06020110 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTnRTIV' C1RMA.Ti`gN �
BUILDING ADDRESS: GREENHOUSES ETC PERMIT NO-06020110
19872 MERRITT DR
„VNER'S NAME: PERMIT ISSUE DATE
DANIEL IVERSON 1532 S DE ANZA BLV 02/17/2006
E: SANITARY NO. CONTROL NO.
(408) 446-1224
ARCHTIECUENGINEEN: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Bopp LICENSED CONTRACTOR'S DECLARATION Job Description
¢ 1 hereby aRlrm that 1 am liccesed oP
under provisions of Chapter 9(commencing
< with Section7M)ofDivWon 3ofNC lusineuand Prefessiuns Coca,and my licenseI.
?� infullforceandeffeo REPLACE 3 WINDOWS & SLID. DOOR
Liecy�z Data class CommON-STURCTURAL/
Data Contctor non
As mail be am DECLARATION ��C±3 ��� gid
n- 'LLpp,11711�N�1aJ71 Siwdjt_o-�yGJ,
I understand my plans shill k used u public record
C Licensed Pnsfeuional
`y5 OWNER-BUILDER DECLARATION (tt�
1 hereby,(Sero that 1am 1. .sumps from W Corturactor'sCad Liansc Law for Ile AI- 2Q06
O O fallowing mason.(Sadao 7U31.l.Business and Professions Code:Any city or county
$ which requires a Permit to consumt,alter,improve,camolieh,or repair any structure -
_Z� poor o its iuuaae,also requires lk applicant farsuch Permit to file a signed statement
E C that k is licensed pursuant ro Ne provision of W Conuaccur's Unease law(Chapter 9 Sq.Ft.Floor Area 11 �+�y ValUatl
a;- (commencing with Section 7000)of Division 3 cruise Business and Professions,Octal or tQ71Opp /�7t
—
that he4 exempt Oerefrom and the basis fm he alleged exemption.My violation of I,' 'If.;
Section 7031.5 by any applicant for a permit subjects W applicant to a civil Penalty of fe,,ppy�����77��uI�11,� P y Type
not mane Wer five hundred dollars(5300). 3 1 b J k:U L Va'r 0 0 "'Oddu ane
❑Luowmactf Uieproperty,amyemployees with wages u Wir�le ccmpennJan. 1100)VVu ..77
wilido the work,and W swctum 4 notimended or onerA4 formula(Sec.7041.Business Required Inspections
and Professions Code:The Conmacurs License Law does not apply m an owner of q P
property who builds arimpro es thereon,and who doessuch work himselfor Waugh his
own employees,provident thatsmh Improvements art not intended moRerM for sale.It,
however.the building or improvement 4 said within am year of completion.the owner.
builder MR have Ne burden of proving Nat k did an,build Lir Improve far purpose of
ala.).
11
u owner of the property,am exclusively contracting with licensed co sc acmrs to
nsmcs W project(Sec.7044,Business and Professions Code:)The Conuacmr's U.
cane law dors not apply in an owner of property who Wilda or improv thereon.and
who contracts for such projects with a comosomeKa)licensed Pursuant to the Contractors
License Law.
❑lamer must, Bk PC far 444 moon
r*wmr� DIO 'I -zo6t
WORT 'S dPEN5ATI0N DECLARATION
1 kmby alarm under penalty of perjury one of W fallowing declarations:
❑I have and will maintain aC.rtlOcte of Consent to self-Inure for WorkeM1Compan
ss0on,As provided for by Section 37M of the Labor Code.for the performance of thin
work for which this permit is issmd.
❑1 have and will maintain Worker's Compensation Insurance,As required by Section
3700 of One Labor Code,for Rte performance of the work for which this permit is Issued.
My Workers Compensation Insuram crier and Policy number art:
Cartier. Policy No, _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This.1i..need not he completed Vsic Permit is froom hundred dollara($101)
or leas.)
1 certify that In the performema of the work for which this permit la Issued,I shall at
amployany person in my manncrw M to kcnou subject to the Workers'Compensation
Laws of Caiif�Nll)a ere./ a"L-17-10�• '
Applicant_�y/ A�,/s
NOTICE TO APPLICANr.IL after making this Cenificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you mum
.J 0 forthwith comply with such provisions or this Permit shall k deemed revoked.
Z tiCONSTRUCTION LENDING AGENCY
[—i I bemby affirm that there Is a construction lending agency for the Performance of
the work fur which 04 permit Is,issued(Sec.3097,Civ.C.)
Q Lender's None ,
z Leader'sAdd..
U Q I comfy Nal 1 have reed this application and mute that the above Information is
tl.(✓ ....Cele I agree—comply Wim all city and county ordinances and auto laws relating to
O V buildingconswction,andherebyaummrimmprtsewtivorNiscitywcateropenthe
W above-mentioned property for inspection purposes.
(We)agree in save,indemnify and keep harmless Ne City of Cupertino against
r y Iiabllitiea,judgmens.eosts and expenses which may in any way accrue against said City
OZ in conequena ofthe granting of this permit.
►� APPLI NT UNDERSTA S AND WILL COMPLY WITH ALL NON-POINT
SO Issued by: Date
REGULyTO S.
Ma./I / fAtnn. -f7'�86 Re-roofs � —
Signature ofAppli onuanror Data
RDOUS MATERIALS DISCLOSURE Type of Roof
Will W applicant or future building occupant mom or handle huudous maerial
As defrnod by W Cupertino Municipal Code.Chapter 9.12.and the Heslth and Safety
Conn,Section 25332(a)7 All roofs shall be inspected prior to any roofing material being installed.
IP ❑Yes ON.
Will me applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cult harerdous air contaminants As defined by the Bay Arta Air Quality Management all new materials for inspection.
District'
❑Yes $%Nu
(have W Wau
reWAi wsmrialsrequimmenuundcrChapwr G95ofW Califon
nine Kohl"SaletyCode,Sation 23503,23533 and25334.l understand the iflhe Wilding ,
does net currently haw a emmc that it is my responsibility to notify ort occurnat of the
mgvi tswhicbm ma 'orw issuance of a Ccnifiete of Occupancy Signature of Applicant Date
2-1 y-ao d t All roof coverings to be Class"B"or better
Owner or Mahonocd s let Data