08080118 CITY OF CUPERTINO , y�♦=q§azr�wwR'�' a4"
BUILDING DIVISION [y]i,RMIT COPaiR`C-To
BUILDING ADDRESS: PERMIT NO.
S7 NEWCASTLE DR BARRAGAN TILE CO 06080118
R'S NAME: - PERMIT ISSUE DATE
J 111)Y JOHNSON 1761. JUNCTION AVE 08/18/2008
ONE: SANITARY NO. CONTROL NO.
(408) 452-7830
ARCHITEC UENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION
I Mreby aBirtn that 1 am Ikcmeproes
d under vutaor Chopter,9(commencing Job Description
�i with Section 7010)of Dirlalon 3 ofine Buriness and Profasolum Code,and any license is BTHRM RMODEL, 25SQ
p in full force and effecl.
?�? License Class Lim.0
Dam Contractor
ARCHITECTS DECLARATION
Z 1 understand my pines Nall W used u public nmNr
gtad Licensed Pmfcmimal
ban OWNER-BUILDER CLARATION
ZQ S I bmaby.(firm Net I am eumpl from the icesm. o License Law for the
p O following me Rmaa. arroft 1 1vernm BYalaeli and PN.&mots Cade:Any city ver ramty
9 fLi which nqulroa a permit reconstruct.alkC Impmw,&permit or mpolr any hwctum
tithe itsiensedp aimpursuant
ntto me Nn provisions
for such permit NEksolgned Chmmenl
�
that he'a licensed pursuam to Ne pmvisioes of Nc Cannoneer License law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Sadon]000)af Divulon)of Ouse Busincu eM Prafrulam Code)or 12000
$ Nat W ts exempt mccefmm and me lass for dm alleged esamptims Any violation of
Section 7031.5 by eery applicant for a permit subiau the applicant to a civil penalty of 3 6 61.7 0 7 3 ��Number Occupancy Type
net more Nan five hundred dollars(M). P Y YP
1,u mnu of dm pmpwy,ver my employcu with mges a Neirwk compenudon,
will ho Newark,and was anet.6 aminkndcd moRered ransom(Sao.7(144.Bund.
and profession Code Tho Coovamrs License law does.t apply m ne OMNI of Required Inspections
pnpesty who buil&arimprows Nemon.mal whodom{mh work himselfor Duaugh his
awn employrn,provided mat soh improwmenu m not imendad oroRered fmule.if.
however.Ne building or Impmvement is sold within a.year of completion,an owner.
builder will love the burden of proving Nal W did not build or improve for purinew of
tale.).
1,a owner of Ne property,ours exclusively conoaning with Eaued contractors to
c wet Ne es not apply
t in Bmtnm and property
who
ds at h The Cmvumrs Lt-
came law saes not m m ownerse panpeny wce Wilds afimpmw thereon.and,
who contacts Law.for auto projects;with a.nuacm&)licensed pununt m the Contru.M1
License law.
❑lam uempr u�nder�Saee �y���.�}s_/� ,BhPC fm Nu mason
r gTj`7�i�y C/ �S1AnO DE aY D.m
WO ER's MPENSATION DECLARATION
I hereby alarm under peeslty of perjury ane of me(allowing declandonc
❑1hove andwill for
eCrni3am Come,
as Wmkr,Compthe
cation,r pmvi&d fpe mi Section 3700 of the labor Co&,(ver Ne peAammamx of the
work for which this permit is instant.
❑I hove and will maintain Woharr Compensation Insurance,as required by Saban
3700 M dte labor Code.far dm performance of the wank rarwhich d&permit is laced. '
My Warl&.CampenW.man.artier and Polity number tae:
Cartier, Polity No.:
CERTIFICATE OF EXEMPITON FROM WORKERS*
COMPENSATION INSURANCE
(rbc lactim owed not In cmnpkted lime permit Is faro a hundred dollwa(SIOD)
or khat) ,
1 certify that in Ne perfarea.e a the work for whit is permit u imucd.I Noll me
employ any Know In any mean. an 9w.t C1ma the Workeri Compensudon
Laws a(Califomiy,p SS JOU s /
Applwam 7 /
NOTICE TO APPLICANT:Writer ma nS t s Ccnifiam of Exemption.you Nwhl
Women subjm an the Water,Compensation provisions of the labor Code,you most
,J O foMwith comply with such pmvowns or Nu permit,h ill ho deemed mvekd.
z`i CONSTRUCTION LENDING AGENCY
[-+ IkmWhich umal spemersa wood
len ding agency for we perfo.ante of
ai ties work for which Nu permit 4 usced(Sec.]15'1,Civ.CJ
M Q
Lenders Name
5 U
,
z fanaeh AAdmu
U O 1 testify ma I hove read this application and sum Nu Ne shove information a
ly conal I agree to comply with all city and comty,ordinances and sum Iowa elating to
Wilding mnrtruetion,and hereby autharin npeconaw ima of Nu city to emus upon the
�y"yabove-mentioned property fm inspection purpmes
(Wit)agree to now.Indemnify and kmp hane was ties City of Cupertino against
cn liabilities,judgments.casts and expenses which may in any my acro against said City
U x in consequence of we leaning of Is permit.
F-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOS-p Issued by: Date
SOURGU N5. O g���O� �L-ytP
�'' TO V �/ Re-roofs
Sign um ofAp ae/Contrcmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will dre appliam or future Wilding occupant wort or lundk haurdam material
M❑YM by ties Cement.Municipal Code.Chapter 9.13,and the Health and Safety
.Section 25332(e)7
a {p All roofs shall be inspected prior to any roofing material being installed.
X(No
Will the applicant or/innttem Wilding m=upant ase aquiparent or devices which If a roof is installed without first obtaining an inspection,I agree to remove
omit huaNnm nit cmumiesnts as dented by the Bay Ana Air Quality Mmogemem all new materials for inspection.
❑Ya Ino
1 haw mad the�aud'mu materials nquinmm s umler Chmarli.95 often Califor.
nu HalN&SafetyCodc,Seen=25505,25533 and25534.I urubwana Net time Wilding
does hot carmay haw a man.was it a my nrposomil y 'fy de occupant of the
require m W met ' ins oL' 'f.mar �� - Signature of Applicant Date
S a !
ownam.mnariv d.gnnt Dam All roof coverings to be Class'J?."or better