06020125 CITY OF CUPERTINO . ` ^••��'
BUILDING DIVISION PERMIT (.CpNTRtCTUR`�INURMA"C-IC1NN
BU"LDINGADDROS: N ITKE & JUDY HART PERMIT No.06020125
10868 NORTHSHORE S
HER'S NAME: FERMITISUEDATE
KEVIN AITKEN & JUDY HART 02/22/2006
PHONE: SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB
MECH
O
30o LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby&farm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Count,and my license is
? � imfull force land affect. ADD 3 SKYLITS/2 SUN TUNNELS,
;nZ License Class Lie.M
Dem C.ntracm, 9 RECESSED LITS
q ARCHITECTS DECLARATION
2
[understand my plans&hall he used u public mummat
5y
k Licensed Professional
my3 OWNER-BUILDERDECLARATIONCLARATION
f 1 hereby.(Sten ut I am excmpl from do Cosicuts c License Law for tic
i e D which ng rc.son.(Soon 703 IS.Business and Psafudon Cade:My city os county
_m which its i su a permit to quiesConstruct.Alter.Improve,dernh permit
er it t ore a sig any ttmcam
pdormits iuuana,elw,.guise&tic applicator for such parmitmfile asignu(Chartent
m�•< mat he is licensed pursuant mNepmvisionsofthe Contractor's U=wLaw(Chapmr9 Sq.Ft. Floor Area Valuati
yF$ (commencing with Section 7000)of Division 3 of the Busirworamd Pmfesson.Code)or
.. that he Is attempt therefrom and ate basis for the Alleged exemption.My violation of ,4�{p�7�;�7as,.iptpsy,'y
Section 7031.5 by any spplicam for a permit subjects the applicanuo a civil penalty of 3 1 O D O V.S /, 0 0 Occupancy Type
not more Nan fin hundred dollars($SW).
0 1,u owner of the pmpeny,or my employees with wages As their sole compensation,
will de the.,it.end themucthrc isnot intended wagered for sale(Sm.7044.Business Required Inspections
and Professions Code:The Consommes Lieeme Law don not apply to an owner of q P
property who builds or improves thereon,and who doessuchwwk himself orthrough his
awn employees,provided that such improvements are natimended oro0emd for ale.It.
however.the building or Impmwment is gold within one year of compledon,the owner.
builder will haw the human of proving that he did net build or Improve for purpose of
.I.J.
V.I.as Owner of she property,am exclusively contracting wish licensed contracmn m
construct she pmject(Sec.7044,Business and Professions Code:)The Conuacm(s Li.
cence law don not apply he an Owner of pmpeny.who builds or improves Neon.and.
who concocts for such pet with a contractor(s)licensed pursuant se NA Contractor's
License Law.
❑lame sept un uSa .B At PC .do;
surae
nee Datatal
tV
WORKERS C M ION DECLARATION
mby a—Mmt under penally of perjury one of lie following declaration:
❑I ban and will maintain sCenifinte of Consent on self-inure for WormesCorrpen-
sation,As provided for by Section 3700 of site Labor Code,for do performance of the
work for which this permit is issned.
❑1 haveland will maintain Worker's Compensation Imuranm,As rcquined by Section
37W of NO Labor Codc,for the performance of the work for which this permit is issued.
My Worker',Compensation Insurance carrier and Policy number am:
Carder: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This=am need not x complemd!film permit Is foranc hundred dollars($100)
or IASL)
I unify that In she performance of the work for which this permit Is issued.I shall not
employ anypermn In any manne ma o ao. ubj t to Ne Workers'Compensation
L.W!ofcw Ise. +tc,,.1.40 se � —
Applkant COLI._ MA/1 P
NOTICE TO P CANT:If.Compensation
t pr esi am of Exemption,you should
became subject y it Worker's Camp or this permit
be of she tned r Code.you most
.J O foMwith ample with such provisions or this permiuhAll bo damcd revoked.
Z 0CONSTRUCTION LENDING AGENCY
[—� Thereby afar.that Nem is aansuuc,mo landing agency(.she performs..Of
CL the.,it fur which do.permit B issued(See.3097,Ci,C.)
Qlend.,',Name
z lender'&Address
V 0 1 certify that I have read this Application and tum 0.1 she shove Information Is
D,F Correct,I agree m comply wife&11 city and county ordinances and sure laws relating to
0 building construction,and hereby auNodm represeroutins of this city to enter upon the
Lk7 ehovomentitncd property for Inspection purposes.
!F^y gy (We)agree to saw,indemnify and keep',useless the City of Cupertino against
t!) IiAbilities,judgments.costs and exp rims which may In any way&=Me against said City
V 7 in consequence of the granting of this permit.
a7 APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON•POINr Issued by: Date 2 2---L-`O
��RCE T s
I� Re-roofs
r o Applies ARDO am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Accupout Fellate n handle h alth Ro mauety
As defined by the Cupertino Municip ask.Chapter 9.12,and the Health and Safetyode,Secll 25532()7 All roofs shall be inspected prior to any roofing material being installed.
Yn a
Will the applicant or future building=upon,use equipment u dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
emit huamous air conuminnu u food by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Ya
I haw mad he hevamr.a mamrialsmquiremem under Chaper6.95 ordw Caller.
nia Heulthk$afelyCo ,SecfinMMM5,25533425534.1undersush
ntl .ifdmhuiiding
does not currently Iran a unset.Nm Itis y pomi 'Ihy m ea l l'y the.:cupant of Ne
u menu kh hem tui u eniframofOm er. Signature of Applicant Date
iR
Ora,.mmadreaasem Dam 6 All roof coverings to be Class"B"or better