03110115 .:CITY OF CUPERTINO ' ' �"
BUILDING DIVISION PERMIT AkCQAiTRA tQ kINFORMATION
.ING ADDRESS: GREATER BAY CONSTRUCTION PE "No03110115
10695 QRLTNE CT LOT -1
ER'S NAME: PERMIT ISSUE DATE
GB ESTATE HOMES SUITE 2
NE: SANITARY NO. CONTROL NO.
(408) 248-6600
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PWMB MECH
u0o LICENSED CONTRACTOR'S DECLARATION O O O O
YwF 1 hereby affirm that I am licensed under provisions of Chapter 9(Commencing Job Description
<Zty with Section 7(k(u)of Division 3 of the Business atN Profession Code,and my liccrsse is
�� infull force eff"` SFDWL-ONE STORY LIVING 3138 SQ FT
j=D? License Cleo LK.R
a Dam Contractor GARAGE 634 SQ FT
tt ARCHITECTS DECLARATION
Z 1 understand my plans shall be mad as public denies
Oyu
C G Licensed Rafcssimnal
5 OWNER-BUILDER DECLARATION
0 I hereby affirm Our 1am 1. .exempt from tW Contractor's License Law for the
i p O following mama.(Section 11131.5.Business and improve.
de sou Cale:Any[an or county
which tequins a Permit to amnmct.iodic improv,dmmmsh,fie aligned
any suecwm
FIy deur W its versed .elm mquirestM applicantfor much permit to file asigncdaatemcm
W (denh.comnimingwii pSmi n7")ofUi suoftr ft Bu ant's d ftclaw(Chapter9 Sq. FL Floor Area Va�11}t(AP9'z0 .
set=-$ (wooexcept
ith Sceffern nd of bulkof r th NC B ed exemption.
anti on.Anynns CsWc)of
y�- Wt back exempt thert(rom and the basis far IW alleged exemption.Any violation of
Samote031.0.fere any
hunatpppltddlenor a permit
er it subjects On applicant to a civil Penalty of APN Number Occupancy Type
am IT,uowm.of Nepropwy.mmyemploycuwiNwg uNe mlecompensadon, 35922076 . 00
will do the work and the structure is not intended Or offered forsale(Sec.7W.Business
and Profusions Code:The Convectors License law does not appy W an owrcr of Required Inspectio
propeny who builds or i m prows Neeson,and who docs s uch work himse If or through his
own cmployces,provided that such imphramum e,are not intended m.11h red fm.m.If.
however,the building or improvement is said within one year of mmpleuon,she owner.
builder will have the burden of proving that he did nor Wild or improve for purpose of
u .).
1,u owner of ere property am uduiwly contracting with licensed cartus cters In
c muss Ne pmjea(Sec.?W,Businessand Profusions Code:)The Conmcmri Li.
case law dos not apply to anowner of property who Wilds or improvesthemon,and
who contacts for such projects with a coneacrorud licensed pursuant m the Contractors
Licnse law.
01 am tempt under Sea ,B&PCf th reason
Dau_�
WO COMPENSATION DECLARATION
1 thereby aRfm under penalty of perjury one of Ne following deelt ntiou:
1 haw and will maintain aCenillau of Consent m self-insure for Workers Compen-
ution,as provided fm by Section 37W of the Labor Coda.fm the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation buuramec,u required by Section
37M of the tato Cade,for the pcRorromen of the work for which this permit is issued.
My Workers Cter,n.tion Insurance card.and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(TTH section need not W camplemd if rW p.mit is inform hundred dollars($101)
or muss)
1 certify that in Nm performance of On work for which this Permit is issued,I shall not -
employ any person in any manner an as W became subject to the Workers'Compensaden
Laws of California.Date
Applicant
NOTICE TO APPLICANT:Ir,after making this Cmnificate of Exemption,you should
become subject m the Workess Compensation previsions of IW labor Code,you must
.,,Z formwith comply with such provisions or this permit shall be dmemed mmkcd.
Z Q CONSTRUCTION LENDING AGENCY
E-' 1 thereby strum that Nen is a construction lending agency lot the performance of t
rL> the work for which this permit is issued(Sec.3097.CO.C.)
W�Q Lender's Name
Z Leader'sAddress
U Q 1 o reify Nat I haw rad Nis application and sum Our the above information is
it, r correct.1 agree to comply with all city and county ordinances and sum maws elating in
U Wilding construction,and hereby aulbotim mpreacnutives or this city m enter upon the
U Z a consequence of On framing
min iofthis umit. sea
(we).gra W cove,indemnify and keep hands.the City of Cupertino agaiut
Fy liabilities,judgments,code,and a.,.which may in any vnyace.agaeat said City
C.3 z inconsequence of the granting of this permit.
.. APPLICAbIT UNOURCEREGULATIR N SAND WILL COMPLY WI ALL ON-POINT Issued by: Date
SOURCEREGUL!
�
5ignaruteof Appli cOU p.
e
HAZARDOUS Re-roofs
MATERIALS DISCLOSURE Type of Roof
Will tW applicant or future building occupant store or handle huardou materiai
defined by tW Cuperead Municipal Code.Chapter 9.11,and the Health and Safety
c,Sceuon 15532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Will Yuthe applicant or, a
If a roof is installed without first obtaining inspection,I agree to remove
mum building mccupam use cyuipmcm or Jcvices which g an p
it Marin.air comand a as doped by the Bay Area Air Quality Management all new materials for inspection.
Disuicr? ` _
CY. Q�Nu
I have rad the hmafdn ..serials nq.inmcnts.aderChapter6.95afOaCalifor-
nQHcalth&SH
Samu255p5,25533and255M.lunhrvandthmiftidi Wilding
dem rpt curean, tomo.Nat h is my responsibility W otiII the p:c.P. L or the
requiter on utilmanaoisCemh to of aparmy. Signature of Applicant Date
Owner or as Ad agent .m I All roof coverings to be Class "B"or better