05040084 CITY OF CUPERTINO
BUILDING DIVISION PERMIT GONTRAGTOWINFOTt ,'
BUILDING ADDRESS: NICE & RIGHT CONSTRUCTION MITND05040084
10295 MENHART LN
OWNER'S NAME: PERMIT ISSUE DATE
JESSICA TIEN 10663 SANTA LU 2005
E: SANITARY NO. CONTROL NO.
(408) 861-0928
ARCH ITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
Sop LICENSED CONTRACTOR'S DECLARATION JobDescrition
t(� 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p
with Section 701X1)of Divi.lon 3ofthe BusinevmdP csalons Cade.entl ylicense is
in full tome and effect. L7 ADD 915 ' & GARAGE 432 ' (NEW LAYOUT)
j0
4
Ucenm CW"___4 LIV. RM/DIN. RM/MS . SUITE/GARAGE
i Dote Contractor
ARCHITECTS DECLARATION
I untleasund my plans shall Ile used u public tanrds
5yy�
o}
Licensed Professional
.1 OWNER-BUILDER DECLARATION ����
f I Mushy.(Tian that 11. exempt(am the Comons Cat:My c Law for the 111■■■111
O O which ng mason.(Saito cAr L5, t.Business and Improve.
daioli Code:Any shy or county
S$ which myuiree n e.elm,m c�res the plug Improve,de Permit
m rtpalr any immuudemerc
prior to is issuance.aim requires Na applicant for each permitm Ne ulgncd mtemcm
gm<
that heis licensed pursuant aNeprovisions ofthe Corsican's�J.. aw(Chapter 9 Sq.Ft. Floor Area ZDU6 Va 8Ib9000
(commencing with Salon 7000)of Division 3 oflhe Business and Professions Code)or L
r3.. Nat M it exempt themfmm and the basis for the alleged exemptia.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicants An a civil penally of APN Number Upancy Type
not mom Nan raw Imulmd dollars($500). 3 7 515 0 3 2 . 0 0
O I,atowner of die property,or my empluyeee with wgas as Nen role mnpensetan,
will&Ne wmL and Ne structure is not Amended or offered for sae(Sec 70X.Busirrss
and Paf enters Cade:The Commart Liceme Law don not apply a an ower of s
papery who builds or i mpreves thereen,and who does such work himself or Nreug h his
Man employee.provided that men Imprevemenlsare notmunded or offered for sale.If.
however,the building or imprevement It said within am year of completion,the owner.
builder will Neve the burden of proving that he did not build or Improve for Mope of
uleJ.
❑1,as Owner of the prepeny,am exclusively connecting with licensed ce eremuns to
construct to project(See.7044.Business and Professions Cade:)The Comrmmra U.
arse law does not apply an an owner of property who buil&or impaw thereon.and.
who conuaw for each projects with amo rmmr(s)licensed purswm m the Convector,
Lkense Law.
❑Iameonniu oder Sec .B&PCforthismasun
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby ainm under penally of pedury am of the following declarations:
.and will meinWn a CemOcae of COMA,a ealf-ineum for WorkersCamper-
uuan,as pmvi&d for by Section 3700 of to labor Code.for Ne performance of the
work for which this permit is lasoed.
❑1 have and will maintain Worker,Compensation lasmance,we ors ulmd by Section
37W of the labor Cada,for tM pepornl...1'the well Me which Nis pemlit u iuueM1
My Workers onPeasetion m—^ara4.eartlm and Poliry number em:
Caller: I d Pol"Percy �
ERTIFICA7E OP E%EMPf10N FROM WOR ERR 5'
COMPENSATION INSURANCE
(The salon need not becomple al ifthe pormh is farms humired dollars(3100)
or less.)
1 cemfy dust in the performance of Oe work for which this permit Is issued,I Nall nm
employ any permn in my mamerm as a became subject an the Worked Compc.dan
I..of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Oentncem of Exemption.you should
Mcorne subject be the Worcer's Cumpeasstion previsions of Nc labor Code,you must
Z forthwith amply with such provisions or Nis Permit&hell be acemcd revoked.
�O CONSTRUCTION LENDING AGENCY
H rN+ I hereby ulfmm that thea is a communion loading agency for One performance of
C> the work far which this Permit 6 isaoetl(Sec.3097,Civ.C.)
GQ Lenders Name
Z)z lenders Address
U Q I certify that 1 law rad this application and sum that tit above information a
B.t" correct. a a I&grcomply with all city sod aunty ordinances and sum law muting a
OC.) Wilding construction.ad hereby authoriae representatives ofthis city At enter upon t1ac
W .hove-mentioned prepery for inspection purpose.
gy (We)agree to cow.irdcmnify and kap harmleu tie City of Cupcnino against
T/5 IlabilWex,judgmans,emu and esp..which may in anycoy accom agamet said City
U 7 In cousegmnce of the gMting of this permlL d
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _—
SOURC BOU AmoNS,
sl an
AppliVContrmtm Re-roofs f
HAZARDOUS MATERIALS DISCLOSURE Type of Roof ,
Will the applicant ser future building acupmtpma"handle boxandom material
as mond by the Caperton Municipal Code.Chapter 9.12,and the Health and Safety
Ca&,Section 2553a(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea CIN.
WIII the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Mxardo.air conuminanu as defined by the Bay Area Air Quality Management all new materials for inspection.
1/ utell
❑Yes ❑Nu
I ham mad the hvamous materials mquimmemu under Chapter 6.95 of the Cutler.
ns HMI.&StfetyCade,Sections 25505.75533 and 25531.I undenwnd Lou ifft building
Jas not currently have a Ienan4 that it is my nespmatality to Artily tin.4.1 of Ne
reyuhemenswhkhmvstemelpdarmi an ofa CeniBceteo G Signature of Applicant Date
o tharimd.War D.te I All roof coverings to be Class"B"or better
O