08040027 BUILDING DIVISION PERMIT f*CONTRAQRINI�OR�MATIOk
BUILDING ADDRESS:
PERMIT NO.
10361 MENHART LN JOHN HAIMES 08040027
NER'S NAME: FERMTr ISSUE DATE
JOHN HAIMES 10361 MENHART LN 05/07/2008
PHONE: .. SANITARY NO. CONTROL NO.
ARCHRELT/ENGLNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
asap LICENSED CONTRACTOR'S DECLARATION Job Description
iun C 1 Eemby aRrm most 1 am Imams d under pmWskma of Chapter 9(commencing
m<i wior Section IBM)ofOiviAw 3 afore Busimucand Proftelows Code,and mytic mmi3 DEMO SINGLE FAMILY DWELLING & DETACHED GARAGE
< n fall forte and effm
Lt..Clan Lk.B
,70 Dam Contruter
'J' ARCHITECTS DECLARATION
LL 1 understand my Puns shall W used as public normal
;yV
y"� mtt
Licensed P ,sst.wl '
5 OWNER-BUILDER DECLARATION
a� f 1 hereby aRrm oat 1 am uempt from tW Contractors License Law for IW
p O following Mason.(Section 903 1.5,Business and Pmmaaiuns Code:Any city.11...ly
e$ which exports a permit to a wernam alw,improve.dempltsh,or mpoir any structure
°i y prior to its;svance.esus mquiru the applicant forsuch Mono;,in ate a signed swcmcnt
< that he is licensed pursuant to des provisions of the Contmcmh LIcenaeLsw(Chapter9 Sq.Ft. Floor Area Valuation
YN$ (commencing with Sermon 700M of Division 3 of Be Business and Professions Code)or - $10000
e;_ that he Is esempt therefrom and me basis for dm alleged usmption.My violation of
DCCU ane
Section 7031.5 by any applicant for a permit subjects the applicant he a civil Penalty of Number
runt mom down five hundred dolW300).s(S37515043 .Nump y-Type
1,u owner of IW praputy,m my m ployces with wage u their sok eampensadon,
wig do oessam;and The
Con m bm's License
a w do forssk(Sec.IOM. wma of
and Property Who
Cade The Contacmn Ldwho ear dnv not apply f an ownor is Required Inspections
ownsurwho W;Provi irepmtsurh improve who doessuchwort wafferoromushh.
howemployees,Provided i provemimpmsemenuartrat ear oftded oro@sW Ire sale U,
wWever.me building or improvement is Gold within ane year of i m improve
a for purpose
ewe of
builder w10 love ore burden of Moving Nat W did not Wild a improve fore Puryom of
MIC.).
CI 1.As owner of the progeny,am exclusively conbusins With licensed rontrusme m
construct the project(Sec.IOM,Business and Professions;Code:)The Cwtauusts U.
cave Law does not appy in an weer of progeny who Wilds or improves oemon,and.
who contracts for such pmjccts with a contractor(s)occnmd pu munt m me Contractors
License Law.
or emptuncha See ,BAPCfor or rtssad
40 ver Dam
W ORKERS COMPENSATION DECLARATION
1 11cley aRrm under penalty of perjury arm of Ban following declarations:
❑1 ban and will maintain aCeABumof Conserv to self-osum for Worgers Compere
scion,As provided for by Section 3700 of d c Labor Code,for the Md...of dm
work for which this permit is issued.
❑L ban and will maintain Workers Compemadon Insurance,As retained by Section
37M of the LAW Code.for me performance afore wort for which door pewit is issued. '
My Workers Cmmpensatiom badman curia and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(sedan need rat W completed lithe penm;t is for.he ndrtddoOms(SIN)
or kis)
1 cuify dist in Be.performance of the work for which this Permit u issued.l shall not
employ any' nmanymanrcry aIle Ewase'%viectmoewculustcomiswYon
lam of Calif 1 am 7-I//
Applicant ps
NOTICE TO I CANT.If. for making his Ceninom of EsempWo,you should
become subject in m,Workcr'a Compensation provisions of me Ls Wr Code you most
., z forthwith comply wio such provisions or mu permit shall W deemed revoked.
Z OCONRUCnONLENDINGAGENCY
[-rte TT
l hemby affirm door is a cenenaeon lending agency for me Mrromanu of
tYr>
the Work for which this Pewit is itawd(Sec.3097,Civ.C.)
0 Landers Name
z Lenders Address
U 0 1 century that I have mrd this application and we that the.Wve information u
0.F' coneit 1 agree o comply with All city and county ordinances and sem laws misting m
0 U Wilding convection,and hereby aumoriae tepresumadins of this city to enter upon tae
W .hove-mentioned pmpony for;omecow putmsaa
(~ gy (We)ages to ave,indemnify and keep harmless the City of Cupertino against
fn IiabiHIme,judgmcros,Costs ande.wroes Which may I.any Way attmc.gaiest said City
U z in consequ cc of m,granting of this Pewit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CER ULATIO�/�
- "r"^ Q Re-roofs
SIBnmLFlor Appinesnnitagun Dam
VV HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding eccupantsmm or humor,hanrdou material
AA denncd by the Cupertino Municipal Code.Chapter 9.12,and me Health.1 Safety
.Section25532(1)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yea `�I No
Will mea lieant or ffut�)u o building noun ant au equipment If a roof is installed without first obtainingan inspection,I agree to remove
PP g P q pmrnt v devices which
ccenii hoadnas air contaminants u defined by me Bay Ares Air Quality Management all new materials for inspection.
❑Yes
I have mad me hnadmmmamriaH requin m w,under ChA;uM6.95ofth.Giifor.
ria Heaath&SafetyCode.Secows2SM5.25533 am125534.1 undersmad muifine Wilding
doesnot currently batt a mnsn4 mm it k my responsibility m Mary Be occupant or ore
mqu me which mon W met prior measured of a comimam of accurst,
S e Signature of Applicant Date
OW. , uthwood agent Dam All roof coverings to be Class'%"or better