07110070CITY OF CUPERTINO-
BUILDING DIVISION PERMIT
G�ONTRA.CTOit
BUILTTMESS:
PERMIT NO.
JUDY AVE
TBD — TO BE DETERMINED
07110070
W NEWS NAME:
FMU47 ISSUE DATE
JIM CITTA & GAYLE JARVINEN
01/22/2008
HONE:
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
I homby affirm Nu 1 am licensed under provisions of chapter 9 (rorromming
Job Description
wiMmlko 7(K)OWDivisisiumon 3 ufthe Business and ProleaCode, and mylianm is
KTCHN REMDL,WTR HTR&FURNC RPLCMNT & PATIO COVR
in full fame and affett g 3 7 37
License Ina Lic.x -
REPLCMMT W/TRELLIS
ARCHI'IELCo DECLARATION
I understood my plans shsil be wed as public rematls
Licensed Pmfassianal
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am attempt from the Commences License Law for site
fallowing moon. (Section WO I.s, Business and Prolamines Cade: Any city at county
which requires a permit in cam"" alter. improve, demolish, or repair any sanctum
prior to its issuance. also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of The Conmctor's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of Ne Business and Professions Cede) Lir
$32000
Nat he ts exempt therefrom and the baso for the alleged exemption. Any violad'on of
Section 7031.5 by airy applicant for a permit subjects to. applicant to a civil penalty of
.g3r�Number
Occupancy
Type
not mom Nan Tisa hundred dollas(M).
37507052:Aff
P Y
❑ I, at owner of the preputy or my aoplowo with wages as their sok compen.tion,
wall do the work and Ne aWctuen is at inkMed mOBemd [.nate (Sec. 7014. Business
and Pmfessiaas Cade The Convector's Liaeta¢ Law dors not apply to in Owner of
Required Inspections
property who builds mimpravnthercon, and who dnesa.hworkhim.lfuthmugh his
own employees, provided thatamO imprommm s arc not inendW mofremd formic If,
however, the building or Improvement is sold within one year of completion. the owner-
buildu will have the Intent of proving that he did ret build or improve for purpose of
.IeJ.
❑ 1. as owner of the property, am exclusively commeling with licensed conuxlan m
counted the pmjem (Sm. 7044. Business and Profession Cade) The Canuactar's I.I.
come Law does not apply o an owner of property who builds or improsm dam., and,
who comment for such projects with a canbnor(s) Bmnsed personal in the Comments's
License Law.
'
❑ lam exempt under Sec ,B&P C for Nis seasono
-
weer Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the fallowing declarations:
1 ham and will maintain • cmull ae O'Conaent to self -insure for WOrkc,i Catalan.
.tion, an provided far by Section 3700 of the Isbor Cods, fu On performance of the
work for which this permit is banned.
❑ I have and will maintain Wukeri Compensation Wurance, as inquired by Section
3700 of the Labor Code, far the pasform men of the work farwhich this permit Is issued.
'
My WarkeYs Compensation lmmance artier and Policy nu atcram:
Cartier. Policy No.:
CERTIFICATE OF FJ(EMPTION FROM WORKERS'
COMPENSATION INSURANCE
-
(ThLL auction need nothecompleed if the Permit Is forwe hundred dollars ($100)
or less)
I certify, Nal in On perform u co of the work for which this Permit u issued, I shall not
employ any person in any mannerso as To became subject in the Workers` Com asednn
Lines of California. D
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of EsemPlion, you should
become subject To the Worku's Compensation previsions of the labor Code, you mail
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affum The, Nem is a contemcdan lending agency I'nr the Performance of
the work for which this permit is iseared (Sec. 3097. Civ. C.)
Leaders Name
Latin's Add.
1 cardfy that 1 haw bad this application and mole that the above information is
Cartmel. I agree to comply wish all city and county on inancea and sons laws relating To
building conswmon. and hereby autharire mpmsenolim of our city in an upon the
above-mentianed Property, for Purya.a
"per.
(We) S. to saw, indemnify and kccp Journalists the City of Cupertino egsiml
which may in any way acme gains[ City
liabilities, WgmenheCON and exthis
p
Aconsequence of the granting of this D WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issuedby: Date—
SOURCEREGULATION
08
Re -roofs' -
y VO
SrgnuumofApplian m Dao
Or
HA,ARDZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the or handle haysrdaus material
Muni ipal ode. Cpanaom2,
he Cupert
as defined by the Cupertino Municipal Code. Chapter 9.13, and the Hulth and Safety
ino
cane, Sectiony. zss3x(a)±
Cy. 324P
All roofs shall be inspected prior to any roofing material being installed.
Will
If a roof is installed without first obtaining an inspection,g I agree to remove
the applicant or future building pant useeyulpment or devices which
emit hmsrdous air cmaminants u y the Bay Amo Air Quality Management
all new materials for inspection.
Chanel?
❑Ya No
1 haw read the ha.mnus materials mquiremeno under Chapterh.95afJe Califor-
niaHealth&Safety Code, ScWON x5505,25533 aw25534.1 undersand thuifdc building
dao not currently ham a us m, Net It is my responsibility to notify de occupant of the
mquimmcna whichp�uuIqmet prior o issuance rata Onifeao of Occupancy
Signature of Applicant Date
rdXWt�L l� Zya 08
All roof coverings to be Class rB" or better
Owner onmhadsed agent I Da -