07080051CITY OF CUPERTINO
a �"a•?+pa?�+ao�-R -.,"'
vr"`*,^it,'°"£")..,s;
BUILDING DIVISION PERMIT
i"C.''U.NTRt1.0 TO
INk�OFRMATT'
BUILDIt[rs.ADORes3:LOREE AVE
TBD — TO BE DETERMINED
07080051
OWNER'S NAME:
PERMITISSUEDATE
04/03/2008
ONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby M. than 1 am limned under provision, or Oso ur 9 (cammcncing
3 width Sadon7")ofDivision 3afiheBond. and PrdliessavCode.andmyliccnmis
MFG HOUSE 18$$ SQFT NEW CONST 689 SQFT GARAGE 689
uurhacciraand efrcm- Lm.e
SQFT—SANITARY IS SUNNYVALE',S JURISDICTION.
DataConvenor
ARCHITECTS DECLARATION
e I understand my plan, shall W used a public record,
J
n Licensed Professional
S OWNER-BUILDER DECe
Conm0N
1 thereby (Brm 1 em exempt from the C'anwnCo License:yc Law Tar Uc
0 . on o
a fallowing moon. (Salon 71n 1.5, Business and Profeaainns Code: My city m county
which requires a Permit to commons eller. Improve. demolish, or repair eery svuctuw
prior in its issuance, than requires the applicant for such permit to rile a signed start:mem
Nat W is licensed to Orc of the Convectors Uccmd Law (Chap¢r9
Sq. Ft. Floor Area
Valuation
pursuant provisions
$186546
$(cmnmencingwithSection70D0)ofDivision3oftheBusinessandProfenimsCode)or
Nn be I, exempt Nertfmm and the bui, far Ne alleged exemption Any violation of
��,,pp�� Number
37515026
O
Occupancy P y Type
Session 7031.5 by any applicant for a permit subjects fee applicant W a civil penalty of
vol... die five Wedred dalim(5500).
.jff
C 1, u ower of the pmputy, ar my emplowes with vnga as Neo role core mussomn.
Required Inspections
will do the work. and the$=lure is not intended or offered for sale 70th. Bmircst
and Professions Cade: The Commea /s License Law does not apply a an owner of
q I)
properlywho Wilda arlmprowLthertun.andwW doe,such warkhimselfor through his
own employees. provided that such Improvements art not Intended aroffered ferule If.
however• the building or improvemem lamld whom an year of ocanned.r. the owner.
build r will have the Wrden of proving that M did not WWW or improve for purpose of
u
1, u awnsr of sits propert, am exclusively conniving wird licensed ronu,cmn be
ronstvtt the projett (See. 7016. Business and Premsmv Cade:) The ConuaemYa Li-
ova law does not apply as an owner of property who Wilds or improves thereon• and
who convects for such pmjecu wird a contractor(s) fico ed pumwnt an the Convenor,
License Law.
❑lama funder Sri ,B B PC far this won
,
Data
WO KMISC a An DECLARATION
1 hereby stand under r my arc of dbe fallowing declarations:
I haw and will maintain a Ce ualcau of Consent to self-Wum far Workers Compere
mer, u provided for by Section 3700 of the Labor Code, far the performance of the
ork for which this permit is issued.
-
C 1 have and will maintain Wades Campenudo t Insurance, u rcNWred by Seniors
37W ofthe labor Cade• far the performance ofthe work for which this permit is Issued.
'
My Workers Compensation Insurance artier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORK ERS*
COMPENSATION INSURANCE
(Thtssecsion need not Wecampleted If the permit Is vara. hundred dollars (SIM)
or leu)
I cenify Wt in the performance of the work for wh h this lamb is Loved• I "I am
m to an' rmninan me y roma se msieW n oro nssdon
Applicant i
would
NOTICETOAPPLICANT. If. Wm aW vfimu of Exemparm
haeme subject m the Workers Comm inn PryyWutae obi Code, yon mvt
fpMwith comply with such provision or tM1u permit Nall We domed rtvaked.
CONSTRUCTION LENDING AGENCY
herby I hey aBirm Nft. is. onof
at Vert la a rotmroctin lendingassay for dm pMrmace
Use work for which thw
is Permit usiaucd (See. 71191, Civ, CJ
'
Larder's Nurse
,
� Lenders Add.
I rsnify that I hats read this applicamet and NW that sire show information U
'
rnrmtt. I agree W comply with all city and county ordinances and aur [am relating m
'
Wilding convection, and hereby authentic mmrtsenatives of this city on Baur upon sise
si shove-mentioned property for Inspection purposes
L (We) agree m Card, indemnify and kap harmless the City of Cupertino against
0 liabilities ludgmcns, cots and expenw which may In any way aeon against said City
in consequence of the standing of this permit.
APP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.';
ON-P INT
Issued by: Date
SOU CE RFGULAT7
Re-roofs
Type of Roof
— t%fr
sign of Data
-.MA R6 ATT+AIALS DISCLOSURE
_
Will sire applic r utum Wilding occupomstore orhandle haurdoamaurial
ss de0tmd by do Cupenina Municipal Com. Chepur 9.11. and the Health and Safety
cam, section 1553:(07—/
Cy. V.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the appficaet or future building occupant um cquipmcnt or derma which
ii hvsWmet air conumirums u refined by the Bay Ams Air Quality Msnagemcm
all new materials for inspection.
v<t7
1 have read the huardnvmasria( roqu punct s unser Chmserd.95 ofthe Odifor-
nsHcaiN&SafetyCade.Sttti 75505.15533 avJ25534. l underaanl duti(ft Wilding
des t sem, haw •ern it s or, responsibility to notify the aavprm or the
req ns which const cam btu issuance aft Centrism, ofO'cup p
Signature of Applicant Date
/ . n
All roof coverings to be Class '1V' or better
owner an a rix. agent Dow