05070199 CITY OF CUPERTINO '" -`"giak
BUILDING DIVISION PERMITYCONTRACTORiINFORMATI,ON
BUILDING ADDRESS: C & D FREITAS CONSTRUCTIONP"""005070199
10390 MALVERN CT
ITS NAME: PERMIT ISSUE DATE
RICHARD & SANDRA MILLER 23610 MORREL CUT-OFF ____(W21/2005
HE: SANITARY NO. CONTROL NO.
(408) 353-1228
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BO et.ecr PLUMB MOF.CH
woo LICENSED CONTRACTORS DECLARATION Job Description
1 hereby&from thoe
Lima I s n licensed under PMVWGM of Chapter 9(commencing p
with Section TOM)&(Division 3 of Ne Business and Prafestaes Code.and my license is
nfull(area and effect. 2, 3961 ADDITION MSTR BEDRM/2 BEDRMM
z LleelClassLle.g
Damad Contractor LAUNDRY RM/STUDY-1, 367 ' REMODEL OF HOUSE
3
ARCHITECTS DECLARATION ELECT UPGRADE TO 200 AMP
1 understand my plain shall he used as public records
G Licensed Professional
OWNER-BUILDER m ISO CoA770N
Zoe) heresy a(Srm on T 1. .exempt from Contravenes L sense Law for the
Zoe)o which mason.(Section 71131.5.Bosirmu and P .daiou Code:My city or mommy
$ which mquhu a permit re uires the alcor.Wprow,ticmdWI,fi repair any ed l n numl
z tr^
poor miBissuance.dpursalso requiree dmvsXn of for Such Conrumittoole Law(calemem
gg � thuheisllcentsdpumranttothcprovistounfNcCanummeslJceueUw(CMptor9 Sq. Ft.Floor Area Valuation
Q (commencing with Section 700G)of Division 3 oftha Business and Profualons CAM)m $651355
Q`3 that he is exempt titrefrom end the buts fos the alleged exemption.My violation of
Section 7031.5 by my applicant for a permit subjects the applicant IP a civil penalty of APN Number Occupancy Type
not mom than 0w hundred dollars($500).
❑1,as owner of tie pmpmty,or my employees with wages Be their able continuants,
will do thework and the snctum i¬immnded eroRemd forsale(Sec.7W.Busi•...
Sam Protestat,Code:The Comncmrs Lkeue Law daunt ml apply to an awnu of Required Inspections
pmpe ny who builds os im proves thcroon.andwho does such work himxlf or through his
own employcea.provided thatsuch Improvements see int intended osaQered fossals.If,
however,the Wilding or Improvement is mid within orc year of completion,due Owner.
build"will haw the W idea of proving that he did Out build u improve fm purpose of
"it.).
Vas awoer of the property.am exclusively contracting with licensed contraction to
ecnatroct the project(Sec.7044,Business and Professions Code:)The,Contractor's Lt.
cents Law does not apply to an owner of pmpeny who Wilde or Improves themon,ad.
who contracts for such projects with a enntr ector(s)licensed pursuant m the Contractoes
License Law.
)]1 am ner, f B k P C fm this lesion
, 77/�l Dam
WORKER'S COMPENSATION DECLARATION
OF 1 hereby affirm under penalty of perjury orc of due following declensiau:
❑I loveand will main Wn•Cardacale of Consent oeself-imam for WorkeesCunpcn.
stian,u provided for by Section 3100 of We Labor Code•fm the performance of the
work far which this permit is issued.
❑I ham and will maintain Worker's Compensation luurance,an required by Section
37W of the UWr Coda,for the performance of the work for which this permit Is issued.
My Worker's Compensation,Insurance carrier and Polity number are:
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ikkscmim need notWousupsAM If the permit tsfaronc hundreddollan($100)
m los.)
1 unify that In to Performance of the work for which Nis Permit Is issued,I Nell nm
employ any petmnin anym rte(m y mb�co�gSobject mtr Wotmn'CompenaNan
Lawsof Ca—li-foorglp D e /.,.L-Wle(,f
Applicant T
NOTICE TO APPLICANT:If,soar making this Certificate or Exemption,you should
become subject to the Workers Compenndon previsions of the Labor Cede,you must
'z forthwith comply with such pmvitons or this Permit shall be annual ranked.
z O CONSTRUCTION LENDING AGENCY
E 4 1 hemhy&aim data them rm
then is a coounn lending agency for the perfoace nof
C> The weak for which unix permit 4 issued(Su.3097,Civ.C.)
�W A Undines Name
D
z Address,
AOdre
U C 1 county Nn I haw mad this application and atste Nn the&how Information b
tks E comet.I gree to comply with all city and county ordinances and scale lave muting to
0 SV' building construction,and hereby authorize npremmadws of this city to cnmr upm the
f17 chew-mentioned property for inspection purposes.
(We)agree to save.indemnify and keep herr^le s the City of CupeNna against
o-y y
liabilities.judgments,coin and expenses which may in my way acerae against Said City
U in consequence
1C NT UNDEof the RSTANDS Aorting,of ns mil.
ND
APPLICANT WILL COMPLY WITH ALL NON-POINT Issued by; Date
SOUR REGULATIONS.
91 2 Re-roofs
Stamm.of ApplicmVCon nor Dem Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building aaupa^utow m handle hazardous material
dcrxed by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
SMtm.25532(,)7 All roofs shall be inspected prior to any roofing material being installed.
Yu wr
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 harard^ua it contaminants u dcaned by the Bay Area Air Quality Management all new materials for inspection.
District?
Oyer on
I haw mid thehvwdmsm HAL mquimmenmoderChepwr6.95 ofthe C&1ifor.
nia ftILh&SafctyCode,S=d=25505.25533 and!25534.lundcncand NuirNe Wilding
does an,currently haw a tee t.dot it u my responsibility to natify tin acupant of the
rexin ntwhkhmutW etpriorminummofacwrcamaroccupmay. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or mthatxed agent 0 te