06060039 CITY OF CUPERTINO nw,ti a a ��7rrgx�n sk�(��nr�?.n
BUILDING DIVISION PER )IOLs!1-.Rr�CTQTi T1V?�,OR`MA�1'qnT'•�
BUILDING ADDRESS: AMERICAN BRANDS CONSTRUCT t° ril-Na06060039
1149 KENTWOOD AV
OWNER'S NAME: PERMIT ISSUE DATE
VLLAH 2878 PRUNE AVE OTE A nr,/06/9006
E: SANITARY NO. CONTROL NO.
(408) 210-4945
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o 9 LICENSED CONTRACTORS DECLARATION lob Description 1 hereby affirm Nat I am licensed under provisions of Chapter 9(commencing
with Smile.7OM1)of Division 3 of the Basin.and Profusium Code,atW my Lica.is
6 in full cera and affect. r '�5 4081 NON HAB. I CBO PATIO ROOM
! a License Clan Lk.N
p Oau Con
7W ARCHITECTS
i I understand my plans shall he used as public records
a.6
rQ Licensed Profcstianal
OWNER-BUILDER DECLARATION
I
hereby aRrts o n I em,Bute from the lfm oto atiCo License c law for tin
O O following moon.(Section 7(131.3,Basions antl Pro(essi.ro Cade:My tiny or munry
:29 which require•permit u,emmuct Alun.hnprow,demurim.or repair any suauure
?i� prior m its iaouanco.also napalm Ne applitsom farsmh pmaitto file a signed suumam
mat M Is licensed purman,usn the provisioof the Comomm's limas Law(Chapters Sq.FI.Floor Area Valuation
2
(mornmeming with Sections 71)(0))of Divicont 3 of the Business and Profession Code)Or $25000
$ that he is attempt therefrom and the basis far the alleged raemptim.My daI&Oon of
Section 7031.5 by any applicant ran.permit subjects the appliam to a civil penalty of APN Number Occupancy Type
mo mom than Rw hundred dollars(5300).
❑I,uownu Ortiupopcny,wmyemployeewithwageutheirwkcwpe Uon,
will do Outwork.and ucture the mis notthunded oraffered forsau(Sec.7W4,Bad— Required Inspections
will
Profeeun Code,The Comms ces Likens e Law donot Apply W an Owner of q P
property who builds or i m prows thereon,and who doessuch work himself or through his
own employes,provided thatsuch Imismwmmm ate Out Intended oroRened for sale.If,
builder Nearto the
No diinot Misr ofmmPutim.theownr-
builder will haw ma burden of proving that he did not dtiW or improv for purpose Of CEJ(
ale,). 3
❑1,an Owner of the SM property,am exclusivelynd actualizingfessCada learned)Thecontractors, -
cnntruct the Project/Sao s art owner
of•and Profession Cade)77rt e,doota's LI• O
team law doe rot apply je an awna o/propety who builds or improsa apeman,notxes
wko ommon
mLAW.farsueh gajeela Wthacantaamr(q Ikansed pmcaumuthe Contraeroh
Lkena Law.
❑1 arum eempt antler See. .B k P C Ice dda reason
Data-
WORKER'S
auWORKER'S COMPENSATION DECLARATION
I hereby a1Mv ander perWly of Perjury arc of the following declar•don:
INC:oral w0l mdnuina Cntifiau of Consentuself-inure fmwarkedaCmnpan-
salon.u provided(or by Section 37M of the labor Code.for the performance of On,
work for which this permit Is Issued.
❑1 haw and will maintain Worker's Compensation luurmm,u mquimd by Schon
3700 of the Labor Code,for the performance of Use work for which this permit is bound.
My WmIuse.Campenadon Insurance artier cad Policy number
Caller, d�T51t'—flyA Policy No.: 'L'VJL
CaRTIFlCATEO$IDEMP170N FROM ORKERS'
COMPENSATION INSURANCE
(Thissectim wood rot be camp bud If the permit is foram hundred de0ata($100)
or los.)
1 cenify that in the performance of the work fu which this permit is Weed,I shall am
employ anyperun In any mm erso as,he become subject to the Worked Comperuadm
Owe of California.Data
Applieam
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
became subject as the Wokch CompenNm pm vion of the labor Code,You moa
.'O forthwith comply with such provis an m this permit sons W decmW rtwkcd.
rt8 CONSTRUCTION LENDING AGENCY
[ti 1 hereby alarm Out dart is a construction lending apomy for the per ormanm of
(Ya. the work fur which this permit as issued(Sec.3097,CW.C.)
Wti a.7 Lender's Nam.
z Lames Address
U0 I certify fun I haw read this application and mW mu the t how mformatian b
[7. Pcovert.I agree m comply with all city and county ordinances and sum laws relating m
U building construction,and herebysuthmim rcprexnum,itr this city,.enter upon the
W above-mcmi...d property for impact of p.mp.an.
y (We)agree to caw.indemnify and keep harmless tiro City of Cupertino against
aE"y IA Iiabllida judgmems,costs and expense which may in my my accrue against aid City
U'z in mosegmme of the granting of this Perm
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR
d Re-roofs •��
Signature o[Applicamt0lusessurVwe
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant a future building occupant came or handle baardoro material
as defined by the CupeNm Municipal Code.Chapter 9.12,and the Hnith and Safety
.Section 25532()1. All roofs shall be inspected prior to any roofing material being installed.
[:]Y. Ar.
Will the applicant or future building Occupant use equipment or devims which If a roof isinstalledwithout first obtaining an inspection,I agree to remove
comic hamdnu air conuminanu u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I hoc real the lu armors maurials requirements under Chapter 6.95 of the Ctllfm.
nia HealthA SafctyCode,Sectitats25505.2553 and 23534.1 umlcnund thalfthe Wilding
don
.at camently hew a unapt.Nat It is to poruibility,u mtil'Y tie accupant of the
ane afaamfiaraca
campSignature of Applicant Date
Owner armmminditim, As. All roof coverings to be Class"B"or better