05070170 CITY OF CUPERTINO r. � . .d , te.>Rtt'3�^
BUILDING DIVISION PERMIT CONTRACTORINFO tMATI;QN
BUILDING ADDRESS: SASO LANDSCAPE PERMIT"005070170
10700 HTT,T,rRRqT RD
OWNER'S NAME: PERMIT ISSUS DATE
GLENN & LINDA WEGNER 520 SYLVAN 05
E: SANITARY NO. CONTROL NO.
(408) 218-4757
ARCHPIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
<Z I hereby effltm that 1 am licensed under previsions of Chapter 9(commencing Job Description
with Section 7")of DivWOn 3 of the Business and Promutuns Code,and my license is
^� Wfullfercoande0ett REPLACE EXISTING DECK WITH ALAN
�z Ow Los—
Date
Corer BLOCK STEPS & RETAINING WALL
ARCHITECTS DECLARATION
1 understand my plain aM1ell M1c used As public recartls
7
LICCwd Pm(CILOMI
.1
OWNER-BUILDER DECLARATION
+� I hereby.(Sinn thin 1 1. exempt from the Cantruteo License law for NC
followi p O
which
reaaoa emotio 71131.5, .1mra and improve,
dem li Cade:Any oily or manly
$ which rtyuUu•remotion comiumis the
aha,impmw,h Permit n t-e a ss any st uni
that hemium
Fiber iLL ieuenM,also e,of the dM aision of the
Permit net gaw Chapter t
<
that he ullcowdpuesuastNtite of Division
of the Ganoacbhlxewlaw(Clods A, I. ea Valu Ib8000
,sF$ (mmmcndngwiN3ecUon70ndth Diviston3 of thea ed Axe andon.My viCok)IX
3..
that he B aempl Nertfmm and the hu4 for the alleged exemption.My violation of
Secdon 7031.5 by any applicant fora permit aubjecu the applicmn to a civil peMlry,of MAY3,t aIrtrnbeT
noQCCU t more Nan Ow hundred dollars(5500} 3�l�I 7 07 . 0 0 panC
y Type
❑1,uowneroftiapmpmy,amycmploym:rwedngesuNob rete cmnpewi
willdo Nedims ndtheiwOmAm Mtiwnded IXoRertd(°soak(Sec.7pI n �r ®�p� _ Required Inspections
sod erty who
ons Code:Tho ConMmon,Llnew Law does ret apply N an net o L 1p��� Q p
property who builds m improves thereon,and who doeuuch work himself ar Nmugh h
awn employees,provided that such impmwmenu are not intended or o0ered(oraak.I.
however.the building or improvement LL sold wiWin one year orcomple the owner.
builder will have the human of proving Nat he did not build IX improve for purpose of
tied.).
❑1,As owner of the property,am euluaively contracting with licensed comrumrs to
conal the project(Sec.7014,Business and Prefesdnns Cade)The CMtncter's U.
cow law does not apply man awner of property,who builds u improve Norton,and
who contracts fm au h pokes Nth a convetor(s)licensed pumoam to the Canmctoh
License Lew.
❑tom eat t uSee �� / ,B&PT" am on
Owner i _I YV r i I Dau Ij
WORKERS COMPENSATION DECLARATION
I hereby alRrm under Penury of perjury one of the following declarations:
have and will maintain eCeNOwIa of Cement Io uIRIMums for WorkersCempen-
'dan,u provided for by Section 3700 of Ne IahIX Cade.for the perform.of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Comparet Wurance,As required by Sermon
37M of the labor Code,for the performance of the wart for which this permit le issued.
My Worker's Compensation Iwrance carrier and Policy number tie:
Canter. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aectlen need net bs complmed lithe permi Isformc hundred dollars(SIM)
or loss)
I anify that in the pciferni of Ne wart for which this Permtt is issued,l ahall On
employanypersonin r m u m hecwtvalectenNCwmaen'Corni Out
Laws of Ctllfomia.Da
Application—
NOTICE
ppliumNOTICE TO APPLICANT:If.after making this ComRes ofE P"
become aubjm he the Worker's Compensation provisions of the Labor Cod-,you most
.J O forthwith comply with such previsions or this permit Nall be doomed meted.
z► CONSTRUCTION LENDING AGENCY
[-t IhembyaRnm Nae Nerc iso construction kindingagency for the performance of
ai F the work fur which this permit is issued(Sec.300.Civ.C.)
W� lenders Name
z Lenders Address
fJ Q 1 comfy Nm 1 haw food this application and sum Nm lite above informawn is
comm I agree m comply with all city and county ordinm s s W sm a Ian relating in
O rV' building construction,and hereby auhi representatives of this city in envie upon Ne
127 above-menwned property for Inspection purposes
gL (We)Agree to taw,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgmcnLL,costs and expenses which may in my way seems,against mid City
()Z in cowqucnco of Ne granlint of this Permit.
APPLICANT UN}}}}}}111111ER������llllllaafaaf��SkkkNDS AND WILL OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU � � %d?
Re-roofs lir+
Signature of Ap icanUCommlor DaD-
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant IX future building occupant swe or handle btuardous materiat
M dellned by the Cupenina Municipal Code,Chapter 9.12,and the Health and Safety
Code.3cewn 25532(e)7 - , All roofs shall be inspected prior to any roofing material being installed.
❑Yea ON.
PWill the applicant or future building aecupant use equlpmrnt or device which If a roof is installed without first obtaining an inspection,I agree to remove
vAndow air conumimm;u de0ncd by the Bay Area Air Quality Management all new materials for inspection.
m lct7
❑Yes ON.
I have mad the huimau matedala requiremcros under Chapter 6,95 ofthe Califor. _
nu HealdASAINyCode,Savour 25505,25533 and 25534.1 understood this ifdc bOWing
does not cunemly hew a east.Oat it is my responsibility m notify the occupant of
requifomcnu wit met?'or utiuu �(a CctuMau of Qcupm Signature of Applicant Date
P f'
owner or AalhoNadagent PEW All roof coverings to be Class"B"or better