08070104 CITY OF CUPERTINOs
BUILDING DIVISION PERNIIT 1`;CO,NTRACT0I2KIm`'0RMATrON.i; .
BUIL 1 G R FSS: PERMITNO.
GLENCOE DR TBD - TO BE DETERMINED 08070104
NWS NAME: PERMIT ISSUE DATE
MR . & MRS. KESTERSON 08/05/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHf1ECTtENGINEEA: BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
°oo LICENSEDCONTRACIOR'SDECIARATION I JobDCSCiDescription
ZC 1 hereby lm Nu 1 are liansed under previsions of Chapter 9(commencing P
<t� wiNSecfia7 Baf DiN n 3 ofdm Business;and Profession,Code,and my licese u ADD OF FM RM/LNDRM(288SQ) 7 NO RE—RF & YES WILL HV
^oNRM
in full(ane aM etteaE •/ ��
pgz Lican L'e.N STRUCTRL. VALLEY HOME 'BUILDERS, INC. PD FOR BUS
Dam ConuacmrCC
ARCHI ECI-S DECLARATION LIC 7/15/8' $110 . 0 0
1 undersand my plan shall W used as public records
g Licensed Prufassknal
OWNER-BUILDER DECLARATION
'�<E I hereby alarm that I am exempt from the Contnctofs Lkcnm Law for the
00 following mason.(Section 70313,final.and Profeetiou Code:Any city or aunty
.9 Pi which require a Permit to cmnsoma alter,improve,demolish.on,repair any suuetum
-v< print to in issuance.also requires One apPlicmt forsuch Permit to rile a signed tammea'
chat he is licensed pursuant to me pmvisi.0 of ate Conuacar's Li¢nse Law(Chapter 9 Sq.Ft. Floor Area Valuation
x�$ (commencing with Section 70(0)of Division 3 of use Busircv and Prollad ns Codc)or 80000
that W u exempt therefrom and are hssu for the alleged eumption.Any violation of
Section 7031.5 by any applicants fora permit mbj=N the applemt In a civil Penalty of �,gY Number Occupancy Type
nm more that Bae herniated dallan(SM 32630017 .q P Y YP
I.u own.of du prepcny.m my mploycu wio wen u uvir rk compemuon,
will do da wok,and ckstrucare is nut kumded ar a flared farsak(Sec.RLN,Business
and Prof.don Code:The Canuacmfs Licmue Law doe ret apply m m at of Required Inspections
pr openy who builds or improves Hereon,and who dao such was himself or through his
awn employces,provided that such improvements art not intended araQered far salt,If,
however.the building crimpmvement is mid within an year of completion,the o amen,
Wildec will have tie burden of Proving that he did not build a improve for Purpose of
ssk.).
1,as Auer of den Property an exclusively contracting with licensed antrmcos to
construct the pmjeei(Sec.7044.Business and Professions Cade:)The Conuattri U.
cense Law docs not apply a an owner of prapeny who Wilds or impmw thereon.and
wWcontractsfor such projects with aeontrwou(s)licensed pursuant he the Conuacrnfa
Lice.Law.
lamuemmander See .Bk PCforthureason
Dau
40— WORKER'S COMPENSATION DECLARATION
1 hereby M.muter pewty of perjury one of do following dish rodear
(]1 hew and will main Wn a Certificate of Consent to self-Wan forWorkc's Compen-
sation,as providW for by Bruen 3700 of the Labm Code,for the perfarmana of the
wok for which His Permit is issued.
1 have add will maintain Wml aes Compeuatiun Ino rance,u required by Senior _
3700af the Vbar Code.for He perform.orate wok for whic4his permit is issuedMyw .
Carte hCom wuon lnsuruaoli
g(Lq�mmef�mcrya t PpTafe�O� ��
CEIMFICA EM MON FROM WORKERS
COMPENSATION INSURANCE
(Ddsscatidn need at W axtucud if the permit ts forest,hatband down(SIOD)
o kss)
1 artif-v Nat in the perforce.of He work Ire which His Permit is issued.I shall ON
employ any person in any matter as m became abject to de Worb:W Compenssuoo
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,sour making this Cenirica x or Exemption,you should
become abject to the Workers Comeamation provisions of the Lshor Cadet,you must
.J O forthwith comply with such provisions or this Permit shall W darmmed revoked.
z '-" CONSTRUCTION LENDINGAGENCY
Fred. IWreh arfum Hat them is a construction lending a
r g gcnry for HC performance of
Ci> the wurk for which this Permit I,issued(Sec.3077,Civ.C)
WA L endees Nara
W -
D,z Lenders Address
U O 1 mutifY Nat 1 have rtW chis application aM sera Hat the aWw iNormation u
I2. coma I agree he comply with all city and county onlineras and eau laws relating in
.O Wilding construction,ad hereby admtlrz rtprtsmnNves of this city maser upon me
propaWw-nunuonedms,ci for k..Rumn purposear which ms
4 (We)agree m save,indemnify sed kap hatless the City of Cupcnina against
Z Iiabllmensudgt.fdososardexpeuRovit. may in eny wayscerne agaiutsaid City
U 2 A PLICANT ND RSTA DS Nu permit.
^' APPLICANT UND RST DS AN Wy(,L COMPLY WITH ALL
NON-P
Issued by:
VS% 9 Date (F-ArIG a
Re-roofs
Sig.fid.e ApplMd)CoAuxc,, .w
rL�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the sppllont or future Wilding ouupant Am rehandle bauNoa material
ss defined by the Cupenhm Municipal Code.Chapter 9.12,am He Health and Safety
Scctkn sss32(a)?
❑Yeo /f\-�`����Ja No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant.,fee..Wilding occupant trm equipment sur devices which If a roof is installed without first obtaining an inspection,I agree to remove
Lmlc haurdna ai,conumimnu as de0ned by du Bay Ana Air Quality Mast cram all new materials,for inspection.
Dismat9 yyyy```` P
❑Yu r No
1 have read the handout materials requimmermader ChmW6.95 ofthe Califor.
nia Neel"Safety Cade,sections,25505.25533 and 25534.1 undersand that if bee Wilding
does not currently ha L that ire u Y mspouiNli m mdrY du aecup em of time
Man
ts hhJ� st ter/,my� ar,Caedreaenra /ry Signature of Applicant Date
�" All roof coverings to be Class Ow or autharvsd agent Z Dau g or better /l
- — n