05060157 CITYOFCUPERTINO a� "
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BUILDING DIVISION PERMIT tSNTRA iTOR TNF'ORMA IO,PfP
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BUILDING ADDRESS: PERMIT N0.05060157
10310 MORETTI DR
Elts NAME: PERMIT ISSUE DATE
ANDY—V= A 08/10/2005
uE; SANITARY NO. CONTROL NO.
✓_.CHITECf2NGINEER: BUILDING PERMIT INFO
- BLDG ELECT PLQ MFCIH
O
g0Z LICENSEDCONDLACIOWSDECLkRATION Job Description
I hereby aflUm Net I rte livened under provisions of Clupter 9(commencing ,(�I
O i/P
with Section 7000)of Division 3 of the Business and Profession+Code.mad my licensh j (� A�
^ in full force and cfr=L ADD ti'}FQRteBATW
?�? Licen e,Class Lk.At v
3 Dale ARCHITECTS DECLARATION -`
I understand my pWu slWl he used as public mcoda /y I�Z¢-
> t1 p
°W
Licensed Professional
O OWNER-BUILDER mDECLARATION
I hereby.(sero that 1 1. .Bumps from the Carnot :License law for the
O 0 following mason.(section 7(131.!. t.alias W Pne.do all Code:MY city Or county
$ which requires•permit m curls the alar,improve.demolish.Ile a sig arty awetum
pow mits issuance.aiso requiesthe Applicant far each lermitm Rle atigued mmmcm Valuation
{F< thatheislimnsedpuravantmdmprovisions of the Courteou'License Law(Chapter 9 Sq.FL
!Sg (cmnmencins with Smdon70O0)Of Div4ion3of the Bmineumul Pmfmsions C.de)w $].8000
that k is exempt therefrom and the basis for the alleged evmpllon.Any violation of
Section 70313 by any applicant for a permit[objects the applicant u a Civil Penalty of APN Number Occupancy Type
nm more Dun five hundred do11strd(M).
❑h As net of the Property,or my mni loym with wage As Neirsole mmpew0m.
wind.thewoh,and thesuumumisnot lntaWedwaRered fatale(Sm.701A,Busircad EH
Required Inspections
Add Potassium Code:The Comminute,LiamLaw does rot apply m an owner of q P
property who builds orimpoves tereon.aM whodoessuch wok Moselfor Waugh his
Own employees,provided that such improvements art not OtentlW murkiest forsale.If.
however,the building or improvement 4 mid within one year of compledon,Ne Owner
Wilder win have the Met of proving that Its did nm Mid Or improw fm purpose of
❑1,as owner of the property am exclusively coma ting with licensed mnuaemrs to
construct the pmjeu(See.7014,Business and Professions Code:)The Contramm's U.
¢roe Law does not apply m an mass of property who builds or improves thereon,and
who contracts for such pejecu with a contrmtor(O licensed pursuant m the Contmetara
License Law.
❑I am exempt
under Sec.
BR P C for this mason
!oiesses
A•-rf� V --7�Dau lg 0WORKER'S COMPENSATION DECLARATION
1 hereby arlrm under pettslty of perjury one of the following decimations:
m and will mainWn a Cemftcau of Consent m salt-htsum fm WmkraCompm-
u provided fm by Section 37M of the labor Code.fm the performance of Oewoor which this permit is issued.❑ aw and will maintain Worlors Compensation lammed.as required by Section
37f ase Labor Cade,far the performance of the work for which this permit it Issued.
MCompewOon Ineu tame curler and Policy number are:
Caller. Policy N..:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
o@issection need not he completed lithe Prrmit 4 for one hundred dollars(SI00)
.rima.)
I certify that in the performance of the work for which this permit is issued,I shall net
employ any person in any manner m n m become subJmua tM^arkcn'Compew0on
lava of California Dal
Applicant
NOTICE TO AP - :sIf.a r making pr Certificate M Latur Exemption,you shmust
become subject y the Workerro Loons or this
ermiitshal of the labor Code.you masa
O forthwith comply with such provisions or Nu permitshill be dcomW revoked.
tiCONSTRUCTION LENDING AGENCY
(•+ l leeby affirm that them isaconstruction lending agency ler the performance or
!Yi the work for which this Permit 4 Issued(Sm.3097,Civ.C.)
aQ Landers Name
Z IaWers Addeo
V O I comfy that 1 have read this appnution aW sue teat de[bow informal.4 -
lL correct.l agtm to comply with all city and county ordinances and stab laws relating to
O U building conduction.and hereby authorise repouunutiws of this city m enter upon tie
W. ahow-mentioned property for inspection purposat
(We)agree to save,indemnify and kap humlw the City of Cupedna against
III Ilabilides judgments.emu and expenses which may In any way accrue against said City
Cj 7 in consequence of the gaming of this permit.
L� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -(D-O�'
SOURCE RE✓GU2L�A�TII{�ON�v'/$' q,��y
sign[ /rAywnUCanmaim cmr '"'/0� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or fuzee building occupant team nr handle hamdous material
°s de0ned by du Canadian Municipal Code,Chapter 9.13.°W the Health and Safety
soden ns33(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑
Yes
Will the applicant or rumm building Occupant um equipment at devices which
If a roof is installed without first obtaining an inspection,I agree to remove
ha"W'out air conuminanu U derided by the Bay Arca Air Quality Management all new materials for inspection.
C17
❑Yes
Ihaw eW me hmadnmmamdata requirements under Chapurd.95ofthe Glifor.
n4HcalWkBafGy Codc,Seen=25505.35533 and 33334.1 understand thulfthe Wilding
dos col currently have•enanl Nu it it my espomlhilitY m notify de occupant of We
mquiremcntawhich OR fasslpdor Iuuanccofaccnincamoroced, gnature of Applicant Date
r. � 6 4 Ts'
Ow.erur t Orisedagent Dam All roof coverings to be Class"B"or better