08040193 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTCTR+INP'ORMAT ON .
BUILDING ADDRESS: PERMR NO.
21.884 MOTE CT CRITCHFIELD CONSTRUCTION 08040193
NEWS NAME: PERnff[ISSUE DATE
ARAKAKI STEVEN T AND PATRICIA 845 S MCGLINCY LN 05/07/2008
PHONE SANITARY NO. CONTROL NO.
(408) 371-3777
ARCHRECOFNGINEFR: BUILDING PERMrf INFO
BLDG ELECT PLUMB MECH
uaQ LICENSED CONTRACf00.5 DECLARATION O O O O
F I maby affirm that 1 un licensed under Pmvuiana of Chapter 9(commencing Job Description
M; Scc6an7O )af DiviAon3afNCBusincva fP uiom Codeandmylia=ls REMODEL ROOF L GARAGE CHG TO PITCHROOF, REPLACE
O N in full force aM e
LicenYclaas Lica WOOD SHAKES W/ASPHALT COMP CLASS A 400 SQ.
h, Date ComaDECcC
J R RS ATION
111 d Y • uud as Public
Dau
a a Liceruc csdonal V -
5 3 OWNER-BUILDER DECLARATION
1 I hereby alarm Net I am exempt from the fusnom Co e:A License taw for Oe
is p O following mason.tWait 17(B I3.Business and w.de oli Cade:Any dry s c,unry
$vo which acquires a permit re uimmet.alcor,improv,h Noah t m repair ed sHrmum
Zy Inormits issuance,alsu mquims tM applicant far such Noah to fileasignM sutemcm
ss< that he is licensed Incident to the provisicensof the Contractors Uccaac Law(Charter 9Sq.FI. Floor Area Valuation
sF$ (Whomeming with Section 1000)of Division 3 of the Business and Profession Cade)or $50000
Q that he is exempt therefrom and the basis fa the alleged exemption.Any violation of
SeNon 70313 by tory applleant for a permit subjects the applicant to a civil pc halty ofNumber Occupancy
net mare than five hanmed dollar,(Lim). 3 2 619 0 7 9 V64 P Y Type
1,m owner of Rie property.m my emplo m with waxes m Nebsolc cmmp=non,
and Professions,
esoda: swctumucotHunaed Law dofatale(Sec.anal.Business
and otywh oIn Code:The Contractors Liarho Law dam not apply lf an mvner is Required Inspections
property who buildaaimpmws Merton,and who ares smhwerk M1imaelf ol through his '
however,
provided that such improvements are WE iateMW aaRrsW forage.B.
builder Neon ingft orimprowmmtislsa within noneyear orcanolve forpur,azar-
builds will love Ile burden of proving Nat he did cot arta or improve for Puryose of
sok.).
❑I,as owner of He Propcny,am exclusively contracting with limned cnneacmn to
cornet the project(See.7014,Business and R cession Cade:)The Contractor's U. .
came Law dace not apply m an owns of propcny who builds or Improves Hereon,and.
who tamers for such projects with a cenuucror(p licensed pmauant no the Contractor
License Law.
Cl l am exempt under See .B&P C for this won
ner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penlly of perjury am of the following declaration:
safloinave•rad ids maidismection3uH of Conantmsest far ran f ss rich this
far by section 3'!00 of the labs Code.Lor the lerformada of Ne
work for which Nis permit is issued. '
❑1 have and will maintain workers Compensation Insurance,as mquired by Section
3700 of the Labor Calc,fa the perfomanee of Ne work,for which Nu permit is Ended, '
My Workers Compensati,n hrY,pR�g lir. and Policy number are.
Cartier.A; Csl"1�11�.ra PvnPolicyNo.: C-15gob?40
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
monk xcOm neW tee bcc,mpleted if de Lacon is foram hundmd dollars(Lim)
or less)
1 malty that in the terformarce of the work for which this Nowit in isaed.I Nall cot
employ any poser in any mmnerso as H become subject a Ne Woken'Cron,mame
Laws of Ctl;famia.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
baome subject to the Workers Campemation p avisiom of than labor Cade,you most
.,z fommilh comply with such Previsions he this Permit shall be deemed mwkcd.
z 'r CONSr0.UL71ON LENDING AGENCY
H> de wocklfawhi�lmhn�tY isacomructinn lending agency for Ne PcRamuae of
a wrmit in issuW(Sec.3097.Civ.Ca
LLl Q larder's Name
z Lcomes Addw
V Q 1 anify Nat I hast rtad this application and state that the above informatiun is
Py F mma 1 agree to comply with all city and cowry,rdinmaee artd suis laws relating m 1
0 building coruutelim,and hereby auNorm representatives of this city u tour none de
F Gabove-mentioned joemny for insmWan Purposes
(We)agree H saw.indemnify and keep harmless IM city of Cupenim against
rn lisb;litica,judgmenMWon;and expenYa which may to any way accrue against said City
(„)z in consegnence r( 6ranunL of i""KILL
e it.
tti APPLICANT ERS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date S SOUP d 0 �`�TIDre
Slgnat o AppllanM ). Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the.,Pliant or far.building occupant mm orh.hd]c hvusms m•mnal
as&flnN by ftCupenim Municipal Cade.Chapter 9.11,and the Health arta Safety
One.Section 25531(x)?
O (A/m--
All roofs shall be inspected prior to any roofing material being installed.
tio `ygN
Will Ne, heart or coram holding—Pat� If a roof is installed without first obtaining an inspection,I agree to remove
Ice a w waiPmmt a devices a mmn g P g
emit hvardnn air contami ts as dcOnN by tics Dry Area Air Quality Management all new materials for inspection.
Dovics? P
❑Yes u
I have read the nvudtwmamnak mquimments under CleptarE95 of the Califor.
nu Heats &S yCade kai 25505. 533ar M534.ItaWcnundthatiftse Wilding
Jou cot dY haw• I my resp,nsihiliry H notify the.'art of the
rcyul whicym Ino ;YaaneenncanifeateofaaP,ncy. Signature of Applicant Date
Owner nor•athan>caa t Dam - All roof coverings to be Class'Y•'or better