04010087CI TY OF CUPERTINO
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BUILDING DIVISIOryPERMIT
CONTRAC`TOR;INFORMATION y(`I
BGILDENG ADDRESS:
SARATOGA CONSTRUCTION
PERMITND04-010087
1
ER'S NAME:
PERMIT ISSUE DATE
JILL CHENSARATor
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SANITARY NO. CONTROL N0.
(408)996-1711
ARCHITECTMNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
lb Description
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t 1 am lice ed under previsions of Chapter 9 (commencing
I hereby affirm Nau
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3 with Section7OM) of Division 3 of We BoinaSNnd1immsomos Cole.andmylicenseu
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in full 'f�ee�a l e ter.
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uan u Lie.., 4 D <
NEW 2-STORY SINGLE FAMILY DWELLING
'Duce Co.&.,.,
LIVING SPACE 5207 SQ. FT. /GARAGE 1093 SQ. FT.
y ARCHDECCS DECL ION
I sMEB&d my Pians shall be uses a u I' rcenNs
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- Licensed Pmfcuional
BUILDER DECLARATION
Sdon
NAZ
I a. Conwcmrs License Law for We
g 1 .(Sere n I am cumpl from d
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following moon. (Sidon ](BLS, Business and Professions Code: Any city Or county
mason. o
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which requires a permit to construct. alter, improve, demolish, or repair any structure
^ prior In its issuance. also m,uimes the applicant for such Permit o rile a signed statement
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Sq. Ft. Floor Area
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Nat he is licensed pursuant to the provisloms of We Contmcmri Ummare law(Chapur9
3 (commencing with Section 7")of Division 3 of the Business and Professions Code)in
000
- that he is simmer Nemfrom and dm buds for We allegro eumpdon. Any violation of
APN Numberok%cupancy
Type
Section 7031.5 by any applicant for a Permit subjects Ne applicant to a civil Penalty of
not mom than five hundred dollars (5500).
32628060.00
y"twat
Weir sole compensation,
❑ 1, as owner of the pmpmX or my employees with wages u n
-
Required Ins ections% .t dy
e 9 P
willdoNework, and the structure is notimmnded urorzered fourdc(Sec. 1044, Business
law door
and Psofeesioru Cods: The Conuactues License not apply m an owner or
property who buil& orimproves Overrun, and whodporguch work himself orthrough his
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Own employees, provided that such improvements are not iecandm Oroffsrel for We If.
howenq Ne building or impmnmcnr is sold within one year of mmplmion. the owner
builder will have the burden of proving that he did not build or improve for purpose of
a1cJ.
❑ 1, as owner of the property, am nmLma sly contracting with licensed contractors to
construct the pmjca (See. 7W, Business and limitations Cmc:) The COnerYbrs U.
Otiose Law does not apply to an Owner of property who ILII& or improves Wermnn. ad
who contracts for such projects with a contrumr(s) liamed poisoner to Ne Contractor's
'ecus Law.
am tempt under Sec. . B & P C for Nis rouon
Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following drelarsriou:
I have and will maintain a CeniOeare Of Consent m self-insure for Worker's COmrem
.tion, u provided for by Section 37W Of the labor Cadc, for the perfomuna of the
work for which this permit is issued.
❑ 1 have and will maintain Workcrs Compensation Insurance, s s required by Section
311 ofthe labor Codc,for Ne performanccof Ne work forwhich his permilis issued.
'
My Work erI Coq.peu Insauntrcc artier and Policy numbs are:
CPolicyliul�'�'t"nLi\fii�
CERTIFICATE OF 11MPf(QQN FROM WORKERS'
COMPENSATION I175URANCE
(This section eecd not be complctcd if tbe pcmth is fiwens hundrtLdollars (SIM)
or Mss.)
1 certify that in the performance of the work for which this Permit is issued, I shall not
employ any Person in any manner so as in become subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Cenincate of Exemption, you should
become subject In We Worker's Compensation Pmvigions Of the Labor Cose, you must
foMwlth comply with such provisions or this Permit shall be deemed mvoked.
5
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat there is a construction lending agency for Ne performance of
We work rot which flu permit is issued (Sec. 309]. Civ. C.)
undcrs Name
r
Lenders Address
I certify that 1 have read this application and Some that Ne about informnion is
correct. I agree to comply with all city and county ordinances and sure laws mitring to
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jbuilding construction. and hereby auNorim representatives of this city to enter upon Ne
shave-mentioned property for inspection purpnsea
y(We) agme to an. indemnify and keep harmless dre City of Cimarron against
q liabilities, jidgmrnts.eor. and ease. which may in any way aectuc agaiut said City
in consequ
his
the Sooner, oftAND
Z
LV.
APP CANTeUNDERSTANDSof
WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SO RRC,E.REGULATIONS,
Re-roofs
Type of Roof
�p
Ignnuur�`ofZi ,Ic VConutay6O� �� pate�'y
RO0, MATERIALg DISZCrCsunE
AhWill the applu:am ter fulum building occupant store or handle Worrdous material
Reed by Nc Cupertino Municipal Code, Chapter 9.11, and Ne Health and Safety
Alwc. S❑T., 35532(101
All roofs shall be inspected prior to any roofing material being Installed.
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If a roof is installed without first obtaining an inspection, I agree to remove
IWill the applicant of future building occupant use equipment or daises which
t: arallous air contaminants as derined by We Bay Area Air Quality Management
all new materials for inspection.
District?
QYcs In<
I have read the hvardnus materials requirements under Chapter 6.95 of the Califor
nit!Health & SdctyCme. Sadists 25505,25533 and 25534.1 umkrsum that if Ile building
docs Out currently ban a tenant that it is my msp ramility W wtify rte a<upam of the
m ma ems which must t prior u issuance of a C 'fleale of OccuPamry.
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Signature of Applicant Date
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All roof coverings to be Class "B" or better
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