08070139 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT C�NTRACTQR INFORM, JON;
"
BUILDING DORESS: w PERMIT NO.
SR HYDE AVE TBD - TO BE DETERMINED 08070139
'S NAME: PERMIT ISSUE DATE
ne _I N) TRAVANI 08/27/2008
PHONE: - SANITARY NO. CONTROL NO.
'ARCHTTEC(ENGINEER: BUILDING PERMIT INFO
ADD 203 SQ FT TO NEW BLDG ELECT PLUMB MEcx
0 0 0 0
u o oENhTI 6E 11_1
LICENSED CONTRACTORS DECLARATION -
Iwrobyalirmamladl'uansedun rpmvieiomof Clupmr9(Commencing .IOb.DeBCRptlon
�� with Secwn70(Il1)af Divialonlof Ne Buvnmsand Pro(csonsCwnandmylianuis .
m aR fere and eff«L
U...0. Lit.g
c— Dam Conowtor
e0 t— ARCHITECTS DECLARATION
U I uMeevanJ my ph s dull w used u public numsa
gQ� Licensed Professional -
3 OWNER-BUILDER DECLARATION
1 hereby M.that I am mempt from Ne COnuactors License law for the
p O following wan.(Section 703 L5.Business and Pmtessium Cade:Any city or county
3$ which a xi lrm a permit re enmuucl,alms.improve.demolish,ale repair any Mooser,
Zipri«miui mnw.Womquires Mmappiwlfats«hpermitmfilcasigncdsummcnt
Nat he is licensed pursuant to the pn,iamscr Ne Comructun License law(ch.",9 Sq.FL Floor Area Valuation
Y�$ (commencing with Suction 70)())Of Division of the Business and Proftessiam Code).,
^ than bu u eumpt Nmerm n and the Ensu for Ne alleged evmpdan.My vlowiM of
Section 7031.5 by any appnmm for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
not mom Nen A.hundred Collars($500). P Y TYP
0 I,aa owem.f du proper y.«my omployee,with wages as Ne'v sok Compensation,
will de Me week end Ne sweture u not intended Or Offered r..We(Sec.7084,Bum.
and Professions Codc The contractor,License Law does Out apply to an Owner or Required Inspections
property who wilco«imvmws rhaMn,and veno eau aaen w«It himreB or Nmugn his
own employees.Provided that such improvements sooner intended aranertd for We.If,
however,Ne wilding or improvement is sold within Me yea acomplewn.an,mmu-
header will have tic burden of proving Wt he did not beat m improve f«puryhu of
sale.).
CTI.a owner of the property,w eseladwiy,communing with licensed Contractors W
comtmet Ne mojmn(Sce.R%<,Business and Protesdons Coac:)T7m Coomuwrs U. .
cense law does hot apply to an owner of property who wilds or improves Men on,and
who Contracts for such projects with a conbactor(s)licensed panmm M Ne Conmatora
License Law.
❑laneactnptmmderSee .BRPCformismamn
Pan W�'_ Date tv g4j-
WORKERS MPFNSA� TION DECLARATION
I hereby afnrm under penalty of perjuryoro of Uu following dedarswru:
Ihaw,M will malnuinuCenifiwm ofConunttoulf-insure f«Workefe Compere
ration,a provided for by Section 77M m Mu labor Code,rer Um perfamu en of the
were for which NW peril is issued.
0 1 have and will Murrain Wortr1,Compenadon Inwrance,u required by Section
3700 of Ne Laver Cook.for am performance of the work for which this permit is issued.
My Workers Cmepensta.W utana Cartier and Policy number ale:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITIS section mad not w completed if Ne permit Is far me hundred dollen($100)
or less)
I Century thus in the perfmmumc Of the work f«which Nis Perot,is issued.l shall n«
employ any person in any man�r3oi�gr nand Mblectto NC waft.,Compenatioh '
laws or Caifomia Dae
NOTICE TO APPLICANT.IL after making this Cemfmam of Eumption, lWOW
beemne subject to Uto Worker's Compensuann provisions or Ne laver Code.you muse
,J O forthwith compty with arch Pnwaamm or this permit shall w doemed raked.
'Z 55 CONSMUCTION LENDING AGENCY
(..m= I hereby drum that Nana.Cammu<tinn kmdlog.geray far the
pufartnaa at
IZ> the woes for whim W lar
Nis rental (see.3119'1,Civ.c.)
a. 25 tenmrs thane
Z) Z Leaden Add.
U O 1 wnify Nat I haw road this application and sum than act show information u
Is-^ COMCL 1 agree 10 Comply with all city and county mad. Lt and,Wm I.,mh4ng m
-0 SV^ building Conswnm
ion,and kreby Narim representatives of Nu Ne
city to enter upon
W abowmenaoned property for inspection purposes
0a (Wal)agree to save,indemnify and keep harries the City of Cupenina against
rn IiabiliUwptui,rcnts.cestsan tuticmw whichmayinanywayaccnuagainstssid City
U'Z m consegmme of Ne granting of Nu peril /7
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 'z 2 •L
sOURCEREGULATIC:� _
f
Seln, Al"22/ " Re-roofsHAZASignatureof ApplicanUCDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will Ne applicant«future wilding Meme ntetom or handle haadom material
a defined by Ne Cupertino Muoiciptl Code,Chapter 1,11,and Ne Healis and 1,1C,
Sec
. Y050
zss3za)7 .
0All roofs shall be inspected prior to any roofing material being installed.
Ym
Will the applicant or future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haamom air Cmuminanu u dcrined by tic Bay Ara Air Quality Mansgement allnew materials for inspection.
Diane?
P
❑Yes [3+C.-
I haw read Ne MamMs maurias mquirtmwuurulm Chapmr695 Of the Citifor.
nia Heal"Safety Cade,Sections 25505.25577 and 25534.1 understand thanifam witding
does not currcnay have a tenant that it W my responsibility to Mary am Meopeat of Me
nqunn cnu which must he to iuum of s Certificate of Occupancy
�t i8'�Z��o�r- Signature of Applicant Date
owner waummixdagent D,m All roof coverings to be Class'W'or better