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CONTRA.CTnRINFORMATIO,N "°:
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
HUTCHINGS CO. /HARMONEY SO
41L/n'ND-06120020
10201 HILLCREST RD
OWNER'S NAME:
PERMIT ISSUE DATE
LIPP STEVEN C
4754 DENEVI DR.
12/07/2006
E:
SANITARY NO. CONrROL NO.
(408)966-6676
ARCHITECrIENGINEER:
BUILDING PERMITINFO
BLDG ELER PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
I hmcby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70(10) of Division J of the Business and Professions Code, and my license u
In full tome and effect. ,.
SOLAR PANEL AND REROOF- TEAR OFF EXISTING INSTA
License class _ _ Cm.
Date Conmmar , r
_
30YR COMP SHINGLES, CLASS A, 9 SQUARES
ARC TfECI'S DECLARATION
1 understand my phos shall o used u public recor&
Licensed Professional
OWNER -BUILDER DECLARATION
I oreby Affirm that I am exempt from the Commacmea license Law for tW
following ,Cason. (Section 7031.5, Business and Psofeaium Code. Any city or county
which requires a permit to construct, alar, improse, demolish. Or repair any structure
,norms its kssuanre.alwrequirosme.powsns fmrmch penni0ofik.ssnoustaterecn,
Law (Chapwr9
Sq. FL Floor Area
Valuation
NuheisliccvcdpuruwntwthcprovismusofNcConlractor'sLitttue
(commeming with Salon 7000) of Division 3 of the Business and Professions Cod=) ser
$37000
Nat he is rump, Nmefro s and the basis for the alleged raceptiart. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjttv the applicant m a civil penalty of
nut mom than five hundred dollars ($5001
1, u owns mf the property, or my orvpl%ccs with wage ss the'v sok compensation,
326166.610.00
Required Inspections
will do me work, Bnd NCaWemR k mol Intended of offered for Yle (Sam. 7014, BuShMSa
and Professions Code: The Committees L iccom Law don no, apply a an Owner of
property who builds m ire proves Ne mon, and who does such work himself or through his
Own emplmyOra, provided that such improvements are no, i ei ndN w offmod!resale. If.
however, Ne Wilding Or impetworm, u mid wi ainone year o(cemplction, the owns.
Wilder will have the horden of proving that he did non Wild m improve for purpose of
Ask).
❑ 1. u miner of the proven}. am exclusivelyconuacsbg with ftamW emn0amoas a
conavuc, Ne PMjeCL (Sec. 7044, Business and Professions Code:) The Conuamri U.
-
cense law does not apply m an owner clinometry who Wilds or improves thereon. and
who contracts for such poseeu with a conummr(s) licensed pursuant m the Contractors
Lkeue law.
lamucrn"imner Sec .BBPCfmtlot...
or Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under porosity of perjury Ore of the following decimations:
,
I haw and will maintain a Certificate ofeonsem a ulf-imme fa Wmrkds Comm.
nation, u provided for by Seen.. 3700 of the labor Code, for the perft rnAtce of Ne
-
wede for which Nis permit is ismed.
❑ 1 have and will maintain WOrkzea Compensation Insurance, ss roquined by Section
37W ofthe labor Code, for the performance of the work for which Nu permit u issued.
'
My WorkeYs omp nsaon In ire. er and Policy number am:
Caricr. Policy NO./o i C 7 y7
' STIFICATE OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sees. need roto completed if the permit h for one hunthW dollars(SIOO)
or loss.)
1 cenify Nen in Ne performance Of the wart for which this Permit h issued. l shill trot
empl%any perm^ in any mmncrm as m become mbjen m Ne Wminco;' Compensation
Laws of California. Dam
Applicant
NC rICE TO APPLICANT: If. after making this Ceniftcate of Exemption, you should
become subject to to Werkces Compensation PROVISION of IW labor Code, you muss
forthwith comply with such provisimes or Nu permit shall W deemed mwkcd.
CONSTRUCTION
ION LENDING AGENCY
l or is. len ding agony fmrtW perfenna cu(
IAMHere issed(Sec.
which
the work for which Nis pemtit h issued (sec. J097, Civ. C.)
3
Name
-
LcMeYs Address
'
1 coolly Nat 1 have mad Nis application and sum tha the move information is
1 agree a comply with all city and county ordinances and sum laws clading to
building construction, and hemby awhmrian represcmadws of this city to enter upon the
abovemmtioned property for inspection purposes.
(We) agree to sane. lnd=mnnfy and keep harmless the City of Cupertino awns,
limilkka.judgmenm. costs and expenses which may In my way Mame against old City
in consequence of the granting of this permia
ANT UNDERSTANDS AND WILL CO PLY WITH ALL NON -POINT
Issued by: Date
OU REGULATIONS.
Re -roofs
Signatureof 11 canUCa or Dam
HAZARDOUS MAfMALS DISCLOSURE
Type of Roof
Will the appliant Or future Wilding Occupmtsmm m hamik, hazardous material
As &food by Ne Cumminm Municipal Cede. Chapter 9.12. and Io Health and Safety
mk. Section 255320)?
❑Yes ONO
All roofs shall be inspected prior to any roofing material being installed.
Will one applicant or future building occupant use equipment or dcvicea which
If a roof is installed without first obtaining an inspection, I agree to remove
omit hvaN^us air rontaminaou u defined by the Bay Area Alf Quality Managcmrn,
all new materials for inspection.
District
❑Ya ONO
1havemod NeoaM mawdahmquimmcnuunderCWpmr6.95ofIWCalifor-
nhHwlNhSafcty COM.Snvwx55D5.x5533v n534.lundcrsuod Ouifdc Wilding
J t curmn0y haw a tenant, Nat it h my ponsihility m notify ds= mcupenn of Nc
/� _ 7 _ a
qtf= ntawmmm Wmepdmr mutt rfacer,lreamorucapamy.
Signa, ofAppllc nt Date
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All roof coverings to be Class "B" or better
Owner ser odmd as=r ate