08020116 CITY OF CUPERTINO '+M a a ,r teat .* *"° '� �`
BUILDING DIVISION PERMITCOI�iTRA.GTOR`INkFUI2MATI0
PERMIT NO.
BulT�lc/rjsOR HALE PL THD @ HOME SERVICES 08020116 -
NEWS NAME: FERMITISUEDATE
MYER JOHN W AND CATARINA T 3200 COBB GALLERIA PKWY STE 02/19/2008
1'HONE )nn SANITARY NO. CONTROL NO.
CHO'ECTIENGINEER: BUILDINGPERMITINFO
R&R 16•'WNDWS 2 BDRM BEING BLDG ELECT PLUMB - MECH
LICENSED CONTRACTOR'S DECLARATIONI brevity affirm Nat 1 are licensed under pmvisiow of Clupmr 9(commencing Job DBSCTIpt10n
^^^
tz wed Section 7MO)of Dbisiun 3 of the Budncas sed Profetium Cade.and my license is
n< in fall forte and effect • Z
z_ Lien'� Lm.0 Dam — Comwcm
2ARCHITECTS DEC A
2 1 understand my plans Nall he used a public records
DIE
M Licensed Prof..mnal
OWNER-BUILDER DECLARATION
ii g I hereby&Rm that I em wempt from Ibr Contractors License law for the
❑O following mason.(Section 703 1.5,Business and Professions Cade:Any city at county
$ which requires a permit m construct.alis.improve.demallm.Or tepohr any sauna.
zy prior to its issuance.also requires deapplicam formch permit to rile signed statement
that he islicensed pursuant to the Interlaken of lM Conmetre,License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commenting with Section]000)af DivbionJaf the Businem and P.Icssiow Cdee)ar
— Nat he is exempt memfrom and the bub for that alleged conniption.Any vlolNon of
Section 7031.5 by any applicant for a permit subjects the SPPHOOL On•civil penalty Of APN Number Occupancy Type
net more dun Res hundred dollars($500).
❑1,.owner of the property,ser my employees with wages asdark sole mmpewatian,
and Professions Required Inspections
uta Prorwh obu Code:The Contractors License Law don net appy lf rt auger Of
Property who builds or im Inovw thereon,and w ho dao ouch wmk himanl f ser thmugb his
awnnor.On w,pmgdeddotcuce at isowsnmuarenot intendedwolfertd fm Weer.
builder.,Ne building orden.wmant b sold within ane yeas of completion,the use of
builder will Mw tike burden of p.ving that he did Out build or improve for purpose of
sale.).
❑1.u Owner of the property am exclusively contracting with licensed mnuamn o
mwtnut f project(See.7044.Business and Prefessium Cade:)The Cooummr's U.
mase Law does out apply in an oma of property who builds Or imismwa durmn,and
who contracts for such pmjecta with acmuanm(s)licensed pursumt m the Congener's
License Law.
❑I antwempt under See .B d P C for dib mason
w Dam
WORKER'S COMPENSATION DECORATION
1 hereby alum under penalty of perjury one of the following declwiow: '
❑I have and will maintain a Ccrdfwuof Consent to air-WarmfurWorkar.Compm-
sation,.p.vidcd far by Sennen 37000f the Labor Code,far the performanceof Ne
work for which dus permit is Worst.
VI
and will maintain Workers Compensation Irmmance,as required by Semon '
00 of lht labor Code,for the perfommceof the work for which this permit is blued. '
My WO s Compeafion les unee nTu and Polley member see:
Grtier. er'Iww s WPoI1ry No.:y q /TO9
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
r1lossectim need net Ecccmpicmd if t e Permit Is fmonchundreL degas(SIM)
nr leu)
1 atdy thm in W puformenm Of the work for which Nis permit is blued,I Nall nm
employ any pnan in my manner an u an become subject to f Workrw'Compewdon
Laws of California.Date
Appllant
NOTICE TO APPLJCANT,If.after making this Cenincem of Exemption,you should
become subject o W Worker's Compm sedon pmvWom of the Lather Code,you most
.J Q Forthwith comply with such provisions or this Permit shall he Owned revoked.
rCONSTRUCTION LENDING AGENCY
y
[ti I hereby alarm chat them is a construction lending agency for de perrommm of
ls' .>. the work for which this Permit Is,blued(Sec.3097,Civ.C.)
aQ Lender's Name
z Lenders Address .
U O 1 citify that 1 nave read this application and sake use des show information b
Ig,^' comet.I agree.comply with all city and county ONlnance,end sum laws relating in
.015.7; building construction,and hereby authorise rtpmamudws of 04 city to coker upon ft
LtJ above-mentioned property for inspection purposes
L} G (We)agree to saw,indemnify and keep ha encs the City of Cupertino against
it Lid Iiabilldes,judgmenu,toms and expewcs which may in my way anew agams,said City
UZ in consequence of the Starting of this permit
AP (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date I 7
REGfu�� TION
,t x371n'ar r§);3�19l..gIq� I'C— Re-roofs
Signature of ApplirinUGmncwr Dad
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building necuPant core or handle havallow mmerial
u dellned by f Cupertino Municipal Code.Chapter 9.1x.and the Health and Safety
,secdanxss3x(.)7
❑Yw J All roofs shall be inspected prior to any roofing material being installed.
011.
Will the applicant or(future Wilding remspant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hevsrdow eirconumiexnu as defined by to Bay Area Air Quality Management all new materials for inspection.
Movie,?
0 YwPu
I haw mod the heathmu materials requhctnenm under Chapter 6.95 of ft califor.
nia HcalthkSafety Cade,Secdau25305,25533and25534.1mukmandthstifde building
i cumndy hew a enant that h u my responsibility m ratify meuaupent of the
nawhkh. comet triss.af.cerdreadafampaney. Signature of Applicant Date
am
Owner or mthariocOgen Dad
All roof coverings to be Class"B" or better
' '