05100069 CITY OF CUPERTINO sy' t�i�tt' Sx
BUILDING DIVISION PERMIT _COIN'"CTOI2INFOR AT QN
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BUILDING ADDRESS: ROBERT PUTNAM PERMIT NO.05100069
OWNER'S NAME: PERMIT ISSUE DATE
ROBERT PUTNAM 18960 BARN 2006
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30o LICENSED CONTRACTOR'S DECLARATION Job Description
I 1 hereby at firm Mal l am licensed under provision of Chapter 9(commencing
with Section 70(1))afDiv41on 3 of Me Business and Professions Code,and my license Is
1nt.11rmcemit AMeL ADD-1ST FLR NEW KITCHEN 302 ' -2ND FLR
pe'�z Damnm Class Co.g MSTR BEDRM/BATH 619 ' -NEW ROOF 100 '
' Dam TS DECLARATION ARCHITECTS DECLARATION
I undersand my plan shall he used As Public records
yo Llccmd Professional
OWNER-BUILDER DECLARATION
.�0 S I hereby.(Sinn that 11. exempt rem the fesmactms License Law for the
i
02 following reason. ormdun 7031.5.s5,Business and Rvfutiuu Cade:My city s county
whic$ prior mqutms•e.also toconstruct,the after,Improve,demolish.fie.repair any smut
z (dormsliesedforbu requires thcapplieectfor CollrancortLicinu al Law(Chapter
< mommencaucdpunwntmtiepmvisiomofdrcCanuancomanccmclsionCodltt9 Sq.Ft.Floor Area Val"&9509
Ila that heissgwllhherfromtion andth basis far
the
rialeged exempton.Any
CsuA)or
of
l� that he 4 exempt memfrmn and Om bu4 far Ne alleged exemption.Any viola0on a(
Section 7031.5 by arty applicant for a permit wbjecv the applicant he a civil penalty of APN Number Occupancy
tet mom than five hundred dollars(ML 37508042 . 00 TyPe
D Lae owner of Ilio pmperty,m my wplayea with waguu deo mle mmpeuadon,
will do the work and the atNelue is Act intanded An offered Waste(Sec.7044,Business Required Inspections
and Profession Cade:The Conlrmmrs Lia"••Law dace not apply m e ns an owner of q P
pmpcnywMMildsmimpr d .,sedwhodmsamhworkhimselfmthroughbis
ownemDloyw,provided thassuch
proven improvemenuarenot tar ofcmplednd theownif.
however,Mebuildingarimprovement4golde did n yearw improve
Nepwneo
Milder wl0 have the Meda of proving that he did ml bWld m Improve fm mmone of
ole.). ,
D I,AS owner of the property,am emosively contracting with licensed convmlos to
came La Me as not (Sec.7094,Business and property
who
Code:)The es t esemfa fid
come Law dere not apply ro an owner of property)who builds or Improves C.man,ted,
who contmc rsuch pmkma WNaeonvmtae(q liceued purwammthe Convaeroh
Lkeme V t�
❑l am e. f under Sea .B k P C for this reason
Owner Dam V�
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
IMy
ve and will mainsin.0 milfiate of Conten m self-law.for Warkefs Comma.
.u provided fm by Section 3700 of Ihe Labor Cade,fm the performance of the
or which this perish is issued.ave and will maintain Wmknes Compevarioo Inman¢,u required by Section
fthe Labor Cade.for the performance of the work fmwhich this permit is Issued.
orker's ComMmiarim luurance artier and Polity number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th4mdlm need not uncompleted Iffl a permll4 forone hundred dollars(S100)
or leu)
1certify th.I in rfumunen of me work for which Shia Permit is Issued.1.ball am
Amployany Pc inany m�mn�r?o,�,lo basofnewbjecita de Workers'Compewtion
Laws ofcalif L /1b
Applicant vL
NGTICE TOFAPPLICXWff.Wr making this Ccdinate of Exemption,you should
became subject m Ile Wohea's COmpenWlion provisions of the IJMr Code,you in=
.J O forthwiN comply with well provision or this Monti hall In dcemcd mvoked.
tiCONSTRUCTION LENDING AGENCY
F+ I hereby a117rm Nn Nem 41 comuucdnn lending agency for the performance of
OG> the work for which this permit ta issued(Sec.3097,Civ.C.)
CUi Q Laraine,Name
O z Lenders Address
U O I anify that 1 have read this application and me that the aMve information Is
V,F eomeeL I gree he comply with all city and county ordinances and Bak laws entering m
O U building contraction.ction.and hereby authorizemprrxnlnires of this city m Amer upon the
W above-mentioned property fm inspection purposes.
LL (We)agree to Save.indemnify and Sump humless the City of Cupertino against
v.n
IA liabilities judgmenu,cote and upema which may In any way acerae agtlmt said City
U F>7 in c LI we f the erecting of this permit r �'/I /
APPLICA NDERST AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C/ Co
SOUR ULA
Re-roofs
Signuum of Applicec✓Comeactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding=11MILLIOM orhande haandous material
ASdelimit by the Cumnme Municipal Code,Chapter 9.13,and Ma Health and Safety
site,SCAMnas3z(.)9 All roofs shall be inspected prior to an roofing material beim Installed.
[3 Y. [}t`Na � P P Y B g
Will the applicant or futum building Occupant use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
harvdnu Air cone ninanta in defined by the Bay Accu Air Quality Management all new materials for inspection.
4 dct7
❑Yu �No
I hers mad the huudnusmamrials requincnwnu underChaparG95ofthe Othfor.
nia Health A Salc yCodc.Scctiana 25705.35573 and 25574,1 understand Nu If the Wilding
Jou tet c have a enecL Nu it is my responsibility m notify the=.Pan,of the
myuimmcn ion hemeI prior w issuance ofa Cceificae of Occupancy. Signature Of Applicant Date
/ Dam All roof coverings to be Class"B" or better q
Owner onuNo v. gcnl Dam