06040085 CITY OFCUPERTINO 77;77777 7Flu'pr - ---77` �' p'
BUILDING DIVISION PERMIT CON'CRA �°TCITt II 'ORW' 'TI �
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BUILDING ADDRESS: FINCH ALEXANDER C AND BARE MVP006040085
7886 FIESTA LA
aER'S NAME: PER'WILSUEDATE
FINCH ALEXANDER C AND BARB�UZA 04/28/2006
TMINE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO ELECT O PLUMB MECH
O O
�00 LICENSED CONTRACTOR'S DECLARATION lob Description
i b 1 heresy dam that I am imu licensed under pesvisof Chapter 9(commencing P
with Section 7000 of Division 3 of the Buuneu sed Promasious Cade.and my no.I.
n full fume sed effeeL INTERIOR REMODEL
j Z License Class Lic.As t
q Dem taConueuar �� /gym LLe 10 If
7W ARCHITECTS DECLARATION HN
Bf'1�9
f 1 understand my plans Nall be used as public records
e Licensed Professional ty4 �yf7f�La
' OWNER-BUILDER DECLARATION - ` [till111
i 1 bemsy afnrm Nm
at I are campt from the Ccu morA Lie...Iaw for the
0 D following mason.(Section 7031.5,Business and Profesvons Code:Any city or coumy
3$ which requires a permit to cnmtroct after,hnpmw,demWu4,or mPdr any swnure $56923
z�n prior to its ismance,almnuions the applicant forsuch Permit m ale aslgned smemceh
3 matheuImcmdPuraanuotheprevislmuofNeConmctor'sliensLaw(CWpmr9 Sq.Ft.Floor Area aluation
(commencing with Section 7000)&Division 3 of Ne Bushe asund professions Code)or p
9 that he u exempt therefrom and the basis for me dmgcd exemption Any violation of
Section 7031.5 by any apPllum for a permit mbjms the applicant b a Civil Penalty of -5"NMFhlJeruu Occupancy TI pe
not mom Nan ave hundred dolWs($500).
❑I.As owner of the property,ar my employe=with wages.fair sole compewdon.
win do the work.and W structs u ml Intended or offered far safe(Sec.70".Bush. Required Inspections
And!Prefi asiom Cade amrh
The Catt ate Lav does 0.1 appy anwner b oOf q P
Property he Wlldsorimpmus thereon,and who dmsauch work Mmself"Onalth his
we employces.provided that such improvements are not intended aro@red image.if.
bowewr.Ne bung m impmwman9 ts sold within one year of compmdm,the owner-
builder MU have the Omtlan of proving that he did not bond or improve for Purpose d
ale.).
❑1,as owner of the Property am exclusively contracting with licensed mniramers in
construct Ne project(See.7044.Business and professions Code:)The Cmtraemrs Li-
cense Law docs not apply m an owner of Property woo builds or immow dance,red.
who contacts for such projects with a cams co r(s)licensed pursuant m the Co0t610r!
Liceme Law. t
❑lunmmptunder5ee .B&PP(�CCj f.2this6--as/�on
Dat
WORKER'S COMPENSATION DECLARATION
i hemby alum under peWty of pcdwy arc of fe folbMng declwdmha
❑I edam and will maintain aCaNRcam of Comem to self-ImumforWorkehCompen-
saton,As provided for by Section 3700 of the Labor Code.for the performance of the -
work for which this permit is issued.
❑I haw and will maintain Worker's Compensation Insurance.As mqumed by Section
3700 of fm Lab"Cade,for the perfoman=of the work forwhich this Permit 1s issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
v
(lhis section need mthecomplead Uthe permit is foram hundred dollars($100)
or Wa)
I cenify that in the perfomanec of the work f"which this permit is issued,l"I am
employ any person in my On >d ahkalu faworimrs'CompemWon
Laws of Gpifomia. V'
ApPllunt r77 Air
s 'r
NOTICE TO APPLICANT:If.eller making this Crus=te of Exemption.you Mould
become Achim in the Worker's Compcovtion provWom d the Labor Code,you mutt
.,O forthwith cemplY wIN such provisions or this permit shJl be deemed mended.
z CONSTRUCTION LENDING AGENCY
(—t lhemby.M.that them tsa eomtuctinn lending agency farthe perfurmanceuf
C> the work for which this Permit Is imucd(Sm.3097,Civ.Q
W Q Landers Name
Z Lenders Address
U O 1 certify that I bave mad this application sed sum Nu the above infestation Is
LU F coact 1 agree to comply with all city and county ordineraa and sum laws miming In
O U building construction,and hereby...hurt.representatives or this city to enter upon use
` W shove-mentioned property for inspacdon purposes. ZI -
eF^y y (We)qme to saw.Indemnify And keep harmless the City of Cupertino against
fn liabilities,jWgmenu.cast andexpenseF which may in any way accrue against said City
U x in consequence Or the gmrUag of permit L{. Z e
"-' APPLICA NDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by: Date I
SOURC TONS. !/' O
Re-roofs
SignaffirctTAppficandContraMr T DamO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will fe appll=vt.fuum building occupant stem nrlundm haallom material
As Cleaned by the Cupertino Municipal Codc.Chapter 9.11.and the Health and Safety
Section 15532(a)7All roofs shall be inspected prior to any roofing material being installed.
I ❑Yue No
Will the applicant or future building amopsm use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit baaNnm sir conuminma a dcaned by No Buy Area Air Qwlily Management all new materials for inspection. .
Dimi=1
❑Y= Nu
I hawread Nehas clusmamdalsmquimmenuunder Cbapmrd.95oftieCaliror-
nuHeats&SdcyCodc,Secfom2Sian
5,25533d25534.1underued th
tatlDhe Wilding
does Out c Mw A moat. ts my rapousthiliy a notify the occupant of tie
require met pn ar,cmfraatgyr Demyn�. Signature of Applicant Date
owner ar mthnr'vad agent T" DO,m All roof coverings to be Class'B"or better