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05080258 CITY OF CUPERTINO BUILDING DIVISION PERMIT CLINTRACTNFORMATION `"I BUILDING ADDRESS: HUTCHINGS CO. /HARMONEY SO MITNo.05080258 10042 MOSSY OAK ( T '.R'S NAME: PERMIT ISSUE DATE JOSEPH & JANET VENTIMIGLIA 4754 DENEVI DR. Q2/26/2005 ONE: SANITARY NO. CONTROL NO. (408) 966-6676 ARCHITECfrENGINEER: BUILDING PERMIT INFO BLDG EIPCi PLUMB MECH X00 LICENSED CONTRACTOR'S DECLARATION 0 0 0 �w,FWF I ion? a)Orm d ander nd Noi is of Chapter 9(commuting lob Deserip[i;tt� I]^�� � y, with SOetion 7BlkBi that Iam lido Bd nwand Profession hapten ndm license is [©I^� [)\ !I nen in full force ander i. SOLAR ELECT. (RROF MOUNTED fj j}�i Liccvc w Lk.M t✓...1„ �o Date —� —0 t— Contractor CONTRACTOR: HUTCHINGS CO. e W ARCHITECTECL S DARATION ^ w< I u�cnond my plans shall be used u public sands OCT t{tS 2005 ZW' Licensed Professional 5 OWNER-BUILDER DECLARATION v,f 1 hcrchy arrnn that I em exempt from the ComractoYs License Law for the 00 following..on.(Seed..RD 1.5,Business and Proftssium Calc:Any city or county which requires a permit to construes,ale,,improve,demolish,or repair any suucmm prior to its issuance.also requires the applicant for such permit to file a signed staemem Eso that he is licensed puraa.ntmthe provisions ofthe,commemrslucenuLaw(Chapter 9 Sq. Ft. Floor Area Valu tbg000 y F-$ (commencing with Section 7000)of Division 3 of the Business and Profcasions Citric)or — Nat he,H exempt theroferm and the bull for the alleged exemption,Any violation of Section 7031.5 by arty applicant for.permit subjects Nc applicant m.civil penalty of APN Number Occupancy Type not mere than five hundred dollars(5500). 34232108 . 00 p y YP 0 I,m owner of lM pmpeny m my employees with wgu u t6cir sole compensation, will do Nc work.end Ne rwcme is not intended a offered Rustle(Sec.7liul Business rofessn and PioCode:The CoaVacmri Liccous,law does Out apply to an Owner of Required Inspections property who Wildsmimproves Nemo.,end whodoessuch work himself Or through his Own employers.probided Nat such improvements me not intended oronead fatale.If. however,the building or improvement is sold within one year Of completion,the owher. builder will have the burden of proving that he did not build or impmw for purpose of - sale.). 1,as owner of the property,am exclusively contracting with licensed contractors to construct the pmjca(Sec.7044,Businw and Professions Code:)The Conlracher's Li. eeme law dors not apply to an Owner or property who builds or impress thereon,and , who contracts for such ejects with a contractor(s)licensed pursuant to the Contractor's License taw. I am exempt under Sec. ,B&P C for this reason er Date WORKER'S COMPENSATION DECLARATION 1 hereby an.under,peoafy of perjury one of the following dalmatians: 1 have and will maintain aCcoiOeate of C.menuo self-Insure far Worker'sCanpen- satiem,as provided for by Section 37010.1'the labor Code,for the perfmmance of the .,it for which Nir permit is issued. ❑1 have and will maintain Wontces Compensation Iwrant ,u required by Section 37W.f thc labor Code,for the perfirmane fdh work for which this permit is issued. My Workeryy Camp nation Imuran.a 'rand Policy /f bcr.are: cmriccS Policy No.IYeZ t3y _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Iris sectio need..)becompkied lithe permit is force hundred dollars(5100) _ Or leas) I cenify Nat in the penfirmaac of the.,it for which this permit is issued,l shall not employ any person in any nuo nerso u to become subject to the Workaw Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT:If,anis meting than Ccrtifca2 of Exemption,you should become subject to the Worker's Compensation provisions of NO labor Code,you most .,O fuMwith comply with such prnvislam or this permit shall he doomed revoked. P'y CONSTRUCTION LENDING AGENCY (-� l hi afOrm that then is aeormsuudi.n kndingapeny,Jul Ne perfumnna of, ai the work for which his permit is issued(Sec.3097,Civ.C.) dQ Lender's Name O z LendersAddress U O 1 certify that I have read W a application and sou Nu Ne above information is FConed I agree to comply with all city and county oniinanas and sato laws misting to OU building convection,and hereby authorize representatives of this city to Omer upon the }W ahnc-mentioned property fn imKelujon p opx,O& (We)agree to ave,indemnify and keep Wool.the City of Cupcniao against Z Iiabilitmijudgments,emts and expenses which may in any way acmeagaimt said City of U Z roto ICANTeof due UNDERSTANDS AIs Permit. ND WI L COMPLY WITH ALL NON-POINT Issued by: Date SO R EREGULATIO Signalof AP uCOn r Die^ Re-roofs HAZARDOUS MATERIA DISCLOSURE Type of Roof Will the applicant or future building occupant store or hurdle ha]didaua material u defined by No Cupertino Municipal Cak.Chapter 9.13.and he Health and Safety e.section 25532(a)7 ON.❑res All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant of future building Occupant use equipment or devices which p mit haaardou air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. Diurict7 B YO. ON. I have mad the hazarNms materials requirements under Chapter 6.95 of the Califor- nia th&SafelyCodc,Satiore 25505,25533 and 25534.1 undcmaM that ifthe Wilding not nmol,hove,um nt Nat 11 ex to po ility m.ally the acupant Of thc requi on xwNehmurl met ri mi C. ccrdfic,eof«cup..ey. Signature of Applicant Date Owar.reu adapem Dow All roof coverings to be Class "B"or better