06030136 CITY OF CUPERTINO + sR �` �'�'-" XU
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BUILDING DIVISION PERMIT 1N .RACTfQft, T,,NT.'. ATI(J�1 „'.-.,
�. .S s•
BUILDING ADDRESS: PERMIT NO.
U b030136
20990 HOMESTEAD RD
R'S NAME: _ PBR•MTISSUEDATE
HOMESTEAD FFC INC 03/28/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGO O PLUMB
MECHO
66 LICENSED CONfRACIOWSDECLARATION JobDescription
ht 1 hereby air,.Nde
at 1 Am licensed unr providons of CWpxr 9(rommcacinj
.thSecnon70M)ofl)iddon3ofdxemin uwprof Code un+e NEW DRAIN LINES-REPLACE WITH NEW ABS' PIPE
in full forte and eOecL 7
.a c
��i License r�...�^Uc.g yr RAY S JONES CONSTRUCTION INC-PD BL 3/22/06 ONLI
ARCHITECPS DECLARATIO
U I uMcrstonJ my plain ahall W used as public records
58t;
GIn Licensed Professional
OWNER-BUILDER DECLARATION
<i I hereby ofOrm
that I am exempt from the Contractor's License Lew for the
O O fallowing remon.(Sutiun 7071.5,Business and Profession Code:Any city or county
which requires a Permit to construct,alter.improve.demolish,or repair my structure
v`, prior x its issuance,also inquires the applicant for such permit to file a signed statement
�< Nat he is licensed pursuant to the previsions of the Contractors license Law(Chapter 9 Sq.Ft.Floor Area
Valu
zC$ (commencing with Section 7000)of Division 3 of the Business and Profusion,Cade)at
3—
that he Is exempt therefrom and the basis fm Ne alleged cumpdon.My violation of
Section 7031.5 by any applicant for a permlt subjects the applicmno a civil penalty of
ot moe Nm Ova hundred dollars($500A 3 0 0 _Occupancy Type
❑1,As owner of the property,or my employees with wages u their sale compeneadon,
will do the work,And Ne auucmre Is not intended or offered for sale(Sm.7W,Business
and Professions Code:The CnnumN�'s Liana,law does not apply N an owner of •p`g�t`,f.`.' k. sP�g1C O(yr.,$�
properly who Wilds or Imports Nermn,aMwhadassahwork himsalforNrough Ma l'�'l � ( nsna
own employees,provided that such improvements see notinmtWed oraffued forsalelf, lFll p�'tQ Y7ev
however,Ne building u improwment is cold within am year of completion,the owner-
Loo
builder will have the burden of proving that he did not Wild or improve for purpose of
ole.). 4,.12-
❑L,as owner of the property,am exclusively contracting with licensed ensed conueM 2� �LSJb
mumct the prejem(Sec.704A,Business and Profmslons Code)The Contramm•s U.
cense Law does ant apply to an awaer of property wbo Wilds or Improves thereon,and. fpf of ,k ee�w
1.4".tracts for etch mokcteNNacontramar(q flamed punmm es use Contractor's `,I p ry
who co Law. wl' It'd-
❑I am exempt under See .B a PS�C for W.^reJams
r `�/�'�. (f<D%e Dated a .
WORKERS COMPENSATION DECLARATION
1 hereby afnmt under pemlty of perjuryinn of Ne following declaruiam:
❑1 have and will maintain a Ceninute of Consent leself-insure forwokee c.pen-
union,As provided for by Section 3700 of one Labor Cade,fm the performance of the
work for which this Permit is Wood.
O 1 haw and will maintain Worker's Compensation Insurance,u required by Schon
37M of the labor Code,far On,perfotmanen of Ne work far which this permit 4 moral.
My Worker's�CnmP1em—Nan Imusance,artier end Policy numWram:,1- 93
Carrier: 1"1 (fc,0J Policy No.: //76
CERTIFICATE OFFC' EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This motion send not W completed lithe permit 4 far.hundred dail.($1018
or less) ,
1 unify that in the performance of that work for which this permit 4 issued,l shall not
employ any person In my mannum as to become subject te the Workers'Compensation
Laws of ClI famla.Dam
Applicant
NOTICE TO APPLICANT:If.afmr making this Certificate of Exemption,you should
become subject N the Worker's Compensation provisions of the Labor Code,you most
.,O forthwith comply with such provisions or this permit shall W domed revoked.
Z CONSTRUCTION LENDING AGENCY
(-+ I Wmby affirm that Vert is a construction lending agency for rite performance of
the week for which this permit is issued(Sec.3097.Civ.C.)
aQ IsMce,None
r7 z LeMees Address
U Q I unify that 1 haw reed this application and rex that the above information is
D.(~ concis 1 Agra to comply with all city and county ordinances and state laws relating to
OU Wilding conmuction,and hereby euthorim reprosenmives of this city to enter upon the
W above-mentioned property for Inspection purPoxs.
(We)Agree N save,indemnify and kap harmless Ne City of Cupestim against
t`..ry liabilities,judgments.coin and expenses which may In my way aura agaimuud City
fJ7 In mr qLa rce of the Summit,of this KMIL
v7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINr Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
�J
Signature of AppliesData
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
WIII the applicant or Muni Municipal
Cg e.Chapter
ar handle Health
material
As denad by the Cupertino MuniclWl Cadc.ChaPbr 9.13,and the NeaIN and Safety
sacuea 2553:(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
Will the applicant or future building occupant use equipment or devices which If 8 roof is installed without first obtaining an inspection,I agree to remove
emit hnardous air contaminants As donned by lie Bay Amo Air Quality Management all new materials for inspection.
Disuict7
❑Yes No
I have mai the hmmdom materiels requirements underCWpmr 6.95 of the Califon
nla Health&Safety Cade,Section,35505,35533 and 35534.1 understood that ifW Wilding
does not currently haw a brant,that It 4 my responsibility m Will the occupant of the
requirements which mustW met prior to issuance of a Certificate of Occupancy. Signature Of Applicant Date
owmr ar,aNarirad anent Data All roof coverings to be Class"B"or better