06060168 CITY OF CUPERTINO p �,'�"� e + F
r :t„" nvre:
BUILDING DIVISION PERMIT FIMITRY
IY•"=�R. GTgRINFUI�Mr'C10, vg•, A,i✓tKd rS,LG "rr S. .f.a; ,sa. s.'cBUILDING ADDRESS: YUSUPOV, & YELENA N 2%Wrto-06O60168
10472 LOCKWOOD DR
R'S NAME: PERMIT ISSUE DATE
DMITRY YUSUPOV & YELENA NA ARE 06/19/2006
PHONE: SANITARY NO. CONTROL NO.
ARCH]ECrfENGINEER: BUILDING PERMIT INFO
O O PLUMB MECHO
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
ee I heroby grim Nn 1 sum licensed under provisions of Chapter 9(commencing
with Section 7")ofctivision 3 of the Business and Professions Coda,and my Iiceese is
+ p, In full fame and affect. ORIGINAL PERMIT 05110079 . REVISION: MOVE HEATER
Z License Clue Lw.0
pp Dam contractor TO ATTIC
eg ARCHITECTS DECLARATION TIM CASEY CONSTRUCTION PAID FOR BL 6/19/06
!s 88 I un immend my Pimaall he used as public moods
�pWUr
Q Licensed Professional �7
OWNER-BUILDER DECLARATION
0 1 hereby.Rrm I emm exempt from mo Contractor's LicenseLicenseLaw for me
C p0 Q o following moan.(Saban
7 o I.J.Business and w.de o l Calc:Any city or county ` /'
m Pi which its issuance,
a Permit r caruumL ams.applicant
demWtsh,m e a sig ed structure
zi andPriorho Itsrsswrep,also requlrca thehonismacmf far Such Contrapermit wice.signedStatement
<
and pSecdon 70DO)a vivmm of me Cewacwr'ali Prtxssionsupmr9 Sq.Ft. Floor Area Valuation
i€m
that he
Sction700dthe baisfeththe Business
exempa Professions Code)w $0
Q�$ Out he b evanpt n^^fraa arld the bub for the alleged eamPUoa Any violatim of
Section 7031.5 by any applicant for a permit subjects the apPGant w a civil perulty OfAFN Number Occupancy Type
not mos than five hundred dollars($M
❑I,u mmf of Oro pmpeny,m my wploym wlthwages u meirmle ampenadon,
willcia and Profeawm Catim Tbc mul co I odors il�4:memnoieAp ly W Whts'`Of Required Inspections
Property who builds or improvesthereon,a d who doessuch work himselforthrough his
awn employ=,provided that such Ih1Pmwmmu arc muhrowded oro@red for ale.11.
however,Ne building or Improvement Ismid within am year of compledon,me owner-
builder will haw Ne burden of proving that M did rot build or improve for purpose of
Said.).
❑1,as owner of the property,am eacletively contracting with licensed...sewn m
construct the project(Sec.7006,Business and Professions Code:)That Conuacmr's Lt.
come Law docs not apply to an owner of property who builds or improves,thermn,and,
who contracts for such projects with a conuactorfs)licensed pursuant w Ow Commutes
License Law.
❑I an tempt under See .B&P C far this recon
or Dam
WORKER'S COMPENSATION DECLARATION
I hereby Whom under penalty of pe0ury mm of the following declarations:
o ihaw miimainwaa Cerdntateafcamentwwlr-Inamrwwodmescompea-
radm,as provided for by Secdoe 3700 of the labor Code.for the perforsoam a of Oe
work for which this permit is issued.
1 haw and will maintain Workers Compensation luuanoe,as required by Suction
3700 of me labor Code.for the perfarmarce of me work(a which this permit is hoed.
My Workers Compensation Inrorarum artier and Policy number am:
Carrier. Policy hht:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cibb vection need rot W compleed little permit Is foram hundred dollars($100)
or lea.)
1 certify that In the performance of the work for which this permit is issued.l shall rot
employ any person in any moneran as an beco of subject an the Woken'Compemaim
Laws of California.Dam
Appllam
NOTICE TO APPLICANT:If.after making this CenlRam of Ewmpdon,you should
became abject m the Workefs Compensation provisions of the labor Code you most
.JO forthwith comply with such provisions or this permit shall h domed rooked.
'.z CONSTRUCTION LENDING AGENCY
1 herch,.M.dot there b.cummucdm reeding ageucr rat me perfarmaac of
rd. .>. the work fm which this permit is issued(Sc,3097,Clr.CJ '
W�Q Lenders Name
z Londees Mdmss
U O I certify that I haw mad this applicaim ave sum than the Show infmmJot b
ll.P correct.T agree In comply with all city and county Ordinances and sow laws mladng w
O U Wilding conswction.>ed hereby autharie,mpresenestives of lois city w over upon me
r C17 .hove-mentioned property for inspecdan PurPows
(We)agree to taw,indemnify and trop hmolOss the City Of Cupertino against
'Fa rrAA Babilides,judgments.costs and espensu which may In any way eccrue agsimt said aly
U.Zin.
APPLICANT OUNDERRSTAND$AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signatureof ApptlemVCom Du
ac
m US MATERIALS DISCLOSURE Type of Roof
Will 0 t e Cupertino
or forum Wading mapmt awrc or handle H.111 Se material
U dented by the Cupenim Municipd Cade,Chapter 1,11,and the Healer roti Safety
Sectan 25531(.)?
❑Yes [3 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building Occupant use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conumimnu as de0ned by she Bay Area Air Quality Mmagcmenl all new materials for inspection.
District?
Oyu ❑Nu
1 haw rental me hnardaw maeriW om ubemems undcrChapar6.95ofOoCaltrar-
nis Hear&SafnyCode,Savau 25505.25533 and 35534.1atlersurW malfOe W10ding
data not c..it,have a Brunt,Out It It my responsibility in ratify the acupamt of me
requirements which must be we prior in iaua¢e oft Catircaw of Occupancy, Signature Of Applicant Date
Owner 01Wthoriradagent no. All roof coverings to be Class"B"or better