06030103 CITY-OFCUPERTINO ��F`+,�att.�.«� >v' a7 ^ '+
BUILDING DIVISION PERMIT CUNTR`�iC�'�OR�TIVF'(1TtMAT1--ON `
BUILDING ADDRESS: SUMMIT# REMODELING PERMITNO.06030103
10560 S FOOTHILL
NER'S NAME: PERMIT ISSUE DATE
PETER & SHIRLEY MATSUMOTO 381 E MCGLINCEY-LN 04/05/2006
ONE: SANITARY NO. CONTROL NO.
(408) 377-5252
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=
3oj LICENSED CONTRACIDR'S DECLARATION Job Description
4 1 hemby affirm that 1 am licensed under provisions of Chapter 9(commencing - P
with Section 7010)of Division 3 of the B".and Profeatlons Code,and my license is
I.fall force oad elfact. 61'Jf REPLACE EXISTING SUNROOM WITH CONVENTIONAL FRAM
jj51
0 Deuu��" 6&sesicommene' u REPLACE EXISTING SLIDER-ELECTRICAL OUTLETS
ARCHITECTS DECLARATION
1 understand my plans shall M used u public me.,&
k u, Licensed PnlfaeelaNl
50 OWNER-BUILDER DECLARATION
tinny I hereby affirm that I am exempt from Ne Conbaclals License Law for tie
i a O fallowing reason.(Section 7101.5.Business and Prafesdom Cade:My city or county
$Pi which mquiras a Numb to convert,alter,improve,demolish.or repair any struclurs
z� prior In is issuance,also acquires the applicant for such Permit m file signed statemcn,
F< dw he Is licensed Pa.an,WMe pmwal°ro°f the Crimnmra stoma U.(Chapter 9 Sq.Ft.Floor Area ' Valu il&000
6g (commencing with Section 7000)of Division 3 of the Business and Pmkasiom Cade)or
a that he is exempt Nemfrom and the basis for W alleged exemption.My violation of
Section 7031.5 by airy applicant for a permit mbjecu the applicant as a civil penalty of APN Numberr.• Occupancy Type
..I more than five huodeddollars(M), 35705018 . 00 K7 MR❑I,u 0wncr of the property,or my employ=with wages as their sok compensation.
will datitework.and the swwweuneuunde4 crofferedLawdef°rukpply In
marnrcu ;fes a •l 0
Nd property
who
ldsor The COnVK1ra, ndmia IJW d=otic apply if rt OW gh is IJ` r`tft
ampenywhos.provided that suhimprandwho dcosmehwwk himulforthrough Ms i UII L:i\\If
0wnaser,M=,provldedprvemimpmsemenuan,
ove,ear ofcaraRerWfw soma-
bowerr,illcbuilding ofimPmwmm,gthat withinarc year or mprowfar the purpose
of
builder Will have the Written of proving Nu he did ml Wild or improve rw pugoxe of _
tele.).
❑1.as owrcr of the property sin exclusively conausing with licensed wnuanom at
convect the pmjew(Sec.70",Business and Professions Code:)The Conuumla Li-
come Law d=not apply W an owner of propertywho Wilda or improves Nemon,and,
who contracts far NKb pmjeeU with aconaactor(s)licensed pwaMY11M m the CwnrawOr•s
License Law.
❑1 am exempt under Sec. .B At P C for this mason
Date
WORKERS COMPENSATION DECLARATION
I Mmby&Risco under penalty of perjury arc of tite following declaudons: -
I have and will maintain a CeNOcateof Comemmulf-Insum for WodulsCompen-
sation,as provided for by Section 3700 of the labor Cade,for the Panama=of the
work for which this permit is issued.
❑1 haw sed will maintain Wa i Compensation Insurance,an inquired by Section
3700 of the labor Code.for the performanm of the work for which this Permit Is issued.
My Warfel Comp"'M an lnstmme artier sed Polity nu her
Cartier, fid. Policy Na.: �U
CERTIFICATE Op EMPfION FROM WORKERS
COMPENSATION INSURANCE
(This section need nwbsecompleted if de Permit israrona hundred dollars($100)
or ksL)
1 certify that In the performance of Ne wade for which this permit is issued,I Pull not
employ any person in my manner an u in became subject in the Worker Compensadm
Laws of Caltim six.Data
Appllunt
NOTICE TO APPLICANT:If,after making this Certifcam of Exemption,you should
became Subject as the Worker's Compensation provisions of the Later Code.you muse
.,O foMWith comply with such provisions or Must Permit Mailbo dero
emed oked.
0CONSTRUCTION LENDING AGENCY
p. 1 hereby.corm sent them is a eoruuuctinn lending agency for the perrarmaos,of
a ti the wash for which thin permit is issued(Ser.3097,Civ.C.)
�W Q Lender's Name ,
7 Z Pander's Add.
U0 i certify that I have rad this application and sum thin the above information is
mnCCL l agree to comply with all city and county ordinmces and sou lave mlaiinp m
p SU^ Wilding construction,and hereby authorim,mpmsenmlws of this city to enter upon the
W
show-
meminnsd properly for Inspection PuryauL
LL (We)again W save,indemnify sed kap harmless the City of Capetian against
0 IlabllWa,judgmenes.toss and expenses which may in sty my actions again,said City
U Z In consegmnce of the granting of this permit.
APPLIC UND TANGS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
souaq GU IO /_ _ r` Re-roofs
Sig//m��rtafApplicHAZARDOUSMATERIALSDISCLOSURE ntractosOU Date Type of Roof
Will the applicant or future Wilding occupant stem or handle wamous material
as dented by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safely
Wc.Secdon 15533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yin 6if No
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Omit haurdnus air contaminants as defined by the Bay Ara Air Quality Management all new materials for inspection.
District?
❑Yes ON.
I haw read the hvardwu mandusraqumununs uubr Chapur6.95 of the Califor-
nsykaluhSaf a&.SccUm2M.25533.dZ5534.lundcrssMftifft Wilding
d=not cu haw a tenon u It u my mapomMility m ratify the occupant of the
coq°Immo mint Mp'wmi arm°racaniBcamarcu Signature of Applicant Date
Owner or sutharivode em Dom All roof coverings to be Class"$"Or better