06030091CITY OF CUPERTINO
BUILDING DIVISION PERMIT
s
„,O]yRA�`I'OR, y T•
BUILDING ADDRESS:
PERMIT NO. 06030091
10122 JUDY
O ER'S NAME:
A
PERMIT ISSUE DATE
LUIS ROA
E:
SANITARY NO. CONTROL NO.
ARCHI'IECrfENGUSEER:
BUILDING PERMIT INFO
BLDG
l�
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby ",an that 1 am Maned under provisions of Chapter 9 (commencing
with Section 7000).f DIAm. 3 of do Business and Professions Code. and my license is
in full forte and effect.
REMODEL EXISTING GUEST HOUSE. REDUCE SQ FT
Class Lm.g
OFF (E) ROOF AND REPLACE WITH TILE
Dam ContractorTEAR
Dam
ARCHITECTS DECLARATION
SANITARY IS SUNNYVALE'S JURISDICTION
I understand my plam shall ho ted as public recoNs
Licensed Pmfadonal
OWNER -BUILDER DECLARATION
I hereby alBm that 1 am exempt from dee Contracuea License Law for the
following moon. (Section 7031.7. BusOhm and Pmfessiom Cade: Any city or county
.
which mquies a permit As conuruC, miler. hnpmw. demnlW, lir repair my strommo
pear As its besance,alsu requires the applus al for such permit on flk a signed summed,
Lkcm U.(CMpmr9
Sq. Ft. Floor Area
Valuation
Nat ho e Hamed pumut m the provisl0m of the Conuacuea
Section 7000) Division 3 of the Busirwa and Professions Cade) or
$12000
(commencing with of
this he a exempt tmefmm and the basis rd, the alleged ceemptan. My dolNon of
Section 7031.5 by try applicant f« a permit mbjacu the aPPBdmI m a civil Penalty Of
APN Number Occupancy Type
not more than ftw hundred doikn (350)4
❑ I,ssowner Of tiro prnperry,«mY wPloyem with wagasstmv mm campewton,17rqqAAA
AP
win da dawork. roti the mucaumkutintevded«o@ted Immes(Sec. 7014,Bud^•"
Required Inspections
9 P
The COnumfa Lmnat law don net appy m an Owers Or
and Professions COdm m
property who Wilda«improwa mereomud whod«ssuch wart himelfor Waugh his
wwn emplay= Provided maemch imp awniceu are ret intended«Orteed for ads U,
henomwr. the Wilding «impmwmmt is, mid within arc year of ccmpktim. the madam.
builder will haw the burden of proving that he did tat build «improv f(a purport of
10 1. AS owns of the pro«rty. ere exclusively conuanag with Remand conusecaorm to
construct the project (See. 7044. Business add Professions Cade:) The Contravenes Li-
me law data n« apply m an owner of Property who Wilda or improwa thereon, and,
.
who contmns for such projects with a canuanora) Iicemed punanl as Ute commnnes
License law.
c l am exempt under See B & P C F.,11,14m n
(iU/ S Data Z G
WORKERS COMPENSATION DECLARATION
IF
I herby afRm under penalty of perjury and of the fallowing declardass:
c 1 have and will maintain a CertiRale ocona now elf -Insure f« Warkees Comped,
titan, As provided f« by section 3700 of the Labor Cade for the performance of me
work for which this Rmll is blued.
e 1 haw and will maintain Workers Compensadon Insurance, As required by Section
3700 of me Labor Code, far me petf«mmce of and work for which this permit Is luted.
My Workees Cornpenmton Insurance cannot mad Polly number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
(The medon aced ambecompkmd if the permit is («mm hundred dollen ($100)
lir lass.)
I Codify that in the perrom eco of me work for which this permit Is Wised, I shall nal
employ any person in any muner an AS m became subject to an Worked Compensation
.
Lowe Of California. Data
Applicant
NOTICE TO APPLICANT: It, offer making this Candidate of Exemption, you Aauld
become subject m the Warkces Campcnndon provision of the Labor Code, you mat
.
faMwids comply with such proveiom or this permit Nall ho deemed Ormked.
CONSTRUCTION LENDING AGENCY
1 herby a(Rrm mat mise i ending agency for me perfurmantee of
s ed (Sec. 30
' the work far which Wer Permit a issued (See. 3097, CN. Cd
Leader's Name
'
v Lenders Address
1 cendly that I haw red da application and sum mat the Show Information e
' comn. 1 agree m comply with all city and county ordlnames and sum laws elating to
building construction, and hereby mmoriw mpreenteaws of this city to enter upon the
alww-mentiund pnmOr y for inspection purposes
(We) agave to saw, indemnify and hap harmless the City of Cupenim gatom
7 liabilitme. judgments, cons and expenses which may In my way acme agdmtdd City
F in consequence of the granting of this pemlt
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
T of Roof
Type
Signature of Appl)aWCanuacmr Dam
DISCLOSURE
HAZARDOUS MATERIALS
Win the applicant or imum building o=pmtme «handle hauadoas material
as dented by the Cupenie, Municipal Code. Chapter 9.13. and the Health and Safety
Seddon 253324)7
All roofs shall be inspected prior to any roofing material being installed.
p� y
c yas /
If a roof is Installed without firs[ obtaining an inspection, I agree to remove
Will me applicant aa favors Wilding Occupant use equlPmrnl «dc les which
emit hazardous air cenuminanu as defined by the Bay Aga Air Quality Management
all new materials for inspection. '
District!
cya ,PN.
Thew tiro hnallous mncrals requirements underChapter6.95ofine Califor.
ate Helm, ycm,"ha 75503.25333 anm25334. I understand Nm hfthe Wilding
doter ml Curren Y haw aen� an mu It is my responsibility m mdfy me oauput of the
mquiementew kat rhe rorm Wuanec Oraccatilksu lira a
r
Signature of Applicant Date
All roof coverings to be Class "B" or better
own .4 rtmad agent Dam