03070186 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTnR INFORMATIM
UDn.DINGADDRESS: NICE & RIGHT CONSTRUCTION fUlIT"°03070186
AMDPN("ATE DR,
_nGR'S NAME: PERMIT ISSUE DATE
PHONE: SANITARY NO. CONTROL NO.
(415) 239-2696
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION '
LmF 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing .Job Description
SZ�y with Scctloo7(0))1f Dlrlelon3ofmcnu'n sand Pr sxinns CoJc.antl my license is
Zi in in full forted fee,. 5j
�?
License cras�_�_C.�:q� 2� 45� NEW 2 STORY SINGLE FAMILY DWELLING
^ Dm ARCHITECTnS:OEOLARATION LIVING SPACE 4046 SQ. FT. /GARAGE 691 SQ. FT.
�v I understand my plana shall be used as puhlie records
Zyv
T u0 Licensed Pntfcesionvl
3 Oat Ia.(UILDER DECLARATION
.'�0 0 1 booby.('firm that I am exempt from the fissions o License Law co the
a O followwhich
mason. Permit t RA1.5.Business and tie.demolish.
Chile:Any coy or county
K$ which its i sat a Permit m cunsl he eller.improve,dcanch ermit t fi repair any structure
yai patlitr toimiensedpalwmquims theapplicantroc Contrarmiuoiense Law(Chapter
'AssN
In (commecingwiit pursuant lalhc of Division 3 Oc oftheBrictur and Preclaw(C Code)
Sq. Ft. Floor Area ud�ylPjl 000
-
x�� memmene sem with Section700D)and of Division r the
the alleged
cas exempt on.Any
Cabo)or v—'
i�$ (hat he is exempt therefrom and Ne breis for the ellcgcJ excmpdon.Any violation of
Section]071.5 by any appli,eantfor a permit subjects the applicant or a civil Penally of APN Number Occupancy Type
not more loan five hundred dollars(SSW).
P Y YP
0 L as owner of the property,or my employem with wages as met sale eampo^ution. 32630036 . 00
will do the work and he swcture is not intended or offend for sale(Sec.70,1,1,Business
and Professions Cade:The Conuxctori License Law does not apply to an owner of Required Inspections
pre,mr, itimas(hcrcon.andwho dxssuch work himself orthrosid his
own c however.
the building or i that such improvements arc nal ear o c.tumefied fireside If.
however,me building or improvement is sold within one year of completion.the camer.
of
builder will Dave the burden of proving mal he did not build or imprors for purpose of
sakJ.
❑has owner of the property.am eselusively convecting with licensed contractors to
construct the pmjcct(Sec.90aa.Business and Professions Code)no Contractors LL /
come law docs not apply to an owner of property who builds or improves hemon,and
who contracts for such projects with a contractor(s)licensed pursuant to me Contractor's
License Law.
❑1 sm exempt under Sec. ,B A,P C for his reason O�
..r Data _
WORKERS COMPENSATION DECLARATION
I hereby alfimt under penally of perjury,ane of the following declarations:
I have and will maintain a Certificate of Corona to self-imam for Worker's Compere
sation,as provided for by Section 37W of the Labor ewe,for the performance or the
work for which this permit isolated.
❑1 have and will maintain Wonon's Compensation Insurance,as required by Section
37W of the labor Code,for doe performance of One work for which this permit is issued.
My Workers Compensation lnsuranec carrier fid Polity numMr am:
Cartier. (icy
No.:_001cyl t ��V
CERTWICATEOF X IppON FROM WORKERS'
COMPENSATI NSURANCE
Oltiaseetitm need not be complemd if tic permit is(m one hundred dollars($100)
or less.)
1 cem(y Nat in the performance of the work for which this permit is imucd.1 shall not
employ anyperm any manner sn n to benrk
come subjeco the Wocrs Compensation
Laws of California!Date
Applicant
NOTICE TD APPLICANT:IL after making this Ocri ficale of Exemption,you should
become subject to the Wooer's Compensation provisions of the labor Code,you most
O Z fordwim comply with such provisions or this permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-+ I heathy affirm that there is a construction lending agency ler the performance of
(Y. 7 the work for which this permit is issued(Sec.3097.Civ.C.)
CV lender's Name
= Z Under'a Add.
U O 1 certify Nal 1 have read this application and sum mat the above information is
ly F-' commit.1.,me to comply with all city and county ordinances and sum laws relating to
V building construction,and hereby amhmim representatives of this City to enter upon the
r U above-mentioned properly for inspection purposes.
(~ 0. (We)agree to taus,indemnify and keep harmless the City of Cup against
D,, liabilidm,judgmcnts,costs and cspct�swhich maY in any way accrue against said City
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCED ATIONS. y
(( N J Re-roofs
t aznice ppticant/Conulol r D m
HAZARDOUS M ALS DISSURE Type of Roof
Will me applicant or forum building occupant Box or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
m.Scatien 25532(a)?
❑Yat 19 No All roofs shall be inspected prior to any roofing material being Installed.
Will thea applicant or future building t use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
pp gby then a Air
..it
hazardous air contaminants m JcOncJ by me Bay Arca Air Quality Management all new materials for inspection.
Digrict?
❑Yes IN No
` IhaveroWmehazamous materials requimmcnts under Chapter 6.95 of the Cal(m,
nia HcalN K Safety Code.$eettam 25505.25533 and2553 .1 undersand Nat if do Foilding
does not tomendy haw a tenant.main is my responsibility to notify the m:cuPam orthe
require cot 'ammust x etpnannfssu ee racemfiaamorOccapancyy. Signature of Applicant Date
—� All roof coverings to be Class"B" or better
wuro
cr t orizcd agent etc