00080213 CITY BUILDING
DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO,
OWNER'SNAMr10277 E ESTATES DR PHOENIX •PUCATIDN. .•�
` \I 'PHONE: SPANGLE YVONNE C 17:5 RODGERS AVESANITARY NO.
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KZcARCIHI'ECTT..N (408) 467-0390
GINIER: - - BUILDING PERMIT INFO o -
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❑LOG GLE v�E PLUM1_uB I
LICENSED CONTRACTOR'S DECLARATION
Z'4= u,ereb rm,,,mamimm�cenxaanndm fCha "90o....ae„cin. Job Description
0 y_C Y n prnvlsinnx n p g _
F"•�C wIlly Sect 70000 it Division 3nr t he Businc,ayal Pec ism Coca and my license
¢m I ^all force ary41 1.
ae z ce suClass LLk•f Lie.a QQQQQ��`����1�������
aOnt' r m Crmmn� �
3.o m— --�3! ARCHITECI"S DECLARATION "r ADD A/C AND FORCED AIR HEATING.
k' H I ardersu:nd:ny pluis shin be wed ar public"'ards
wo Licensed professional
ca OWNER-RUILIIER DECLARATION
1 hereby affirm Nat 1 um exempt from the Commucmr's License Law for the
C X following reason,(Schon 7031.5,Business and Prolessinna Codc:Any city or county -
Sa O width requires a permit m corxxBuct,xlmr,improve,dcmnlixh,nr«pairany xbuamre
�u3^oE prior mo its issuance,vivo requires the applicant broach man 1.file a si,md.vamnrem -
thathelsneen.sedwt.uantto the provirm,esnfthe ContratmrsLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing wits Section 70001 le)
of Division 3 of the Business and profession,Coal
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of section 7031.5 by any aPplieam for a pennh.tubiecax the applicant to a civil penalty Occup' )
armare
nor than 111,e mad,ad dahlias asap. . APN Number
01vel pnpenY or my cande,ce,with wages n,h mpen:au n,
will do he weak. he arry,burs,
' dei or offered for sub, 7044.
Business and Proaressions Code The C t r:I c e x i apply an
3690601 E4quired Inspections
ownproperty h buildse yh c n and lted e:. M1 k himself
or Ily h l " plyev piJ d by(sh t e 1. tintendedit
❑1,mownerrinepmpenya,nexclusively ca..traerngwith licensed rentractaraoffered I .If.1 d b Id ng improvement Id di year"!
completion.
ompiet ,me ownerwuamwnhave N mtmenmproving mthedid not nynaar 204 — UNDERFLOOR FRAME
improve 301 — ROUGH PLUMB INO 3�0
—
restrict the Pieter:(Sec.7034,Business and Professions Cale:)Tnnr'e 303 ROUGH MECHANICALhe Oman
License Low does not apply to an bona of properly who build%or improves thereon.
.ad who contracts for such pnjectx with a cremation.)licensed paracent to he 304 — ROUGH ELECTRICAL
ContextO l am exempt made,Sec . ,It&P C fr,his reason 505 — FINAL ELECTRICRL
Dwmer Date 507 — FINAL PLUMBING
WORKER'S COMPENSATION DECLARATION 506 — FINAL MECHANICAL
I hereby affirm under penalty of perjury one of the following declarations 514 — FINIALPUBLIC WORKS
0 I have and will myinialn a Cenlfimte of Consent to xelf.lnxnm rill Wmkcr'.v -
Conipensation, as pnry Idled fir by Section 371%1 of the Labor Cade, for the
penmmance of the work for which this permit is issued.
01 have and will maintain Workers Compensation Insurance,as required Is Section
371)of the Lunar Code,for the perrnnnance of the work for which this penin is .
Issued.My Workers Can,pvnimion Insamnce conic,and policy
number are:
iccnjN"Lfn4w✓ policy Na:AHB liFiI
CER rIpl ATION 01:EXEMPTION FROM WORKERS'
COMPCNSA'rioN INSURANCE
Ghis.mction need nom be enmpleted if he pin:it ix Ibr one hundred dilly,
(s 100)(11 R10 -
1 o iry taut in the perfonivnce of the work for which this pared,is ism ed.I -
shall not employ any person n any manner so as to become subject to the Workers'
Compensation Laws of California.Date _
Appntam .
NOTICHTO APPLICANT If.ofmrmvkmilhis Ccniticamnf Exemption,ye.,hnuld -
Z becomeupro
subjecn the Workers Compensation visions b
ofthe Lae,Code,you must
Z2fnnhwiN comply with such provisions or this psemit shall be deemed revoked.
F '4CONSTRUCT ION LENDING AGENCY
(Yi I hereby alloy,that the,is a conswnio i:mating agency ka there fnnmmec -
of the work for which this permit is issued sec.3097,Civ.C.) .
SQ Lender's Name
U Z Lenders Add.,
U 1 evenly that I have read this application and stale that abuse information ix
Gz E. correct,1 agree to cmnply with all city and county noinanee_s and state laws relating
O U rebuilding commotion.and hi omherixerepf.semadves niches city m inue"Tm .
the ahovumentinned pmpeny for inxpectirn Purtmays, '
(.� d (We)agrecrosave.indemnify and keep handles,the City of Cupertino ag:unsi
eA babilide,jnagments,costs and expenses which Ina,in any way Became against said
U 4 City in consequence of the gaming of this penon. I '\
AP ,CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
NS. 8 c Issued by: Da
Signature Applicant/Contractor it Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will tore rte handle lycnNous maal6id Type of
es delined by the Cup,mrs,Mm icipul Code,Chuptcr 9.12,and the Health and,it n y
Code.Section 25532(x19
0 Yes 13No All roofs shall be inspected prior to any roofing material being installed.
Wi 11 the applicant or future but ding exechister use equipipent or devices is hich If a roof is installed without first obtaining an inspection, Pagree to remove
111youl hi am In, in can:demi nems as defined by the Buy At.Mr Quali:y fell scut,
a til to vex ❑Nn all new materials for inspection. Applicant understands and will comply with
x all non-point source regulations.
1 have road the harardrus unnamed,regeircments•andcr Chapter 6.95 of the
Culionyiu Health&Safety Code,Semdons 25505.25533 and 25534 1 undoesmnd raw
if lho hullJing dour ern enrrcnay hnvenicnunt.in
it ix my mspnnvlbillty to nrnily the
ice um of the yuiru.,at,which into be mm prior m issuance of a Cenifcmo of
`n"re Signature of Applicant Date
owacrora mnedageat o� All roof coverings to be Class "B"or better-
' _ OFFICE