05120030 CITY OF CUPERTINO 7Tia „eb r�. '�T'j" fay ?"y''A��♦.'y }/3
BUILDING DIVISION PERMIT ,roN'TRA 'I, RT „'sfAllYA,J',
BUILDING
ADDRESS: CHARLES SCHRAMM IFRMITNo.05120030
14 JAMES TOWN DR I
I OWNER'S NAME: PERMIT ISSUE DATE
CHARLES SCHRAMM 01/04/2006
E: SANITARY NO. CONTROL NO.
(408) 839-9979
ARCHRECTIENGINEER: BUILDING PERMrf INFO
BLDG ELECT PLUMB MECH
iloo LICENSED CONTRACTOR'S DECLARATION O O O O
�+ I hereby affirm that 1 Am licensed under prunaov of Chapmr 9(Commencing Job Description
with Section 7000)o(DMilon 3afthe BOd and Profeaalov Code.and my licensees
a I.full I..and.ifem. REVISION--SW TO SHEAR WALL
j Z Lt.=Class Lk.0
� — Dam Contoomr NO NEW PERMIT ISSUED/ORIG. #05020048
ARCH IECI'S DECLARATION
I understand my plana shall he used As public nwroda
kW Licensed Pn4cssional
OWNER-BUILDER DECLARATION
W • I hereby Affirm that I am exempt from the ConlncmYa License Law for the
i following reason.(Section 7031.5,Business and professions Code:Any city or county
Alit which requires a perm,to com mucl.alter,Improve,demolish,nu repair any a1.CtAm
prior On its issuance,also requires the applicant for such permit In file a signed statement
zFF< that he Is licensed pursuant to the provisions of to Can=tur'/License Law(Chapmr 9 Sq.Ft.Floor Area Valuatio 214
S� (commencing with Section 7000)of Division 3 at the Busincas and Profcaaiona Code)or
3
that he Is exempt therefrom and the bub far the alleged exemption.Any violation of
Section 7031.5 by any applicant for A perm,mbjecu the applicant to A Civil penalty of APN Number Occupancy
oat more drum, hundred d.IWm(S500L 36610067 . 00 ��
an fin
❑I,as owner of the property,or my employees with wags As than role compensation,
will do the work and the structure is not lntemded or offered for sale(Sec.7044,Enables Required Inspections
and Pmressons Code:The Commctoes Liceve Law does ml apply m e ns an Owner of q P
property who builds or improves thereon,and who docs arch work himself or duough his
Own employees,provided that such Improvements Are not Intended oraanned for sal,IL
hove..the building or impmnment is mid within oft year o(Completim.the Awar-
builder ,will haw the burden of proving Nat he did not Wild a Improve for pumose of le
k
[]I.
❑I.As awftr Of the property,amBusiness
Aexclusively PrefooContracting with licensed Conoacm,a U.
vs'
=La the es not (Sec. 0/A,Baines property
rty who
Code:)TW Cmuw.mh Li- \
ave leve does not apply an owner of pmprny who Wildaar improve thercm,aM
who cormomuforme,Pro withacoarmer(s)lic<raedpAmeAat m the Conuenoh
Leese law.
❑lam aacmptu ,B3PCfm N'
Date
iT
W ATION D.eLARA'nON
I rcby,alfa under penalty of perjury Arc of da following deelandons:
I hsw an H ilnuinaCeNOamo(Covcnlmsel(-insurtfmWarkef/Compen-
aatian,v provides for by�Sadm 7700 of Ute labor Cade.(e the performance of the
wank for Wb. talo perm,is issued.
❑I ban and will main maintain Workeh Comprnsstion Ivurmce,es required by Schon
37000(the later Coda,for the performance of the want for which Of.permit is Issued.
My Workees Compemadon Immnexce carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seclion need not he comptewd If IW permit is foraw hundred dollars(SIw)
of len.)
1 o nify that In the rfu o of dm work for which thla pennh Is issued.10.11 nm
employany A my —W
ossa m Wcomesublectsothe Workers' omprnaation
ws of Calf a
A imam
N E TO APP A n eek ng tea anifica of Ex Cop Ian,you hall
WCome bJecl to N We
r9 Compevatlon pmvlilam the hat Code,you most
.JO foMwith m
provisions or this permit shall W deeed revoked.
tiCC SIRUCTION LENDING AGENCY
E~
lbenchylainoths there Is.construction lending agency for the performance of
adm work for which this permit Is Land(Sec.3097,Civ.C.)
�W 0 Lamises Name
7 z Lc.&es Address
U O 1 certify that I haw Lead this Application and sum that the Allow information is
FCOOCCL 1 agree m Comply with All city and county ordinances and lute laws relating to
0 U Wilding cowroction.and hereby authorize representatives of this city m enter upon tae
N i2) above-mentioned pmpeny for ivpection purposes.
F C (We)agree m taw,indemnify and kap harmless the City of Cupertino agilvl
,..,yy liabilidv,ludgmenu.cosb espeves which may in my wyamaagilvl said City
I.Z
U^s APPL ANTCUNDER " ' ' ND WILL COMPLY WITH ALL N -POINT Issued by: Date
SOU EG un S
Re-roofs
SignalumO AWIAoA pmmr am
H US MATERIALS DISCLO RE Type of Roof
Will Ph rfuture building occupant them or handle haammus material
as defined by dm o Municipal Code.Chapter 9.12.and the Health and Safety
ode,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future Wilding occupant uta equipment or deices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnus air cmmmivms u defined by the Bay Area Air Quality Management all new materials for inspection.
19VIm17 r' i
❑Yc/
I haw,ea th Waardnusmamriabrtquimmenuunde,Chepwr6.95ormeCalifor-
niebkelthKS fc1h. .W.Arath4lilbelynalpOnobilltyAl
a.253()5,25533ad23534.1.m mmnd dutifft Wilding
does not curt timdfythemecupantofthe
u himet prior toissuance Ara en m/ rampancy. Signature of Applicant Date
owner ter Apt read/eem All roof coverings to be Class"B"or better
J