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BUILDING DIVISION PENT
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BUILDING ADDRESS:
PERMIT NO.0 6 0 3 0 0 9 0
10122 JUDY AVENUE
ER'S NAME:
4
PERMIT ISSUE DATE
LUIS ROA
06/02/2006
E:
SANITARY NO, CONTROL NO.
ARCHI'fECT/ENGINEER:
BUILDING PERMIT INFO
PLUM!B MECH
BL I1G ELECTE
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LICENSED CONTRACTOR'S DECLARATION
Job Description
Wrathy affirm that 1 m licensed under proninom of Chapter 9 (commencing
with Section 7000) afDivisi.n 3 of the Business and Profusion Code. and my Rcetm Is
In full forte and affect.
ADDITION -2, 0691 -LIVING/FAMILY/MSTR BEDROOM
License Class Lic'"
MSTR BATH/KITCHEN/STAIRS-REMODEL 878'
Dam.Contractor
ARCHITECTS DECLARATION
1ST FLR 1,251' -2ND FLR 818'—SANITARY IS SUNNYVA
I understand my rims Mill be orad an public reeorm
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby v1Em that I M exempt from the Canuscters Uctu a Law far Ne
fallowing remon. (section 703 1.5, Business and Profession Code: Any city at county
.
which requires, a permit In c. L alter. imimme, dcomrsth, m mrvlf my "=lure
prior n its Women. also requires the applicant for such Permit he Bk a signed sou tom
License Law
Sq. Ft. Floor Area
Valuation
that W is licensed purmunt m ft provision of the Committers (Chapstr9
Section 7000) Division 3 of cite Business and Pmlwiaus Code) or
$531990
(commencing with of
this he u exempt therefrom and the basis for the allegrA esempdom My violation of
Section 7031.5 by tiny applicant for a permit subjects the applicant m a civil penalty of
APN Number Occupancy Type
am mart than 0w hundred dollars (55001
❑ I, u owtws of tie pmaperty. ser my vmploycn with xgn u thea sole compewuon,:791
1 11AA GA
mmabmes rat an
dolhewons
Required Inspections
q P
i mcam Law.ems, owm,.r
Case Tie C.vumstrs Lion¢ law dos, rot apply te m awmr of
and Edernbe apply ur
and
erafesslaru
property wk Wiwdaoimprows Nvmmve win. aamhwnkil
oro eorlhroughh,
own emplam i proWaed nonsuch ani os art oraBema far awe. U,
year
afr
coldedid amyear of mmP�on, theawmn
h Willful: oldwit he
IMoriden Ofpnemg
builder w•iB have Use When of prorinL that k did rot W(B or improve for purpose of
Wilder, win
❑ 1. as owoa of tie Property, am acludvcly cammaius with licensed mnvmos In
emmutt the prolan (Sec. 7a4, Business ab Profession Code:) The Cmuumr'a U.
cease Vv sew vo apply m m Dano N propenY soba hWW w hrlpraq tieeon, rod.
.
who ... macts for such projects with a e"nuacurti) Respond posmm, in the Coouemrs
I.i Cme Low.
❑Ism aero/yys tinge See 77 .BAP CIor
7U' P2011 Dov Z
WORKERS COMPENSATION DECLARATION
1 hereby aQ"me under penalty of pmlusy me of de following decwummnm
❑ I bate and will maintain aCeruBau ofConentm elf -Inert for Workers Compete -
mum, as provided for by Sermon 3700 of 0e Labor Codi for the performance of the
wank for which this remit W issued.
.
❑ I bane sued win maintain Workers Comp smoker Ittsmance, as, required by SoNon
3700 of the labor Cade. for the performance of ermit la the work for which this pWood.
My' orker's Compensation Insurance wrier and Polity numMr are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thin enwm need mtbeconpisted if the permit is fame hundred do0ars(L1001
or taxi)
1 om ry that I. the performance of the work fn which this permit W issued, l "I m,
employ my permit in my mannerist M become subject 10 this Warletre mpenNan
Laws of California. Dau
APit
NOTICE TO APPLICANT: If, &fur making this CanfBne of Exemption, you should
become mbjeo m the Workers Compensation pr.visimu of the Labor Codi you mum
' forthwith comply with such provision or tho peril shall be doomed! reoked.
CO PONcons LENDING AGENCY
Whet Is a fending agency for the pcmormame of
I herby alum that chert 4 • ted
(Sm 30
' work for which this remit ts iasurA (Sec 3097, Ch. CI
Lenders, Name
La
Isndeh Mdress
1 ce ify Nat I haw, read did, applicadon and sou Nm the above Information Is
' coma 1 agrtt to comply with all city and county ordinances and sum laws relating m
Wilding construction, and hereby au horim reprtmntatiwa of this city to enter upon the
ahove-mcmwoned property for inspection purposes.
(We) agree m saw. indemnify and lump harmless The City .1 Cupcnino against
j liabilities, Judgments, coati and expenses which may In my way amine&&aim, mid City
' in..mequema or the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULA
Re -roofs
sign m son nuazmr °ic
HAZARDOUS MATE RIALS°ISCLOSURE
TyI%e of Roof
• material
future Wilding mmpammoc 2.r
ReaAous
Cure int
and the
ss defined by 1e- Cupertino Municipal C.ac, Chapter 9.13. and cine Halth and Safety
ed by
m, Section 35532(4)7
❑Yes rNNa
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occopan, um equipment or devices which
emit hamholous air comm Ivan an dcrined by the Bay Amit Air Quality Management
all new materials for inspection.
District?
❑Yes IN.
I haw mad & hasardous mistrials requirements under Chapur 6.95 of Nc Califon
ma heal" SifetyJ2624,Section 35505,25533 and 25534.1 mdenind this lithe Wilding
does mmicturromilfbiti. unan4 Nae it is my maponNllhy to notify the occupied of the
require cnmwh' f SLb =Lpdormivuamco(&CcrlifuauorOcmp cy.
Signature of Applicant Date
U a
All roof coverings to be Class rB" or better
til m tie
CITY 0,
0 PEkTINO
L
2
GENERAL
Buil
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
De a.rtmen1
PERMIT #
PHONE # C,5z>
FAX #'209--1,
I am not using any subcontractors: ,--� !26 8
V �� Signature Date
Please check applicable subcontractors and complete the following information:
rM.
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
rM.