06050178 CITY OF CUPERTINOa..a =cmea�v}x .sa "�"°` ����`` ''
BUILDING DIVISION PERMIT �nItN'kQRMA'TIa
BUILDING ADDRESS: a4 CHENE MON—REN ET AL PERMITN0.06050178
7554 NORMANDY WAY
OWNER'S NAME: PERMIT ISSUE DATE
CHENE MON-REN ET AL 7554 NORMANDY WA 6
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
IO EO PLO MECH
3a iJ LICENSED CONTRACTOR'S DECLARATION Job Description
�n<p�
F 1 bemby affirm Nu 1 am licensed unsr pmvis one of CWpmr 9(eommaneing
-m`� with Section 70M)afDivision 3 ofthe Business and Profoulans Cada,and my license 1.
in full fame and eff.L 4401 1-STORY ADDITION: MASTER SUITE, LIVING, DE
�?_Z `D;enec°"' crones FAMILY ROOM, KITCHEN, LAUNDRY & DINING
ARCHITECT'S DECLARATION
I mtecnsnd my pit. hall W trued as public reemcia
bCt LoProfessional
OWNER-BUILDER from
DECLARATION
I Wmhy.affirm that 11. aempt from the l a Ines Co :My C tyw fm the
O O (allowing mason.(Scotian 703 1.5,Business and rile.de oli Cas:Any oily Of county
S$ which requlms a permit re ecredthe ales hnpmve,demolish.t ri repair any avuclum
—zY
prior miu issuance,also required the Applicantforwch Permit rile asigned sutemcm Va 5108000
pp <
that he Is licensed purneent Us ft provisions of the Commuclor',1.1come Law(Chapter 9 Sq.Ft. Floor Area
y�$ (commencing with Section 7000)of Division 3 of the Busineu and Pmfoshme Code)Of
Q Nat he k exempt thereftam and the basis for Ile alleged eumpdma Any HOlatian of
Section 7031.3 by any applicant for a permit wbjecs dee applicant to a civil penny of Njlilller Occupancy Type
.at mom than Dw hundred dollam($300). 3 6(j 17(J fj 5 . 0 0
❑1,u owner of the prepeny,army employers with wagesu deev role eomplauation,
win douewmM,and de,sentence enotkmnadmoffered liesule(Se<.7ofal.Basement RequiredInsr�pctions
affect P1,11,111 Cade Tie COmY4YM's LILTwL'Law data Out apply m an Carol of Inspections
who builds or ire prover thvean,and who does such work bimvJf der theough his
Own employees,provided thmsuah impmvemenri arc not Intended oroQemd ferule.IL
however,the building m improvement is Gold wlthmans year ofcompledon.the owner-
builder will have the burden of proving teethe did rot Wild or improve for purpose of
Ea owner W die property,Gra esGusiwlY Contracting with licensed annaactms m
wet the project(Sec.7094.Becineu and Prolamines Cade:)The Commences Li-
rove Law does not apply an an Owner of property who Wilds at imperwa thereon,and,
who ce scents fm such protasis with a anuutertU limned punwm m Ibo COntexteh
Iheve law.
forrescrairlatilder aPCfards
owner Data
OG
WORKERS COMPENSATION DECLARATION
1 hereby,aft under penalty of Perjury oro of the fallowing declarations:
I ham and will maintain acenifieate of Covent in self4nwre(m Workces Cout
titian,u provided for by Section 3700 of the Labor Code,fm dee performance of thc
wart for which this permit is Issued.
❑1 haw and will maintain Wersces Campemadon Inwrua,as required by Section
37M of the l,bm Cod,fm the pertmm.neea(the watt far which this perms la uveas '
My Worlses Compew0an Inwrana ariu and Policy number am:
Cartier. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(TMs radon ateN notboeampkted If the permit is!mune huMred Moan(SIM)
or Imo)
1 unity that in the performance of the work for which this permit is Lewd,l shall am
cmployanYpersoninanY mannewop brmmo wbjea m the WOd¢rs'Comprometi ,
Laws of Calif.rry� O/1..P-�L
Applicant /Ni,�Kd
NOTICE A PLI NT:IL after making Nu CemRcete of EumPti s".you ahwid
became subjM an the Worker's Compenutlon provisions of the labor Cade.you must
.JO forthwith comply wide such Provisions m this permit shall W desired ermined.
Z� CONSTRUCrION LENDING AGENCY
t%v I Wreby afRrm that alert u a cmwmc0an lending agency for the perfevesevx of
the work for which this permit Is Lsned(Sec.3097,Civ.C,)
4 Q Lorimer Name
Z LUnices Antras
U 1 certify that 1 Mm rmd this application real same that the above informasian k
I[. Fcarmen I agme m comply with all city and county oNinames and slats lawn milling W
U building conwuction,and hereby authorin rtPxs"U'ixs of this city in enter upon the
44F above-mliuctrt
cnned property for insi,con purposes.(We)agree to an.indemnify and keep harmless dee City of Cupertino ageitrl
Til liatelides,judgments,emu aM expenses which may in any way aanm aNnst saidCity
U in consequence of the granting of this prnnit. /J p
^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C. a
SOURCE LA NS.
'61V1016— Re-roofs
sl amarAppOcanbConua te Drs T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or forum bWlding occu netsoore or handle husrdoes maumial
U deMcd by tui Cupertino Municipal Cos.Chapter 9.12.and the Health and Safety
Code,soothe 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes W51
Will aha applicator or foram Wilding accupam dew cquipmem or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
m4 haumnu air contamficus no
sOned by dee Bay Am Air Quality Management all new materials for inspection.
D suicR
❑Ya No
1 ban read the hvgNaus materials requirements Order Chapter 6.95 of Ile Califor-
not t Hutdek Safety Cade,Sections 25M.25533 and 25534.1 uMcmud that lfdte building
dna nut currently haw a tenant,this It is my nespanslbr iky m nadfy IN Occupant of the
myuimnte lehtn Wmet prior aafaccnirmalef,ofaup�a� Signature of Applicant _ Date
rri�d a=cn-.I D,m All roof coverings to be Class"B"Or better
Garner anude