06040054 CITY OF CUPERTINO
BUILDING DIVISION PERMIT JCCIN:T ' A� '(�I �P� f' ;IIt1vIA" II)
BUILDING ADDRESS: DENIS COLIC PERMIT N006040054
WJOHA0585
NSEN DR
W TS NAME: PERMIT ISSUE DAM
.N IS
COLIC 07/11/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 393-1484
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLO O
±Op LICENSED CONTRACTOR'S DECLARATION Job Description
I u 1 hereby affirm Net I am licensed under provisions of Chapter 9(commencing
with Section 7000)ofDivision 3 of the Business and Prmfcasimm Cade,end my license is
+< in full force and effect. SFDWL 2 STORY - SQ FT. 2284 ; GARAGE 400 SQ FT
j'qz Lleenee Class Lk.x SANITARY IS SUNNYVALE' S JURISDICTION
a � Dau Contractor
ARCHITECT'S DECLARATION
eeG I undersand my plans shall be used as public record,
as
x c Licensed Professional
q OWNER-BUILDER DECLARATION
d<@ I hereby.eflum(Sat Net 11. aempt from the Caatracar'a :A me law for the
L e O following mesas.permit
t 7031.5.construct.afwsa end ve.da inns Cade:Any city or county
C w which requires n e,Blau to tirestealms improve,demolish,ter mash ed structure
thPrimal its issuance,p als�re he ft lhprovisions of forweliMe Com ormit a Cite cense Law
(Chapter
Va dC[I 17 3
=i thatheiesingispursuant? OoofDofdteeBeat r'sLicenselaw(Chador9 Sq.Ft.Floor Area
E�$ (commencing with Section 70W)nf Divuion3af the Businw and Pro(ngsians Code)or
— that he Is exempt Nesefrom and the buil for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a Civil penalty of �'yap7a.��ier Occupancy Type .
not marc Bun five hundred dollars ISM 375:344W 0 0
❑1,m awnng of the pmperty.or my employees withvnges ss theirmfu compensadmn,
will do the work,and the,tucture a notaanded oreffemd formic(Sec.70,4,1usiness Required Inspections
and Profession Cade:The Contractor's License Law slang out apply a an matter of q p
property who builds orimproves Marcos,and whodoeuuchwmrh himselfor Waugh his
own employees,pmvided that such improvements ve not inanded orofamd for We.if,
however,the building or improvement is mid within one year of ompfuuan,he Owner.
builder will have the burden of paving that M did not build or improve for purpose of
au.).
el,an owner of to property,am exclusively contracting with licensed commeaa an
compact the pmject(Sec.7044.Business and Professions Code:)The Condenser's U.
cense law does not apply to an owner of property who builds or improves demon.and,
who contacts for such pmject with a contrador(d)licensed Pasant to W Contractor's
License law.
ism axem oder Sea .B&PCmrthm
isssan
CEO
WORKER'S COMPENSATION DECLARATION
I hereby alliin under penalty of perjury nn of tee following dxlaralions:
❑I barn and will malnWn a Cerinesu of Conant a mlf-alum far WoftesCompen-
sation,an provided for by Section 3700 of the Labor Code.for tee performance of die
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Imam,an required by Section
3700 of tee Labor Cans,for the performance of tee work for which this Permit is Issued.
My Worker's Compensation Insurance carrier and Policy number ane -
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu needed need not he completed if the permit Is for(nc hundred dollen($100)
or loss.)
I certify that in the performance of tee work for which this permit is lamed.I mail not
employ any person in my mmA�so u la become subject a the Workers'Compensation
laws of CaH a.Dam
Applicant /y
NAPPLICANT-.If. or making nam ofExemption,you shoulki
become
subject o the Woheet Compensation provisions od Labor ode,you mm
7z forthwith
comply with such provisions orthin drmitshal hfe doomed
revoked.
Z-s O CONSTRUCTION LENDING AGENCY
Er I hereby affirm that dart u e construction funding agency for tee performance of
(3: the work for which this permit is issued(Sec.3091,Cih,C.)
W~n. Lender's Name '
D, z Lender's Address
U Q 1 cenify that I have and this application and sum ail tee shove information IsIT,F toren.I agree to comply with all city and county ordinances and auto laws misting in
C V building convection,and hereby suthorim mimsaurives of this city to enter upon the
I2] shove-mentioned Property for inspection purposes.
CLr (We)ague to save,indemnify and keep hermlues the City of Cupertino against
„y fA liabilities.judgments.costs and apena which may in my way accrue against midCity
V z APPLICANT UNDERSTANDSf AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S REGULATIGNS.
&�'Vl_ - 07 -# GA Re-roofs
Si azure of ApplinnUCanrrsetor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantor future Wilding occupmtstore or handle hamedou msurial
ennd by the Cupertino Municipal Code.Chapter 9.12.and tee Health and Safety
.Section 35532(a)? �� All roofs shall be inspected prior to any roofing material being installed.
wy
❑Yea mr.le
If a roof is installed without firs[obtaining an inspection,I agree to remove
Will the applicant or future building occupenl use equipment or devices which
emit hanrdnua air contaminants as dcfiwd by tee Bay Area Air Quality Management all new materials for inspection.
District?
Oyu uNu
I have mad W hazardous materials requirements under Chmurd.95 crime Califor.
nia Health&SafclyCocc,Sections 25505.25533 0,125534.1 understand duiflhe building
dins sol currently have a anent,that It u my maponsibility a notify Me occupant of Me
re nu wMcuu.be sun pdara bauance mfaceninua afaapan, Signature Of Applicant Date
C�P or �'A All roof coverings to be Class"B"or better
Owner or authorized agent Dow