04060185 CITY OF CUPERTINOz *' - a�'atv0«'"�.,ex"kPfslTx?zbr.T ��
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: FINEST DIMENSION HOME BUILP /19ND04060185
OWNER'S NAME: PERMITISSUE DATE
E; SANITARY o. C RNOL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
z LICENSED CONTRACTORS DECLARATION Job Description
1 hareby affirm that 1 am licensed under provisions of Chapter 9(Commencing P
i withUWU S don70fX))ofDMeon3ofdte Basin udit(cWomro ,andmylicanseu
^?�, in full forte and eR
5�z ucemse Cl I Cy_ Lic.g ADD 596 SQ. FT. FOR GARAGE & LUNDRY/BATHRM
z� Dale earn CONVERT GARAGE TO FAMILY RM (483 SQ. FT. )
'q ARCHITECTS DEC ATI N
oZ I understand my plans shall he used As public mcmd
6
c Licensed PnttcuiOnN
5 OWNER-BUILDER DECO Conti ON
. a 0 I hoar (Sec that 1 A.1. exempt Imre Ne Contractors License Law far the
m,
O o following uires a Permit
t AIL.d,Business and fl,core li Code:Any city nr county
$ which its.a a permit ro,ii.,h t,alley.impmw,de ximit t or,pair any specie,
'^ priarmiu,coaml pummrcquithe mnriSaimnt for such CmUractoe,ReesI,Ae ned statement
aw(Chater9
Natheullcenxd puesuant total or Divioenn(the eBuarors License❑w(Chaptm9 Sq.F[. Floor Area Valuation
z $ (cRLM Is exempt hounSectian70W)on Division]ofthecgcd essandan.MyonsCMc)car
Nat he a exempt Ihcrtfmm and the buts for the aflegetl eumpdon.My violation of 8120000
Section 7031.5 by arty applicant for a permit aubjecu the applicanuo•civil penalty of APN Number Occupancy Type
not mate to.live hundred dollars($50y. v
❑Lo oer rofthepmpmy.mism,inoycmwiN a gfor xitwleeompenutlon,
Add Profession.
and.Thn Comutrotintendedm oncnda not apply to An Busirtof
Ina Impart,
bat cotle:Thr Improves
mra unene Law doer o apply lf an ownar is Requi Bkktl/r/ a tl 05�
pmpemploy b.provided
idth.L, thenogandwho ments Are rinfirfacrodd eseuchwork himsellor though Ms
howear,Onbs,ping., arovermmpnwd who... carat
a.far owner.
-
builder Nebuildingerimpmwmentis Coldwithinoneyid ofcompletion,dueawmr-
W inter will Mw the burden of proving WI he did wt bdld Or improv for purpose of
tile.).
❑I.M owner of the property am eulumvely contracting with licensed Contractors in -
cmmtmct the pmjen(Sec.7044,Business and Profmslons Cade:)The Convacmr'a U-
came Law rims not apply in an owner of property who builds or Impnvm demon,and,
who contracts fur such projects with a contractor(s)licensed pursuant m ase Contractors
Law.
0 1 Am Lft p j� A►, p 'aces
Am aemptuMU S,. .B&PCI,Nu rtuon 1�1.J,d 'feta
Owner Data
WORKER'S COMPENSATION DECLARATION
I hembY affirm under penalty of perjury am of the following dmluatiom:
have
and will maintain aCW Certificate of Consent till-ienum for Warkda Compeer
1CM-11
n,u provided for by Section 3700 of the labor Cade,for the performance of the
for which air permit is issued.
haw and will maintain Wuheh Compenutlan Insurance,u required by SeNon
ofthe lborCode,for ac pet(armanec ofthe wontfmwhich air permitis Issuedorkers CorFeaudan Ienunn¢crier end Poll,mrk,tie:
er. Policy No.:
CERTIFICATE OF E(EMPI70N FROM WORKERS'
COMPENSATION INSURANCE
(This smtlon teed not Wcompleted if the pctrnk is foram,hundred dollars(SIM)
or loss.)
I cenify that in the performance of the wok for which this permit is issued.I shall trot ,
employ any person in any an!Fe gaticc a nine the Wartcn'Compemallan
met Calif a Da .RRP, lM_ • cf NOTICE
am�,
NOTICE TOA P s' After making dpr Certificate of Exemption,odyoushoos
bore tromp to the Wortero Compensated provisions of the Labor Cade,. most
.,0 forthwith Comply with such pmviafou or this permit mail W domed rewked. ,
'�.~Ni
CONSTRUCTION LENDING AGENCY
PIhereby affirm that then is fouwction lending agency for the performance of
E the wart fur which au permit Is issued(Sec.3097,ON,C.)
ts1 0 Lcndces Name
IL Lenders Addrom
U O 1 ttrti(y au I have .it this application and sou that the show information is
!+ cosecs I agree to comply with W city and county affinities and sou laws rotating to
0t building construction.and hereby authorize rtprtunutiv,of this city to enter upon the
If7 above-rentiomd property far impaction purpura&
(We)agree m caw,indemnify and k,p harmless the City of Cupertino strident
,A liabilities,judgmenu,costs ands.,.which may in any myuctue Against said City
U in conseguema of b,granting of this permit.
APP 1CANQ'UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SqU CER OUL(Qf1DNS.
( t P. R LWy 2,0ts4 Re-roofs C7
Si tau MpplicandCon'uutor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof 1 /
Will the applicant or fru,building recupantatort or handle stainless material
as dcRned by ac Cupertino 14 cip I Coat.Chapter 9.13,and the Health and Safety
Code.smaanus3x(e)7
❑Yu a All roofs shall be inspected prior to any roofing material being installed.
Will the Ippficmt of future builling occupant me equipment or deviom which If a roof is installed without first obtaining an inspection,I agree to remove
larudnus oir can uminmu u recd by the Bay Area Air Quality Management all new materials for inspection.
In
❑Yes ❑ u
1 how read the ha»rdnusmateriau requirements undcrChapter 6.95of the Califon
nu H,Ith&Safety Code,Sections 35505.25533 and 35531,1 maxnund low ifdat Wilding
roes t eurrt her a in "set it is my maponaibility m notify dr amupant of the
rcyi emu nick IWm,prior m issuance of a Crflqcaw of Occupancy. Signature of Applicant Date
.her or authorised agcm L AU 1,D2� All roof coverings to be Class "B"or better l///