08040022 CITY OF CUPERTINO �
BUILDING DIVISION PERNUT 7aCgA,...��6,
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euIL0lydG.lvgf3REs$.EEPROSE PL ROBERT GIANCOLA P08040022 ,
OWNERS NAME: llCONST PER ILTISSUEDATE
JUDY CRAWFORD 384 BREEN RD 04/08/2008
ONE: SANITARY NO. CONTROL NO.
(831) 623-9245
RCHRECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMBMECH
0 0 0 0
m�o0 LICENSED CONTRACTOR'S DECLARATION Ib Description
rd t� 1 hereby Warm NOCSCTIP
at I.e Hommed under provisions of Chapter 9(commencing
with section 7")of Division 3 of Ne Business and PrefessionsCode.And my license is ADD DECK
i'z u.cnlm Clams_-e.rt-�em-. Lic.g A 964
1: Dau q-Lyda Conuactor A.hr riid.a/,�f..f,4'1
/_ARCHITECTS DECLARATION
I I understand my plans shall he mrA as public records
7
g� Licensed Proria"i...I
y 3 OWNER-BUILDER DECLARATION
9 I hereby ARrm that I am exempt from Ne Canrutors License Law for the
0 0 following recon.(Section 70313,Business and Professions Code:Any city or county
$ which requires a permit to construct.alar,improve,demullvh,or repair any structure
_Z_L^ prior he its issuance.sherequimn Ne applieat fersuchpermit m rile aligned statement
<
that he alicammsadpmwm.mmthe provisions ofMeconuanaraLice=Law(Chapter 9 Sq.Ft.Floor Area $4000 Valuation
S�s (commencing wish Section 7000)or Division 3 of MeBeat .and Professions Cade)m
l� that he is contempt therefrom And Ne basis for Bu alleged emmpt um.Any vialWon or
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy act mere than Bae hundred dollars($lam. 3 6 9 0 5 0 21 .A I P y TYPe
0 1,u owner of tie property,or my employees with wages As their sole compensation,
will do MewmY.And Me structure is at Mounted or offered mreale(Sec.7D44,Buw
sinRequired Inspections
and Proressions Code:The Conhaemrs Licen. m oe not apply to A.Law dewner or 9 P
property who builds m improwa Nvean,and w ho does such werk himself or through his
own employm,pmWMA Nam each Improvements am not intended attracted fm We.If,
however,Ne Wilding or Improvement is sold within one year of completion.the owner.
builder will have One buNee of proving dust Ise did men Wild or Improve for purpose of
aa).
M.of the property am exclusively contracting with licensed comments;to
construct the project(Sea 71344,Business;and professions Cad
ne:)That Contractor's Li-
coe Law d.rot apply m an owner of property who Wilda or Improwa Nemon,end
who contracts for such Projects with a conuanor(s)licensed Pursuant an the Contractors
I.1cemma law.
Owner aemp oder Bee et�_,B A P Cs for Nu moon
WORKER'S COMPENSATIO OECL,k,kRAAATIIOONa/H'L/���
1 hereby Arbor,under penalty or perjury oro of t e following deccimatio�n:—u
1 ham and will mainWn•CeNOcere of Conserv m sair4n.a.for Workers Camper
it,a provided for by Section 3700 of the Libor Code,far the peaommce of the
for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,As required by Sadm
3700of the labor Cade.for the parformurceaf Me work for which this permit is issued. '
My Workers Campewum hum.artier and Policy mother art:
Cartier. Policy No.:
CERDFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rush melon need rot bo completed If Ne .It Is froom hundreddell.a(SIO)
nr kis)
1 certify tint in the perfomance of the wart for which this permit is issued.I shall am
employ any person in any man,r so As b�cAmimrIsubject be do WedmY Compensation
Taws of Califomia�Auc1�>/D
Appllant •f119t�
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become Subject to the workers Compensation previsions of Ne Labor Code,you must
.J O ronbwith comply with such provisions ser Nu permit shall bo deemed revoked.
,zm 0 CONSTRUCTION LENDING AGENCY
[-v air., I hereby affirmthat Nem is a construction lending agency for the performance of
�: Ne work for which Nis permit ts issued(Sec.3097,Civ.C.) .,
GQ lander,Name .
=z Lenders Add.
V 0 1 unify that 1 have read tido amlicatien arta sub dust de show information Ise
Up E correct.1 agree to comply with all chy and county andinamoas and some laws mlaung b
0 Wilding construction,and hereby authorise repmaenmives of Nu city to enter upon Ne
W ahove-menianed property for impaction purpose&
9L (We)agree to save.indemnify and keep harmle.the City of Cupertino against
saw rA Ilabiliti.,judgments.costs land expenses which may In any my acme agdmuaid City
()z in consequence or the granting of this permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AU NON-POINT Issued by: Date
SOURCE I�GUI.ATIO�isa 4 ��
��,B.IJ � Re-roofs
Signabm of Applica suCanuactor 'Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occ rpant rare orhandle .aamateria
N
u denncd by e Cupertino Municipal Municipal Code.Chapter 9.13hNn
,and the Health and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yat EV.
Will Ne applicant ar[.tort Wilding occupant use ryulpmrol or devises which If a roof is installed without first obtaining an inspection,I agree to remove
h h.aAoa At,cmuminar s.dented by Ne Bay Ami Air Oalhy M.upemmm all new materials for inspection.
:17
❑Yat [�io .'
I have mad the haxardmusmaurialsrequimntenu underChapterti.95 arise C4lifer-
niaHaaW&SafetyCa ,Sc.U.7ri505,25533atu175534.1undcmtsnd N.Ifdat Wilding
doesnot c O haw n.Nat It u mY nesNaudbility m modify Ne useupat of Ne
requlremc whkhmu t ormi.vamsafaCerdlkauafOccuq.nry. Signature of Applicant Date
Owner or mNodssd spent one
All roof coverings to be Class'%q"or better
D ou'