05090075CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INk'OR ATIQN
ave,
Bu 1L DING ADDRESS:
SPECTRUM FINE HOMES, INC.
PERMIT N005090075
22303 N DE ANZA CL
ER'S NAME:
PERMIT LSSUE DATE
MARK AAKER & GAIL BROWNELL
1734 EL CAMINO RE
10/07/2005
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SANITARY NO. CONTROL NO.
(650)960-2449
ARCHI'IT-C IEN'GINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
ing
hereby affirm 1 are licensed under, prowmmts of Chapter 9 (commenting
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p
with Secdon 7WO) or Division 3 of he Business and Professions Code. and my Ileenm is
infnnmmeanec
INTERIOR REMODEL -NEW FL. PLAN/RELOCATE
License Clsss Lle.g
Date Contractor '
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RCHITECI'S DECL4 TION
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1 uneeuund my plant shall he axed as public reonNs
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Lk:O=d Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I em exempt from the Conuactor`s License Law for the
MAY 2006
following mems. (Section 7031.5. Business and Profession, Cade: Any city of county
.
which requlms a,Pemdt to construct. ales, improve. demull.N, or mpur my structure
prior m iu iauance. alsomquims,he applicant for such permit w nie a signed wmmenl
�' Va 22365O
e Camwr's License Law(Chapten9
Nat he provisions pursuant the proviatoOf Nrso
O
(commencing with Swtion 7000) of Division 3 of the Buainea4nd Professlmu Code) or
Nn he Is exempt ,from and use bait for Ne alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit ubjects the applicant in a civil Penally of
no, mom sun five hundred dollars (SS00).
35602
❑ I. as owner of Ne property or my employes with wages a their sods compensation,
Required Inspections
Cner
willdo Ne work and Ne avucwmhnotimm�eed oroRered fona1.(S.C. 7044, Dust=,
and Pmfeumn, Code: no Ce mseurr't License Law does not apply w an owof
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property who but Ida or i mproves thereon, end w ho does such work h Int W f or through his
own employers, provided Nu such impmvemmu ate notinunded oreff red for W. IL
however, the Wilding or improvement is sold within one )em of mmplcuon, the owner.
bulkier will have rhe Widen of proving W, W did Out Wild or improve for purpose of
sale.).
❑ 1, as owner or that property, am exclusively contrsoting with licensed conhanon to
construct Ne project (Sec. 7044, Bwinesa and Profusions Code) The Conlacwr'a Li-
cense Law dors not apply ve an owner of property who Wit" or Improves thereon. and,
who convect, for such pmjecu with a emtrsolor(s) licensed purruan, w the ContramoM1
Lkmm Law.
❑ 1 am exempt under Sec. . B & P C for this mason
.r Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pedury one or the following declarations:
I have and will maintain a Ccntfiesm of Cement elf-insum for Wmter'a Compen.
ation, as provided for by Section 37W of the Inbar Code. for the perfommnce of ,he
woh far which this Permit it issued,
haw and will malnlain Worker's CompemNort Insursnee, as required by Section
7 of the labor Coca, for the pceformma of be went err which this permit is issued.
My Worker's Compenaiton Ism nce esrties and policy numbor are:
Carrier, PoliryNo.:
C RTIFICATE OF E)(EMPnON FROMWORKERS'
COMPENSATION INSURANCE
Mu section need Out W computed HOW permit uforonc hundred dollam (SIU)
or lana.)
1 certify No, in the performance of the work for which this permit is issued, I shall not
employ any person in any mannerm as in hommosobjecuo doe Workers' Compenn0on
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
became subject to the Woran's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit Nall be deemed mwkcd.
CONSTRUCTION LENDING AGENCY
1 hereby affifm WI Vert is a construction hndinj agency for the performance W
the work fur which this permit Is issued (Sec. 3097. Civ. C.)
'
Lender`s Name
,
Lender's Address
1 certify that I haw read this application and sum est the allow information Is
'
corms. I agree to comply with all city and county mdinsnces and tum saws relating to
Wilding construction, and hereby authodm mpreanu lm of this city to tmr upon Ne
ahow-mentioned property fm Inspection purposes
'""agree w saw, indemnify and keep harmless the City of Cupertino against
Imbilitietjudgmenu, costs and expenses which may in my wry accrue agalostsald City
in comegoenee of the grantin is Permit.
APPLICANT UNDERNA S ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S RE U ONS
Re -roofs
Type of Roof
6A A AAn
ign o ApplicandContractor D
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or forum Wilding acupmt some or handle hmNout material
denond by the Cupertino Municipal Code, Clupmr 9.12, and the Health and Safely
Smtios 255324)7All
Yes 40
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 o fuwrt Wilding omupant use equipment of devices which
It hmandnm air ronumlmnu a donned by the Bay Area Air Quality Management
all new materials for inspection.
uviet7
❑Yes ^0
I have mad the hvardmmmamdals requirements underchepter 6,95 of the Califor.
nia Hcalth& Safety Code, Sections 25505 25533 and! 25534 I undenund masif the Wilding
docsIly how a mount, thea LL y responsibility w ratify the occupm, of Um
uirtmen 'h met pdwi umenrac .tenroectcan,
Signature Of Applicant Date
w o,m
All roof coverings to be- Class "B" or better �j
sit m.nthndzed.gpn,