08050241 CITY OFCUPERTINO ; '' 2 4N"'. ""�x4��'r *
BUILDING DIVISION PE12AUT R�ColvUt1CTC3 OR, TIO•• N.
PERMIT N0.
BUILOIWiCysA198ARDEN GATE DR TBD - TO BE DETERMINED 08050241
aaaadOWNER'S 2NSAlMEE: lhi PERMIT ISSUE DATE
DAISY LO 07/02/2008
ryE; SANITARY NO. CONTROL NO.
ARCHITECVENGINEM: _ BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION Job Description
4 U I laveby affirm that 1 w Releasedunder pmviSM115 of al ler 9(mmme«Ing
with Seen=7")ofDoison 3 ofthe Bushmen and Professions Code.and my llcemeeis DEMO SFDW W/ATTCHD GARAGE
n�H inf ilfome aM cIT ^,o
j gt Z Lived DI Lk.e
Lic.stracter
AKUH1'ECTSDECLAIEATION Ir
ee 1 understand my plans shall W need as public records
Jy
y Wt; Licensed Professional
OWNER-BUILDER DECLARATION
' Z I bcmhy a?rte Net I am exempt from the Contractor's Licence Law for the
D O rolmwing moon.(S«ton 703 1.5,Business and Pmfleasm.Code:Any city or runty
$ which requires a permit m cmnsrraeL a1w..Improve,demmuh.«slant any avuctum
I p, prior W its fuuanv,also astruires the applicant for coach permit to Rk a signed summer
pEss<
that he a licensed pumant10Onprovisions ofOcanuacwr'sLicenmLaw allhv9 Sq.Ft. Floor Area 8000 Valuation
y+Fs (commencing with Section 7000)of Division 3nf the Beat.and Pmfessimns Code)w
Q�_ than be,is exempt thdefmm and the buss for the alleged essmption.My violation of
Section 7031.5 by any appllantfor a permit subjects the applicant m•civil pnedly ofNumber Occupancy
not mart tun rive Watched dollars(S500y 32630046 .E P Y Type
I,u wrkr of the pmpmy.c my vmploym with wagv a Mev role compemdan,
and dothcware,and the The
Ianw Llkndes Lawdostreak(Sec.70M,Buirm
arta Profession Cade The Conuercon.Liven law tau rot appy lf an roon.h of Required Inspections
ownenywhabuilda idedtavutharcnn,aMwho a«ssuchwwkhinuelfor through his '
awnemployees,provided that such ins is mid within
timor ofe«anded fw.we0.
border.the building«dem of ismidwithinarcWildofimroveiforthe ownd-
builder will Nw the burden of proving that he dna not Wild w improve for purpose of
ukJ.
1,u owner of the PropenY•w exclusively concerting with licensed conferrer to
consmM the Prescott(See.70&4,Bmsiness and Proksed.Cade:)The Conuss3nr's U. .
due law dons not apply m an owner of property who builds or improvu Merton,and
who emurnets for such projects with a eemtacmr(s)licensed pursuant to the Contractor's
Licenm law.
❑Iameaempmmien See .B@PCrmthis.
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby alfrm order pertly a perjury o«of the fallowing declanations: ,• .
I have and will maintain•Cenifinm ofarm.,to serf-Wum for Worke'sColoNo.
nation,as provided for by S«tion 37M of the Labor Code,for the perfarn.of On
work for which this permit is issued.
❑1 have and will maimain Worker's Compemanion Inmranv,u required by Section
3700 of Oc labor Code.for the performance of the work for which Nu permit u issw4. '
My Wcr aC peeution Lowrance arriv and Poli numWr
Grtie ry No.:
C FICATE OF ON FROM 0 ERS•
COMPENSA INSURAN
This modem send rot be cornplekJ if to permit is furume,hundred dollars(3100)
or lees)
I certify that in the Palo nes«e of On wort faagg which this ldmit u uoec0.I a1W I nor
employ airy peraan in say men«r eeubbasi�f Cromthe WOrkm'Compvuato0
Laws of Califamis Dam 7Il wV
Appllcant L
NOTICE TO APPLICANM if.after maki g this Cemfinm of Essmpton,you thould
become subject or the Worker's Compcuetion provisions of On Ulan,Cade.you sou
.J z forthwith comply with such pmvisou or this permit ahall Ise themed remkcd.
z y CONSTRUCTION LENDING AGENCY
[—i l herby affirm dead thele is.conmuctimh knaing apney for the performanv of
6i the work for which this permit is idmd(Sec.3(Y97,Civ.C.)
Q lender's Namc
D z LendeelAadmu
U Q I comfy than I have rand this application W sou this the above information is ,
U. ^ cornett I agry to comply with all 61,and county ordinances and seek lam relating to
.0 building construction.and hereby amnrice mpremnmatises of this city to cmerupon tic
r shave-muudgm property for topaNan purpoRwhich ms
f+gym (We)agree m save,indemnify and keep harmless the City of Cupertino against
ti T/1 inconsequence emu.costs and ox tenspe which roily in any way avry against said City / r
U z A PLIC consequence of UNDERSTANDS
ing of this per mit. Issued by: Date ! - z'- r
► APPLICANT UNDERSTANDS AND WILL COMPLY WRH LL ON-POINT
SOURCE REGULATE
Re-roofs tj7a Y
Signdure of ApplianVCan rof Dam
HAZARDOUS ATERIALS DISCLOSU Type of Roof
Wllldkapplivntwfutum Ildngo«upantsa Or Wndkhwa oumakrial
u dNned by the Cupertino Municipal Codc.Chapter 9.12•and the Health and Safety
Code.Section
uzss3z(a)7 Co / All roofs shall be inspected prior to any roofing material being installed.
win robe a Leant art rwwre bwilam «a.rot one If a roof is installed without first obtainingan inspection,I agree to remove
nn e p W uipment or device which Pe
it huardnm air con amirund u flood by the Bay Arta Air Quality Management all new materials for inspection.
Diwicti
0s. No
I marc mad the hvardaur nutriais rtquimmew undo Chager G93 of the Glifw-
do s oe,comend yCade,Seth n.09 its,my re M 2553x.1 undmund a Occup building
tau rot curmntY h t a mnana Nan it u my reapmmihility b mortify the«cupent of tier
mquimmcnu MEon=1pnonolvoanceOra comficato r. Signature of Applicant Date
/ x. lig
Owner ormitori ed agent j I Dat All roof coverings to be Class'7T'or better