08050150 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR II UT2MATIDN
- a .
Bul"MApSR : PERMIT NO.
LINDY PL MD CONSTRUCTION 08050150
.1'
912 E MISSION STREET 06/11/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 279-4653
ARCHn-EC IENGINEM: BUILDING PERMIT INFO
BLDG EIFC7 PLUMB MECH
000 LICENSED CONTRACTOR'S DECLARATION : I IObDeSCrDescription
w 1 hereby affirm that I am licensed timer prernalm a or CMpwr 9(commencing p
n woos«tim7Ufp)oroiviuoPrefeacomeode.andmyBeenxu REVISIO14—RAISING CEILING OVER BEDRM, STORAGE AREA
_mor n fun forte and effect
Dnz License Class Lic.0 BELOW FOOTING TO PIER DESIGN CHNG,KITCHEN, LAUNDRY
Dam
ARCHITECTS DECLARATION BATH ORG#08020151—NO NEW PERMIT
I ��D
1 Undersand my plans shall he used u public records
�wLmcnwd Professional
y3 OWNER-BUILDER DECLARATION
i F I Mashy alimi that I am exempt fmm the Contractors License law for the
i o o won.on.(Section 7031.5,Busisess and Profusions Code:Any city or county
1$9.1 which inquires a permit to construct.alcor.improve,demolish,or cop err any sncture
—zy pd.,m its issuantt.afro romr.Weapplwant for such permit,.IIileasi,ond,tammem
< that he is licensed punuanuoNcprovisions ofUmConuocmr'sLlcmucLaw Chamer9 Sq.Ft. Floor Area Valuation
.�Q (commencing with Section 7000)of Division 1 ofd,.Businev and Profession Code)or $40000
f5§ Jut he I,exempt therefrom tial the basis for Us alleged wmpUon.My violation of
Section 7011.3 by say applicant for a permit subjects the applicant to a civil penalty ofNber OType
mtmore than nm Wddmd Mars($.SW). 3562400535624005 .W umOccupancy Y YP
I,u owmr of Ne pmpmy,m my empluycu wish wages u their mk compensadon,
and Pr fe work and th The Com snot sLMed Law does
hot a(Sec.7014,Businea
end property
who
code:The Cenuacmrs Liana Law don oot apply lf an owner or Required Inspections
own cra who n.provided
d dowuth imp,and who dmsauchwork himnelror Wough his
awnemployes,provided proveh improvements mid wi secnotintendedmpleticd for owner.
however.the have
tWilding ru improvement u sold within one yes of c prove for
the owner-
sailder will have Ih burden or porNg that M did not MW a improve far pugox of
sale.).
11
u owner or as property.am exclusively contracting with licensed commmers m
wtmet the project(Sec.7044,Bniness and Notesion Code:)The Conuactufs U.
cc=law does not apply m an owner of property,who builds or improves thermn.and,
wmconwcufmuchpon, w,.1 camancmr(s)littnsed pursuanHotheomosswe,
Littre law.
tem same,
DECLARATION
1 thereby df news, t f perjury rn or Ju following helantions:
❑Iha.odd will maintain•Cartiicamdf Cnnacmmself-internfwWmkcraCompere-
easier,u provided for by Section 37M of We Iabm Cade,for the performance of the
work for which this permit it issued. -
❑1 have and will maintain Workers Gompcnation Insuane,u required by Section
37M of JmLabm Code,for once PCRormanceofthe work forwhich this permit is issued. '
My Workers Compensation Insunme carrier and Policy numberane:
Carder Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Masectim need mtM..pl.wd ifthe permit sfa me,handed dollars($IOD)
m lea)
I certify Inst in the err of t e rt fw which (s pa u issued.l shell not
employ any
e= ,a a�/Bg Nu Centrism of Exemption,you smell
beronm Subject y it W penution Provisions of dm labor Code.You mus
.Jz forthwith comply with such provision or Nu permit shill M domed revoked.
'Z O CONSTRUCTION LENDING AGENCY
I hereby af0rm this Nem sec cwmm,,ww kMing agenry for the'mr.mea
a > Jrc wort,for which this olmoit u IssuW(Sec.3097,Civ,C.)
W�M Lenders Name
z Lender`s Address,
U O 1 certify,Nat 1 have mad this application and tum Nu the above infoda m u
[s. correct.l agree m comply with dl city and county ordinances and sum was selling m
Wilding mnsoactien,and hereby•uNodm mprxnudws of Nu city m ease,upon lM
•cove-mentioned properly for inspection puryoaea
F 4 (we)agree m alae,indemnity and kmp hamJess Um City of Cupcnino against
fq liabilities.W
saM expenw which may in any way accreagdutsdd Ciqz A PLICAmuel. ti the permit. //�APPLICATWILL COMPLY WITH A NO -POINT Issued by: Date 6'SOURCE
to P e y Re-roofs
signuum I base
HA
H out MATERIALS
tMo..,DISCLOSURE Type of Roof
Winthese Cupcnt oforum Wading .ChaptBom sir handlehealth anmamdal
Bncd by Um Cupertino Municipal Codc.Chapter 9.@,and the Health and Safety
.Section 15333(1)? All roofs shall be inspected prior to any roofing material being installed.
❑Tat �e
If a roof is installed without first obtaining an inspection,ection,I agree to remove
Will the applicant or future building occupant um equipment or devices which
colt ha,a dnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Disuict7
❑Yes �JWu
I have mW the huaodoumamdalsrequimmcnuww1crChapmrG95oftMcdifor-
niaHcalthlit otycock see 15503,35533ud3534.1mdcnmndwaifthc Wilding
dasent t coroody ayIt u my respensibility w netify the occupant of the
requirements h rerleamanceofIcertificate IOccupancy Signature ofApplieant Date
Owreror aathorined ag t Dem All roof coverings to be Class'n'or better