04060025 CITY OF CUPERTINO
BUILDING DIVISION PERMIT a4CONTRACTAOR INRORMATION'. ,
BUILDING ADDRESS: PERMIT'904060025
OO4O6OO2S
20078 J014N DR
OWNER'S NAME: PERMIT ISSUE DATE
PFUND KONRAD AND
NE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n00 LICENSEDCONTRd under
DECLARATION Job sC ��®
1 hereby affirm that 1 an licenced under provisions M chapter Y(commencing ttf
with Secoan]qIU)of Divii on 3 ofthe Business atb Profetsiurts Code.end my license u y
11 mu One.ata ernes 241 SQ. FT. ADDITION T JJR
Lmemer L'c.M
�� Datecmnnmr 'FAMILY DWELLING DEC
FF ARCHITECTS DEC A k Z x'1001.
y$C I understand my plans shall W used a public records v L T
31U
G Licensed hereby nal BUILDING B ®I
` 5
OWNER-BUILDER DECLARATION ■`r() L ISG
I hereby affirm mal 11. exempt from the Lhslonsaoo :censeAny
Law co 1W
a o following mason.(Section]!131.5,Business and improve.
d.rua Code:Any city or county
a$� which mqulrea•permit m mnsuuct.alar,impmw,demolish,or repair any mmctua
prior m its isvuanm.alarequiru dteapplieat fnesoeh uppoltmble assigned summent
—Z< that W is licensed purcuentm the Previsionsof the C.pt.h 'a License law(Chapmr9 Sq.Ft. Floor Area Vah.t�QQo
z�O (commencing with Section 7rMfof Division3 Orion BusinesslandProfcssina Code)or
y that he u exempt memfrom and Ne basis for the alleged exemption.Any violation of
Scion 7031.5 by arty applicant for a Permit objects the appl¢at in a civil penalty of APN Number Occupancy Type
not more man five hundred dollars(SS00). 36934026 . 00
I,as owner of the pmpeny,or my employees with wagu as their We compensation,
will do On work and the structure Is not intended predicted for sale(Sas.7044.Business '
and Pmfessinru Code:The Cnnvazlare Liman Law does trot apply in m owner of Required Inspections
propeny whobuildsm improves thereon,and who doessuch workhimself or0uough his
own employ=.provided that such improwmenu ase notinankri predicted for We.IL
however.the building or hnprowmmt is sold within oro year of comPleuon,the owner-
builder will have the Widen of proving that he did not Guild or impraw far purpose of
-*I
1.as Owner of the property.am exclusively contracting with licensed conttacmrs m
construct the project(Sec,7061.Business and Pvfcssmas Code:)The Camaanelt Li.
mase Law docs not apply m an owner of property who builds or improves themoo,and
who contracts fm such projects with a con actim(s)licensed pursumt m the Comraeors
11 Ligeve Law. n
M.exec ,See. .B&PC far Nis tease/a
O her Di
WORKER SCO
NSATION DECLARATI
1 hereby alRrm under Penalty of perjury am of the fallowing doelarauov:
I have and will maintain a Cerufcate ofComcm m al(-inseam for WmkafsCompcn-
adon.a provided for by Section 3700 of the Labor Code,for the pimme ancc of the
work far which this permit is issued.
1 have and will maintain Worizes Compensation Iran==,as required by Samoan
37M of the Labor Codc.for the performance of the work for which this permit is issued.
My Wmimes Compensation Ionian.eanicr and Poll,number
Cartier. Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Obba etion need mit WcOnplemd lithe permit isforanc hundred dnllus(SIM)
car less.)
1 century mat in the porformarce of d�c w rk four which th it u issued.I shall not
employ any peranin any manner eco uY' oche Worked Compcnsatlon
Laws
corgi,
I/
Appli am ' 9.
NOn APPLICANT:If,after making mu Cenificate of Exemption,you should
bac jot m thc Workeh ComPemation provision,or me Labor Code.you most
Oforthwith comply with such provisions or this Permit slut]W deemed mwketl.
z CONSTRUCTION LENDING AGENCY
[-.4 I lemby arm that there is•construction lending agency for the performance of
a, > the work for which this permit is issued(Sec.3041,Civ.C.)
4I Q Undoes Name
Uz Under'.Address
U 0 I certify that 1 haus read this application and sum that Oc show inform omm is
p.F coven.I apm to comply with all city and county ordinances and state laws mlating to
L]U Wilding construction,and hereby sorption rirt represemmiof Out city m enter upon thc
U about-mcnuoned pmpeny for inspection Pusposea
(We)agree to ave.indemnify and keep harmless the City of Cupertino against
jj liebilioea,judgmcnts.cOaend expcacs wM1icM1 may in any way acrncagegnst aid City
UKin consequenec of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
S URCEREG CATIONS. ti/^� ^�e
s-a.,J CY Re-roofs
gnamm pr Applin HAZARDOUS MATERIAISDISCLOSUV Dam Type of Roof
Will the applicant tar future building occupant stare or handle haaNaue material
u defined by me Cupertino Municipal Code.Chapter 9.13,and this Health and Safety
.on,
Section 25533(¢)? All roofs shall be inspected prior to any roofing material being installed.
r]Y.
No
Will the applicam or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air comaminama as defined by the Bay Aro Air Quality Management all new materials for inspection.
Wic"
U Yes f u
1 hove mail the has minus materials mquimments under Chapter 6.95 or the Califon
nuNcallb&SafctyCodc,Sauon535505.]5533 and 25534.1 invasion the ifum Wilding
docs not ctsemdy haw a tenon.that it is my ms milidity m noddy the occupat or me
mqa' eros hichm stxmetpriorinas Ceud amer0, Signature of Applicant Date
���"'� 7- All roof coverings to be Class"B"or better
Owner or aOhmi.d agcm Dam