01070059CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
10675 MINETTE PL.
TERRY MADDOX CONSTRUCTIO
01070059
OWNER'S NAME:
APPLI TION UB DATE
DAVID , LISA CHAN
10591 CARVER DR
07/13/2001
PHONE:
(408)255-0391
SANITARY NO. CONTROL NO.
Z ARCHITECIENGINEER:
BUILDING PERMIT INFO
O
BLDG ELECT' PLUMB AfECH
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i LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby afirin that l am licensed under provisions of Chapter 9(commcncing
7000) Division
DEMO. B00 SQ. FT.
j with Section of 3 of the Business end Professions Code, unit my license
rs in full tome and eRepppp
Licenses a=.. 3 (08
J Data for
A CHITECuse DECLARA O
S DEC
g 1 understand my plans shall be used as public recoNe
jLiccnscd Professional
y OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt fmm the Contractors License Law for the
following reason. (Section 7031.5, Buancs and Proles...... Code: An, city o county
$10000
which reyuires n permit to conswct, ulmssimpro.c, Jomolkh, m repair any svuame
- - - -
_primu,aa issuance. also reyuires lhcapplicant fursoch permitto life asigned smmmenl
_
�'3733C3$tO i l f.• ,x
Valuation
- dot he it licensed Forstmann to the provisions of the Contractors License Law (Chapter 9
fcomoicncin in Section 700 fDiskion3oftheBusimcssandI' rsawion.Cork
or that he is em'mpt theremmon, ad the basis for me alliBcJ' ciemriumn Any violation
1- - ",' ' •�,:, 4
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally
mf nor marc man five hundred dollars 05W).
NO AM� INSPECT
ONS' "' Occupancy Type
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections'
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'
wilhdo'the work: and the structure is not intended or offered for sale (see. 704x:
Busities andProfessionsCode: The Contractor's License law does not apply to an
owner of property Who builds or improves thereon. and who docs such work himself
or through his own employees. Provided that such improvements art not intended or
howev is ail., within one year of
sale. IChoweveeme buildingor imof
pool
o the uwneo Wilder will have me burden of proving thin he did not build or
completion,
improve for puryoze
prove for
" _..---.___.- --- -..___,ito. _
•, ❑ I, os owner of the Propene am exclusively commcting with bcenud contractors m
_ _
..... .. .. -.- ._.'_.__. _... -... .. _ ... _ ....-_.._...
construct the project (Sec. ](44, Business and Professions Calc:) The Contractor's
- License law docs not apply to an owner of property who Wilds or impmvas mercan.
. and who.contrams for such projects with a co ar=roo -licensed pursuant to the
. _._ _ _.... _ .. __ ._-. ....... _ ..._.......__—..._._. __.. _...... ___.._._ .. _.
Contractors License law.
_ ❑ I am eacmpt under Sir: '� �B&PC for this rcamn
- Owner - Data -
,
J I•..Q..
U
SS
WORKER'S COMPENSATION DECLARATION
{,
` I hereby affirm under peaelty of perjury one of the following declamtions:
f�
❑ I have and will maintain 'a Ccniricase of Consent to ulf-insure for Workers
Compensation, as provided for by Section 371(1 of the labor Code for the
performance of the work for which this permit is issuN.
❑ 1 have and will maintain Worker's Compensation Insurance, as requital by Section
3700 of the Labor for rhe of the work for which this permit is
�p�kirfismance
YYCo�dee
issu d M+W1 rv1.1;�°='oi!-''gg�C�rt e1(I�,Pnitcyf`=art.. ..
�wq9.-
C� nmyNtt
CERTIFICATION OF EXEMPTION FROM -WORKERS'?
COMPENSATION INSURANCE
.._.
It' ' (Thrs scrdcm need not W comp&tod d the Permit is for one hundred dollars
($100).11., )
1 ccn'fy that 'heP<f a 6l kf huh lht. pe t'. Isstid I
f:.. r 'It .. t '
ibidl mr, employ any prison to any crantrer of as to become subject In the Walkers
Compcmminn Lit—of Callfurn, ia. Dom
Applicant .' ... - _ '_
._. .... .. ._. ... _._ ... ...... .. .... ...
NOTICETO APPLICANT: If, after making this Cmificate of Exemption: you should
'
become iubjecun the WnrAcr's Campcnsatlon Prov Bions ul me UNa Cude, you must
forthwith complywim such provisions or this permit shall W domed mokN.
'
p' CONSTRUCTION LENDING AGENCY
1
Ihemb (firm that is a conazuction Ierahr 'for the rformance
yes gas. pe
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C.)
of the work for which this permit is issue) (See 309]. Clv. Cd
.._ ,... ..
" tender's Name
_. .. .- .. .. _ _ ..' .... ......... _. ... ..
I.endn's Athlon e
r t
I ecnify that 1 have read this appllcatinn and oats,loo me above information is
correct. I Inc. m comply with all city ani county ordmancas: nd .marc lows ndming
to building construction, and hereby authorise representatives of this city to enter upon
the h W mei eJ properly 1 pees V s, ,.
y (W N,no,o. eInd torify amjk ph i City ofrpenini against
�A//J�Jv_
nen
zCityi J dg ee, e I .pensee M1 M1 Y n any ) e against said
L Cit se4 a of Ih g i g t th
L/'"Y.a�
Lcord.
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AP ".. NT INpER. ND , . D WILL COhIPLY WRH ALL N N INT
Issued b Date
SOL C. EpULATI S 2
Y
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Re -roofs
Sign t A scan✓C nr t=
IIA DOUS MATERIALS DISCLOSURE
w�u me ppllcam urfmurt Wilding acupam .tort or handle haaardnus mammal
Type of Roof - - -- -!
- as d red hY the Cupcn no Mun x al Cud Ch Pt 9.12, and tb H hh and Sufcry
CW 5 ion 25532WC
• t s• '. I s , • � • '1 . `,
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Cvet ' ' '' "° " - '.'' I ') `: •
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'_ All roofs shall be. inspected prior to any roofing material being installed.. ..,
. WiutheapPlieamorfuturehaildognecupnntuseequimaintordevicet Which
If a roof is installed without first obtaining, an inspectidr, Faoree to remove
emit .aI`dous air eommminants as retired by the Bay Arco Air Quality Management
D11.101 .
all new materials for inspection. Applicant understands will comply with
-... . O Ye. i 17KNo 1 ..
g�\ �
-and
, - -..
- all non -point sourceregulahons., ._,, ,
1 have read he huamdous materials rcyuircmenLs•unJer Chapter 6.95 of the
Callfomia Health & Safety CWe. Sectors 25505. 25533 and 25534. 1 understand that
' i foe buil ding does h".a c. min. h, it is my msponfibdiry to mmify the
occas ant of the occhich must W met prior to issuance o' a Cer irica a of
.'" 04-m amcy.
•;
uk.
Signahgl:,ofApplican[Da[efi,e
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All roof coverings to be Class "B" or better ,
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v-, OFFICE