08070035 CITY OF CUPERTINO .^� �K �. �== . nem
BUILDING DIVISION PEPNHT CUN:TRACTaR INFORNIATIaN'
BPERMIT NO.
mLpIttQ ApQ-R DENISON AVE TBD — TO BE DETERMINED 08070035
111C
ELR'S NAME: PERMIT ISSUE DATE
13UCCINELLI EDWARD AND LYNN R 07/15/2008
NF SANITARY NO. CONTROL NO.
HTIECnENGINEER: BUILDING PERMIT INFO
BLDG EI.f.Cr PLUMB MECH
(� 0
goo LICENSED CONIRACTOR5 DECLARATION Job Description
iI u C 1 busby affirm Npe$GnP
al 1 am licensed under provisions of Chapter 9(commencing
-]=w withS gm70110)ofDiAAon3ofdmBusi wditfessionCod...dmylicensein REPLACE WINDOWS DOORS,ADD CAN LIGHTING,REMOVE NON
in in full force and e L
z IxenseCT�Lk.g STRUCTURAL WALL.MAKE OPENING BETWEEN LIVINGRM &
�4 Dam ARCHI7ECCTSDECLARATION FAMILY RM. REMOVE DOOR, REPLACE W/WINDOW. NO RE—
I undersand my plans shell W used as While rec.Na RF
t wt; Licensed Pmfcuwmmal
h OWNER-BUILDER DECLARATION
if I meby same that i em tumor from dm Contractor's license IAw for IW
O O following return.(Section 7W 1.5.Business and Professions Cock:Any city or county
which requires a permit to et muucL saver,improve•demolish.or repair any momentum
_Z< prior W its issuance,also mquims lW applicant forsuch Permit to rile a signed statement
Fs0 that he is licensed Paramount m the provisions of the Connectuss Usessm Law(Charter 9 Sq.Ft. Floor Area Valuation
d s- (commencing with section 7000)of Division 3 of the Business and Pmicet ousCode)or $15000
f5? that he is exempt therefrom arsd W basis fes,the alleged=umpdun.Any violation of
Section 70315 by any applicant for a permit subjecu dm applicant no a civil Penalty of Oceu aneYTYPe
nor mre man five hundred dollars(S 31628010 . Number
❑I.uneve(.fshrpmpcny.wmyemployesvimedgesudeirmlecompe don,
willdotheworLandtheseamsunotinvendedoroRemdfor W=(Sm.7 .Bu moss
and Professions Code:The Cnnuacara License Law does nor apply to am mann,of Required Inspections
Property who builds on imlmwa deans,aMwhodaessWmwork himvdfm Waugh his
own employees•provided that such impmsemrna are not intended oroRerrd forsak.IL
however.the building or impmwmmt 1ssuld widen ma/ear of eempleuon•de owrcf-
builder will have On WNcn of proving mat he did not Mid or impress for puri.¢of
1.u awes of On s..7 Y•.B esciuswdY eenussting with licensed mm tris -
.uwnNeesMo (Sec.7am. of and Py.1on,WiCode:)The es,ft . nd .
who law des nor apply b eco owlet of progeny wce Wilds rs impmwa thereon,and
who contracts for projects with a canwcmgt)licensed pursuant to Use C.nrrutofs
L'rcn law.
❑lam eacmpt under See ,BAPC for this mason
nor Data
WORKERS COMPENSATION DECL RATION
1 hueby air=under proudly of perjury me of the following deelaratimaw
1
have and will maintain.Cenimateof Cormorant
oventm self-imus for Wedwe.Compete
cation.as provided for by Second 37W of the labor Code.for the perfoeasux of use
wok for which mu permit Is issurl
❑1 haw and will r dment Worker's Compensation InWranQ,as requited by Section
3700 of me labor Code.for the performance of the work for which vis permit is issued.
My Worker' Co peuarion Ina aanen carrier
"and Policy number am:
Carrier. g rte s�policy No.:
CERTIFIOFIDEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(ILlssecus,need notbecompleted if ft permit is foene hunmedd.0ua($1 00)
or Ica)
1 arufy Wt in the performance of the wok for which this permit is issued,l shell not
employ any Person in any arossr an as an become aub'=tto'peW iCompematim
La;
of Cattle .Dam
NQfICE 70 A If,'Al matlng this C=nirmam of Exemption•you should
become subject m the Werkefs Compemid.provision of the lab.Code yes maw
wJ 0 forthwith comply with such provisions m shit permit shall W doomed mwkcd.
E[-n in CONSTRUCTION LENDING AGENCY
I hereby affirm mat inu le
them s ronstmctinn nding ageray W for performanceof
fY> Ou work for whim Our Permit is issued(Sec.3097,Cis.C.)
A (vender's None
7 z Lender's Address
U 0 1 cemify that I have read this application and sham thus the show ormmauon is
it, " comet.1 agree m comply with all city and county ordinuwea and state laws relating to
.0 CS J^ Wilding commuedon,and hereby mthorire.pre Mven.(this city m cover upon Ne
aWw-menues dgm progeny for inspection purynma
Fes„y (We)agme m ate.indemnify and keep hartolrss the City of Copmine against
to in consequence
of grauandof Ois eawhich mgin any waY accrue against said City
f,Jz A APPLICANT
of she Ranting.(muDWIL / G
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature ofApplican AZARD or Dam _.
xnznRDous AdsDmereosuRE Type of Roof
WIII serapplicantu(muco building Co ecenpantsbre orhandlehawdoumaveriad
u deBrcd by be Cupertino Municipal Code.Chapter 9.11,sed tW Hnith and Safety
.QYn 15532(a)? No All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or mtme Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Di
it Isar me,air conumimmu ni
a deed m=by Bay Ma Air Quality Management all new materials for inspection.
striet❑Yes QNo
1 Mrs read the Mormons materials nuIo ce ew umkrchaPerd.95ofine Califof-
niaHealth k SafetyCody,Seences 25505.23533 ao12553e.l undersand muifine Wilding
does rot curmndy have a a'nanl that it u my rnpondrolity m Wort,the occupant of the
mgnlr=mcmawhich most bemetpri.rmivmance fmam.facwpwey. Signature of Applicant Date
Owner o authom
am
All roof coverings to be Class'p 'or better