08010086 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA.CT�O°RNFORMATIO, =
BUILDING ADDRESS: PERMIT NO.
20634 MAPLETREE PL TIMBERLINE HOME SERVICES, 08010086
OWNER'S NAME: hITI'
PERLSSUEDATE
LARRY CHAMPAGNONI & ABBIE 27724, N.EDLAR DR 01/15/2008
NE;av Pnm SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMITINFO
RMDL KTCHN, 1/2 BTH, WRNG- BLDG EO PLUMB O
Sop LICENSEDtwoImeCONTRACTOR'S nderp DECLARATION ..-Job Descu tion
u�F I hereby affirm tiuI l am Ilanxd under Prevision of Chapter 9(commencing --^^•• ^•^-^ ^-•• -^ •• }3
wlthsutian]IXkj)of Dl Jof cine Budnw and Praf� sand mylicewla
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! ARsDECLARATION
I understand my pew shallIM used ss
public mrnrda
2
b ud�
Licensed Profwionel
y OWNER-BUILDER I me D cept f. the CmiTION
a I haemo.(nrm Nat 11. eBudw from tine Conuacmo e:A License Law for the
i
JI
O following moon.(Sutton 1 construct.
Baines and Ra(ae)av Cade:Any city m comm.
S 9 whish rcquisa a premie no c im.,dut.pilo,improve,demuhah,v repair MY auunum
Z y prior m its issuance,rise requires the vision of for such permit m file a Law mtemcm
�< that(commencing
ncit pursuant dom 70the of Division
of the Conua Liawlaw(Chapter 9 Sq.Ft. Floor Area Valuation
3 (cot be isc g pt therefrom and of basis n 3 the
tie Business ecemn d on.Any vi Cade)of
that he la exmpt therefrom and the Eub for IM allegrA ea.mpOon.Any vlolNan of
Section 7031.5 by any applicant for a permit subjceu the applicant m a civil penalty of APN Number Occupancy Type
iwt mere duo five hundred dollars(SSW).
❑I,u awrcm of tik proper.,m my aoplaycea with wge u the'v xis comp.wtion,
will do IM dem,and the tuuCm la ret Licenses aRemd fasskpply to an Budrcx
and property
ld.or Th Communes sthsonLkeve law dos nut apply if ser owner err Required Inspections
proper vrM builds i improve titneogand who daaouhwak Mnuelrar Waugh dela
own a however.
the Wilding
that such improvements;in not dear or completion.m'aertd formleline ow.
Ir.
however.Ne buil dre mimprovement is sat he
oreynroforNeawner-
builder will have dre burden of protan{Nu ha did mat bWk er improve for Purpose of
sola.).
❑1.u owner of tire proper.w aelueively commando{with Banaed commom m to
anawn the project(sec.]OM,am.sM ProreW on Code:)The Cnemwcte'.W. _
ave law does not apply in an owner of property who wilds or Improves theman,me. . ...
who anmxuferr avch pmjecu wiNamnuanorD)IkenQdpmsamlo Ne Canuanoh - _
LAW.
ocm
ty.k
�Iam aempt undo See ,BAPCfor this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 Mreby affirm under penalty of perjury,One of one following dulwdov:
have sod NI maintain a CenJax of Covent In xlf-inert for Worker'sCosepen-
.m provided for by Section 37W of the Labor Code,for the perrormsna of the
wade for which this permit is issued
❑1 have and will maintain Worker's Compensation Insurance.u required by Section
3700 of the lab"Cade,for the performance of Ne work for which this permit Is Iuned,
My Workda Compensation lemma artier and Policy number us:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSU C"z
(lldssecuoenced uthecamPlemd ifWWee {{j��kis(((MMM one hon doll $100)
or lose.) / /5�
e cosily Neter the performance of a /MMM,MMUkkk/XXX/160b perm a lou I ehfa/ll not
employ any person in any mmnereou eau jedmNe micas ompavation
Laws of California.Dam
Applicants
HOME TO APPIJCANP.If.after making this Certificate of Eaempdon,you should
buome subject to the Worker'!Compensation provision Of the Leiser Cade,you most
.J O forthwith comply with such provision v this permit Mall M dermad revoked.
'�
,y y CONsmucnON LENDING AGENCY
[-t (hereby affirm Nat them is a covu cdon lending agency for the Performance of
a > the work for which this permit Is issued(Sec.3097,Civ,C.)
Q Lenderh Nun. ,
=z Lender'.Address
V Q I certify Nu I have read Nig application W sone that the above infamatiun U
{Si corms I agme to comply with all city and county ordinances and crane laws misting m
_0 buildin{earuuuetion,and hereby mthorim repnuceutives of this city le cow upon the
tS7 above-mentioned proper for WmOmam pugtoxa
gy (We)agree to save,indemnify ad kap homeless the City of Cupertino agent
N IhbAd, omm opens which mer'In any wayurnuaPivt mid CityIncgrantin fthu swhi. y RST�5 AND WILL COMPLY WITH AL NON�INT Issued b : Date
�cRe-roofsCon. Dsne
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant mom or handle hammous msnerisl
as deOnd by the Cupertino Municipal Code.Chapter 9.11 and the Health and Safety
Cale,Section 15532(a)? All roofs shall be inspected prior to any roofing material being installed.
C3 Y. 04.
Will ft applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,.1 agree to remove
harallous airanumirunas M defined by IM Be,Aro Air Quality Manccmcnt all new materials for inspection.
n?
❑Ya /�
I have mad the haYallo smaterie/li req immenu under Chapter 6.9SofJuCalifor-
ni4Hahh@SafeY.Swum25S 533uW25534.1unticnundthulfthe Wilding
s mYmapolulhllilYmnotify / cy. /�en (t
ho...r.COdliicateofOcap ry. Signature of Applicant Date
Gwn Jon era a{e �iD a I All roof coverings to be Class"B"or better