that he is licensed pusauanl to the provisions of the Conuactar's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Pmfesions Code) or
that he is exempt themfrom and the basin for the alleged exempdorL Any violation of
Section 70313 by agcy applicant for a permit subjects the applicant to a civil pointy of
out more rias five hnndned dollars (5300').
❑ L as owner of the property, or my employees with wages u their sok compensation,
will do the work. and the structure is not intended or offered for axle (Sec. 7014, Business
and Professions Code: The Contractor's License Law does not apply b an owner of
property wbo builds or improves thereon, and who does such wort himself orthrongb his
we employees, provided that such improvements me not intended of offered for ole If,
however, the building or Improvement, is sold within one year of completion. the owner.
builder will have the burden of proving that he did no build or Improve for purpose of
❑ L as Owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec 7014, Business and Professions Code:) The Contractor's L4.
emu Law does nes apply to an owner of property who builds or improves thueon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec. B h P C for IRs reamn
owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a01rm under penalty of perjury one of the following rYn•..w r
❑ I have and will maintain a Certificate of Consent to self -Issue for Workers Compen-
sadon as provided for by Section 3700 of the Labor Code. for the performance of the
wart for which tib permit (s issued
❑ 1 have and will maintain Workers Compensation Imou2nee, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit L.areal
My Workers Compensation Insurance artier and Policy number arc: 6 C U0r
Cartier. , Policy Noz U—J a % 17$16. 7
CERTIFICATE OF l;](F7viPTTON FROM WORKERS
COMPENSATION INSURANCE
(Thissection need not be completed U the peril b forone hundred doom (5100)
or less.)
1 certify that In the performance of the work for which this permit is issued P shall not
employ a y person in any manner so as In betmmo subject m tis Worlxrs' Comprnotlon
Isws of California. Dae
Applicant
NOTICE To APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Warke s Compensation provisions of the Labor Cods you muss
forthwith comply with such pravlsions Or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
1 hereby affirm that dare is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, CN. C)
Lenders Nene
Lenders Address
I certify that I have mad this application and scam that tis show information It
'noccl 1 agree to comply with ail city and county mdirnances and state laws relating to
Wilding construction. and hereby authorize mpraernadKs of this city to ester upon the
above-mentioned property for inspection purposes .
(We) agree to save, indemnify and keep hornless the Cary of Cupertino agsimt
liabilities. judgments, costs and expenses which may In arty way arsenic against cid City
in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
sig *dc of ApplianliConuanw ' IDae
!/ HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant smrc or handle baardos mascrial
as defined by the Cupertino Municipal Coda Chapter 9.12, and the Health and Safety
Code, Section 25532(s)7
❑ YNo/
rs
Will the applicant Or future building accuPnnt use equipment Of devices which
emll ha-rardoas air conuuninams as defined by the Bay Ann Air Quality Management
❑ Yes p No
1 have read the harudaus materials rerpthcmrmu under Chaprer 6.93 of the Callfor.
uia Hardt do safely Coda Sections 25505.25533 and 25534.1 undersand t atif the building
dans not currently have I taco, thin It la my responsibility to notify the ocenpant of the
requirements which const be met prior to kssuanco of s Certificate a
Ow or authari=d agent Date
(510)887-1667
ENCLOSED PATIO 240SQ
. Ft. Floor Area
32615124;
Issued by:
Re -roofs
Type of Roof
PFRMrr NO.
08060119
PERMIT ISSUE DATE
07/18/2008
SANITARY NO. CONTROL NO.
BUILDING PERMrTINFO
BLDG ELECT PLUMB
Job Description
$15000 Valuation
Required Inspections
Occupancy
Date
L
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
all new materials for inspection.
Signature of Applicant Date
. All roof coverings to be Class's" or better