04120082 CITY OF CUPERTINO T� �r.�.�a �Bu, PE PL` 'MIT "COI tE TORINFORMA�TIQN ,".
BUILDING ADDRESS: MOCELIN CONSTRUCTION PERMIT NO 04120082
10866 LINDA VISTA DR
(' 'ER'S NAME: _ PERMIT ISSUE DATE
IDIT & BARUCH DEUTSCH _ 1537 ORILLIA T 12/13 /2004
PNONE: SANITARY NO. CONTROL NO.
(408) 732-6655
ARC HITECT/ENGINEER: - BUILDING PERMIT INFO
• BLDG ELECT PLUMB MECN
0 0 0
fire,O o LICENSED CONTRAC TOWS DECLARATION ,
m C 1 hcmhr arfirm Nas 1 am littascd Pmvi"..a lir CTspier Y(commencing Job Description --u.
iro with o 70f1B)uf Dwision3of NcB"n arld Professions Code.andmylicenscix
a1ninm^im ndcrfcc[' �</ONp7 ADD 27 . 5 SQ. FT. /REMODEL BATH & BDRM
zP'= o" loos i`'" r ORIG. $ 04040078 EXPIRED/ PAID HALF OF--PERMIT FE -
�'-� A soEc TION ($614 . 74)
ndcrx lid my I II k e a rtc mat
JyUF
`LLN Licensed
DER DECLARATION
D S 1(fN/1 hY a?rte t I am exempt form Nc Contractors License Law for Nc
p yoy followinb* on.(smo. 131.5,Business and Professions Cade:Any city lir county
1f m LL which re4uir0 a pefrllil t e imorm, all[r,ImpfnM.d[mnllxM1,a!mpall NY slNelam
Fula prior m its issuance.also requires the applicant for such permit to file a signed statement
££ that he is licensed pursuant to the previsions of the Contmcmr'sLicense Law(Chapter 9 Sq.F[. Floor Area Valuation
.y�ct (commencing with Section 7000)of Division 3 of the Business and Professions CMe)or $25000
i $ Nm he N..,I tkrtfrom and Ne buffs far Ilse alleged euntpuon.Any violation of Y
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of - APN Number Occupancy Type
not mole than fixe hundred dollars($500).
].1,as owner of the property,or my employees with wages as their sole compensation, llI//� I rI N l,� n
will tlo the work,and the structure is nmimunded oroficend foraale(See.7014.Burin 3 6T.4047 . 00 Required Ins ectlons!' Jf-
and Profesdons Code:The Con menti Liana Law discs Trot apply m an owner of q P e-I -
-
progenywhobuildsorimprovesNemon,and who does suchwork himselfor through his
owncmployees,Oing or improvement
ent is semcnuiartnet year
ofdsopletio.the _-
awex'c4Nebuilthe orimprovementishalt within one year of completion,the owner-
builder
of 9 n
- builder will have the burden of proving that k did not build or improve for purpose of - - -
aa /l/j /pl llIJJJ/7 Ia.� Ud
arowof pamesdusivd contracting with ) eedcnntnnorsm
omtrvnt proper(Sec.7044.
04 Business and tis Cade: The Contractor'a cnue o an owneof property who Wilds or improvs Mertion.and, -, O (`(vJl)L(,l LI{)S`lllqJj �/�1.• E�s j�/ \y
01 apply
- •- - /_, )1, ! _ .. .
wh nhacts for such projects with o emoractor(s)liecrmmd pummon to the Convaetors
mgt and See. .B b.PC fw is - n
er A Data _
/lN ONDECLARATION
1 b dRum under nil 4ury ane of tl¢fnllawing dcdentiom:. - - - -
❑IhaveanEwillimmsina nifepm of Consent la self-insure for Worktrs Compere - -
se0an,u pmvidcd for by Section 37W of the labor Code,for the performanm of Use -
workforwhichthiepertitisissued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code.for the performance of she work for which this permit is issued.
My Workers Compensation Insurance emricr and Policy struck,are: -
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
(Dissection need not ic comptncd iflhc permit is for one hundred dollars(SIM) a
less.)
1 w,ifv Nm in to perfosma of N work for 'eb i`is issued.l shall nut
employ any rha . any liens t Id�sj c t G s'Compcnsation
Laws of Cilifo t -
plicam
OTICE TO APP IC it r i£ enificale of Exemption,you should --
foMme wbjat m c w'a Co unit provisions of the labor Code,you most
with comply w1 s eh prnvisinnx or this permit ishan no deemed revolted.
Z CONSTRUCTION LENDING AGENCY
[-. I hereby affirm that them is a construction lending agency for the Pufunnanee of
C Ik work for which this permit is issued(Sm.3097.Civ.C.)
(y Q
Land l'
enNamc
G Lders Addmsx
� z
U Q 1 sends Nat I have most this application suds sm.Nn the chose informadun is
ly ^F torten.1 agree to comply with all city and county oNinanco and suite laws relating m
�U building construction.and hereby authonre upoesimuldws of this city to enter upon the
r W alcove-mcntloned progeny for inspection purposes. .
(Wo)ju agmt m cast,indemnify and keep harmless the City of accrue
id Ctagainst
o-F•,y Iiabilita,judgmenu,cosuiand expenses which may in any way accrue against soil City /
ng
U^ A PLICu`n"UNDartER$TmI this
nn'I ` OMPLY WITH ALL NON-POINT Issued by: Date
SO CE G A 0
Re-roofs
signs c se(r P HAZA OUS MATEAIAIS DISCLOSU aro Type of Roof
Wil applicant ser mm building acupam share or ban mous maronel
as ticfinttl b Cupertino icipal Code.Chapter 9.12,and 11ca1Rm and Safety
.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
secs I�(�
Win the apPlicam or(Ulu.banding occupant use egaipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardous air contaminants as defined by on,Bay Area Air Quality Management all new materials for inspection.
District?
❑secs
I have mal Ne harard x materials requirements under Chapter 6.95 of the Cali fon
SafctyCodc,
do 505- 33 sud2553a.luMcrsuind Na drone building
ds `a I c lilts sic a a[tl is my a, hit m nou,the occupant of Nc
Nrents mat rte cut acevi cine or can ey Signature ofApp(rtcant Date
n w. rued agent Da`" All roof coverings to be Class "B"or better 0