08060245 �w-
CITY OF CUPERTINO �" w eTa 7
BUILDING DIVISION PERMIT12t5iC""TMINFOR t�T, �, N
O1111D NG DRESS: PERMIT NO.
675 JOHN DR DEBELL AND DEBELL 08060245
R'S NAME: PERMIT ISSUE DATE
HOSHEZAKI JON A AND MADELEINE 2715 DELAWARE AVE 07/11/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 465-1205
ARCHTfECT/ENGINEER: BUILDING PEIbMR INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION lob Description
1 bmcby affirm Nall am licensed under pmvisiaac of Chapter 9(cammcming P
nz16 viNSmuon]pghiNd n3of&Badress Pmfusi mco&., mylkeaxis REVISION: ROOF PEAK CHANGE TO GABLE LIGHTING
n full forte aM e
_=z. LicenxClua Lk.e
DESIGN CHANGE IN L.R DEEP -SET CUT ELIMINATE POST
roto cxrlT3crsDDFC BY USING BIGGER BEAM ORIGINAL PERMIT # 08040129
1 undawnJ mY Phm shell be used u pub c mcmals
JyU
g G Lkertxd Pmfudond
5 OWNER-BUILDER DECLARATION
C s O harchy.ll.(!SWT that 1 1. exempt faro Ne Cssion,o :cense I.A.far
ft
I p O which re moon.Permit
r 7 onno s.Business and no.demolish.
Calc:Any airy or county
S$V which requires a permit to eonLrucl alar.imPmw,damalLah,m repair anY suuclurt
Zi• prior m its issuance,aim requires the applicant for such Permit in lrk a signed saament
pp < thuheislicensed pumnnitodoe provisions ofthe Contractor's UamaLaw(chapter 9 Sq.F[.Floor Area Valuation
mm
Y�s (coencing with Smuon 7000)of Division 3 of NC Businesamd Professions $Cada)or 100
Q r3
that he is exemPs therefrom and the buff fm the alkgcd camold on.Any violation of
Section 70313 by any applicant fm a parole subjects the applicant x a civil penalty ofNumber Occupancy
our mart Nafl.n w hundred dollars OM 36923006 ! P Y Type
0l,uawmof Uepmpvty.mmYemploymwithwagauN 4mlec pemdon,
will Pr Newark ane Ne he Gorst a is t License
Law does.1 apply oras,Bader of Required Inspections
and anywh otr Code:The Cauherer,Ucense Law dm rot apply lf rt owner is q p
pmpenywhoes.moArimpmtsu Nei mq andwhowments dmnot int work Mm elfor motioned
his
bonemploym,pmvidad Natsuch impmwmmtsart not fendedoronued for ale. r-
builder,Nc building or impramomt u sold ei within one Year of mprowe far she owe of
builder adB hail the burden of provin8 Nu be did rot atild or impmw fm Parole of
uky
0 1,as owner of the pmpcny,am excludusly containing with licensed mntaacers to
W.I.Use prejen(Sec 7016,Bu mos and Pefendot Cada:)The Omommfs U.
an=law dm hot apply m an owner of property who builds or impmws thereon,am
who contracts for such pmjects with a eonwctor(l)licensed pursuant m the Convector's
License law.
amaamrmunder See .BAPCIm Numasoh
Dan
WORKERS COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury arc of t e fallowing deciaeuot:
E]I hswamd will maintain.Ccr ificaa ofComenuo self-imam forWoducesCompen-
,uion,u provided fm by Sedan 37M of the labor Cade,for Ibe performaen of the
work fm which this Parrott is isamd.
C1 I have and will maimaln Workcr's Computation ImuraSectionee,u required by Section
3700 of the labor Cada,far the performance of Ne work fm which this permits issued.
MYWorie" ped
mo
ol vranm carrier and Pal' be
Cartier. ) Policy Ne.:
CERTIFIG OF EK PTION FRO ERS'
COMPENSATION INSURANCE
(Thu se mon reed rot be cam plead ifthe me permit is fone headed daBars(S 100)
or less)
1 ramify that in rise performance of she work for which Nu Permit is issced,l shill rot '
employ any former in my maomrso as to became wbjmt to the Warken'Compud
son
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making Nu Ccnifite of Examption,you should
become =to the WIftes Compensation prvvidem of the labor Cade,you moo
.,O forthwith comply with such provisions or Nu permit mall he resonantmeted.
z y CONSMUC ION LENDING AGENCY
Ihereby affmot that Nee is a wosvunion lending agenry for than performance of
W' Ne wu It fm which utis Pettit u issued(Sec.3097,Civ G
Lcndces Name
z LcMeYS Addition
U O 1 cad ify Nat I taut read this application and sae this she show iNurmation u
B+— WoWL 1 agree x comply wish all city and county oNinamt and Ina law,elating to
.0 building construction,and hereby mtharlm rtprtenalim ofthie city to enaruPnn the
Uj abaw-medomd property for itpceuon putpmen
Fw a' livbili (WEt tonna, mfy and beep harmless ft City of Cupertino against
VI 6 a and expenses which may in any way scene against and City
t)z in asequence of th Ins f Nu NWML
PLICANT U SEAN WILL COA]p WITN ALL NON-POINT Issued by: Date
OURCE REG ONS. �C/)
Re-roofs
Sigma,71517A,li amrxmr Data
xA2Alot=b MATERIALSDISCLOSURE Type Of Roof
Willy t e C.par or luxe building occupant nom orhandlet hneAms maarial
'Med by 15 Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
':than us3Zp)7
[]Y. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or latae building occupant sex cyulPmanl w device which g agree to remove P
Writ hauNnm air conamirunts as dcfimd by Nc Bay Area Air Quality Management all new materials for inspection.
Cha i
Yma
Thaw red mmmeriaumquimmewumkrChapvs695aflheGlifm-
rra ns h YC 25531.IuridmnwoE Nnifde buiWug
dm rot ndY M an usual t u m mihilily m notify,the mxupanl n Ne
eyui cnuwhk aloe tpriormiss ar.C.Mr. ra Signature of Applicant Date
ower. m;mda a D,w All roof coverings to be Class'Al w or better