08020111 CITY OF CUPERTINOy{��('g`"'"'! "
BUILDING DIVISION PERMIT � Lvl"l i�l'1 � R rQ^ '^^ kN
PERMITNO.
Bu1LDINTF'hATHANSON AVE LAZER CONSTRUCTION 08020111
STS NAME: PERMIT ISSUE DATE
BONELLI ERNEST J AND HELEN L 665 CHAUNCEY WAY 03/24/2008
PHONE: SANITARY NO, CONTROL NO.
(408) 286-8466
ARCHRECT/ENGINEM BUILDING PERMITINFO
D EO FLUME
O O
�oo LICENSED CONTRACTORS DECLARATION t
ei1 hereby atm Thu 1 am Ikxrved mWcr Prownims.(ehopter 9(rnmrromem{ Job Description
< with Section7")ofDiroonSofthcBhol.andprufsssionscode, dmylicenseis KITCHEN, FAM RM & 1/2 BATH & LNDRY RM
3 uUUI^l rosea atw elrect,� Lie.. �'T REMODEL.LAZ ER
D
Dow ARCHITECTSDDECugrsl�32
awnO CONSTRUCTION RENEWED BUS LIC, 24324, 2/19/8
U I undermend my pkat"I he wad an public menthe
si t Licensed Professional
h OWNER-BUILDER DECLARATION
gS I bomb, M.that 1 em exempt from the Conwmtars License law for the
40 following....(Section 7031.5.Bainess and Profesaians Codc:Any city or county
9 which requires•penal(to cmturutL alter.Improve.demolish,m.:Pair my museum
Z„ prior ta its issuance,also requires this applicator for such Permit to file a signed comment
< was,hculicensed pmam(mtheprovisions ofdwcommunes ueshow aw(chapter9 Sq.FL Floor Area Valuation
9 (eommencingwith SeNon7000)ofDivision 3ofdcBusiness and ProfessionsCobs)or $75000
`c that he is attempt therefrom and the basis for the aileged exemption.Any violation of
Section 7031.5 by say applicant for a permit subjects the applicant to a civil penalty of �p Number Occupancy Type
ass more such five hundred dollars(5300). 32643014:(
0 1.a owner ofth pmpmy.ser my raployas with wgo o dmbmlecompemdm,
willde themark,and IheswcWntsnoti mndedoroRered farsaie(Scc.70M.Bullnose
and Pronalsom CadC License re
The Cm acmes Lletaw down apply to m aMKf of Required Inspections
property who buildaarimproa sther.n,and who doeso.haorkhimulf.rthrough bis
own employme,provided On such improvements are not intended oraneted for now.It.
haweve;th have the or dmprovemantg war he did enc ruld of improve
far the oww-
builhr will have W buNan of proving Nat h did ret.5.51.5 or Improve far pumas of
ask.).
0 1,u owner of the property,w e.muaively comewaing with licensed cenmcmrs to
cmuu.n the pnejem(sec,704.[Instances am Professions Cotler)The canux7afs U.
..law dons not apply to an owner a pmpeny who builds or impmws thereon.aW,
who commis for awch prejeets with a eamlmmr(1)licensed personal in the Contractors -
I Items Law.
0 lamuemptundersee. .Bt Pcforthltreasen '
or Dam
WORKERS COMPENSATION DECLARATION
I hereby alNm under penalty of perjury,am of the following declattdowe
0 1 haat atW will eminWn a C rdlicam ofConsen(m self-Insure fur .WartcYsComFen-
adm,as provided fm by Smsum 3700 of the tabor Cade.far the perfmmutce of the
work for which this Permit is cued.
0 1 have and will maintain Wortrla Compensation InBwutee,as required by section
3700 of we lather Code.for the perform.of than work f«which oris permit k oma
My Worke�ey.Co�tu-ation nsunnce noire and POIiry number art:
CartiMx Paltry N.Ak* —7A 3—4.7
CERTIFICATE OFF MPI3oN FROM WORKERS
COMPENSATION INSURANCE
Than used.reednm h<orml ted Ifthe permit is forarc hundred dollars($100)
.kis)
I candly Nat In the performa.e of the work for which this permit is blued.I shall not
employ any person in my manrcrm w m became subject m lin Wartrss'ComperuNon
Laws of Califunia.Due
Applicant
NOTICE TO APPLICANT:If.ager mnsati this provisions
Certificate th EanborCoo you should
become subject
omp y the Worh pie Cmnpcoudon proit mal of the labor Code.You most
.J O fOnhwith comply with such proviai.ns or this omni,NJI h decnred motrQ
zr y CONSTRUCTION LENDING AGENCY
[-s I hereby alnme dust then is a construction lending agency for do performance of '
C the amk for which thin pemit 4 wised(Sec.3097.Civ.G
W�Q Lenders Name
]Z lenders Add.
U 0 1 anify mal l have reed this application and sum Ito the above Information L
U,!'�. .nen.I agree to comply with all city and county ommeces and sum law missing in
0 SU^ buildingconstruction,and hereby authorise repreenutives ofthis city m enter upon the
L[7 abave-mcnuaned prDpcny for InspeN.puryoas
C (We)agree to aux,indemnify and keep homeless the City of Columbus us against
,r W Ilabllitin,judgmenu,corm am expenses;which may In anyway amrc against said City
V Z in consequence of than grad.{of this pemil.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ej `-�
SOUR ITEC AT/I,g[k�
✓��s�r. -_2 se—Cd Re-roofs
- 3
SI tum of Applican✓Conl(alar 'Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building moupontnom or handle haudaus material
call
had by the Caparison Municipal Code,Chapter 9,13,tib the Health and lately
Smile.25532(.)1 All roofs shall be inspected prior to any roofing material being installed.
EI yaw JKNO
Will the applicant or future building ovmpan,sea equipmen(or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit haaNaas air cmum ums a dcflmd by the Bay Area Air Quality Management all new materials for inspection.
Dimict7
❑Yea O&No
I have mad tie hsardau materials requirements under Clupimh.95ofd¢Collier.
no Health&Surety Codc,SmUM255(15,25533 md25534.l understand thuifdte kidding
does rot cumndy hve.tenant,that It is my responsibility in notify the eccupant of the
mgmn�me w�an �m `mato. ar,CcnkatearOapucy. Signature of Applicant Date
w ice- 3 Z Fdy All roof coverings to be Class')."or better
Owrcr or authorised ager. Dote