04070010 CITY OF CUPERTINO
BUILDING DIVISION PERMIT dt%O' .,vN,<T- RA«' C'^T"�QpaR NF3VR1"AT� Nn"' -BUILDING ADDRESS: GREATER BAY CONSTRUCTION PERMITN%4070010
10705 ORLINE, CT- LOT 9.
OWNER'S NAME: PERMIT ISSUE DATE
idk GB ESTATE HOMSE SUITE 200 07/02 /2004
NE: SANITARY NO. CONTROL NO,
(408) 248-6600
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
sell. LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapin 9(commencing Job Description
ucj wl SSe en]IXNq of Division 3 of the Business and professions Code.and my license is
a=or in eandeffect. �d REVISION--TRUSS FRAME
Li Clan Lk.N
Dam contra NO NEW PERMIT ISSUED/ORIG. #03110114
TE OEC TION
i 1 understand my plans shall M mind ss public records
1yU
Licensed professional
3 OWNER-BUILDER DECLARATION
0I 1 hereby.(firm on 11. exempt from the Coad memr'a Any c Law for the
y20 whichivgrereaa Permit
t IlDIS,Buaitessand wn,derom Code:Any city or county
3 which rtquirus a issuance.also re constires the
etre.imprr such
h permit t fl repair ed ummum
Fly prior U)itaensedpalsore to the
pre inion of for such Permiuoiense Law slaemem
F <
that heiectingwJPuection7 )ofDivision
islomofoftheBusthe ines undPruLsonsCodmr9 Sq.Ft..Floor Area Valuati(7p115
g $
trusteeecuiisgwith Section and of Doodis n3 oftheeged ecsmpt Professions Code)or
WI k u exempt therefrom end the bub for the alleged eumption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of APN Number Occupancy
not mac than than five hundred dollars(SSW). Pane Y Type
0I,uownuofliteprep.ray,ormyemployeewlthwagamNirmlecompenu0on, 35922075 . 00
will do the work and theetnuture is mat intended unaltered for sale(Sec.ION,Business
and Professions Cade:The Contractor.Liave Law does not apply to an owner of Required Inspections
,in parywho hulIda or improves Hereon,aradwho doessuch work himself orthrough his
.We employee,provided the,such improvements.net intended oro@red routers.If,
however,He building or improvement is cold within can year of completion,the owner-
builder will have the burden of proving Hu M did not Mild or improv for purpose of
ole.). ` ,V
❑1.as owner of On propeny,am exclusively contracting with licensed conuacmu to S
construct the project(Sec.ION,Business and Professions Cade:)The Cmaroc oz's Li- F
cemu Law does not apply to an owner of property who Milds or improve thereon.and \
who contracts for such pmjems with a commumor(s)licensed pursuant in the Contracture
License Law.
0 115.mmmp ntle Sec. ,B k PCrfthis& n
n Data
WORK IPENSATION DECLARATION
I hereby same on ern tyof perjury..of the following dmlmtom:
haveandwillmaimei Certificate of Consent to self-i®urefor WorecesCompen-
on.as provided for by Section 3100 of the Labor Code,for the performance of the
work for which His permit is hidden.
❑1 have and will maintain Wmkers Compensation Insurance,as required by Secdon
3700.1'the Labor Cod.,for He pcdormanee of the work for which His permit is issued.
My Worker's Compensation Insurance a er and Policy number am:
Cartier. llty No.: ,
1 I CERTIFICATE OF E%EMPION FROM WORKERS'
COMPENSATION INSURANCE
(Thu axtion recd not be completed if IM Permit is for one hundred dollars(SIM)
or leu.)
1 certify Nat in the perro mance of the work for which His permit is issued,I shall not
employ any person in any manderu m an become subject tothe Worleced Cmew aud.
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making His CeniOam of Exemption,you should
become subject to He Worker's Compensation previsions of the Leber Code,you must
.JO forthwith comply with such provinces.,this Permit shall k deemed revoked,
y " CONSTRUCTION LENDING AGENCY
f~r Ikreby affirm Het them is a cdnsUuclinn lending agency for the Performance of
!Yi 7 the work for which Hie permit Is issued(Sae.309'(,Civ.C.)
fd7 Q Lenders Name
CL Lenders Address
U 0 I poorly Nat 1 bare read this applirmw and sum mm the eburs information is
IL P conem l agree to comply with all city and county ordinances and mum laws elating to
0U building construction.and hereby auloodm representatives of or&city m enter upon ue
C)W move-memioncd ns.etycam for e adexpenses Purywes
a (We)agree to lava,indemnify and keep harmless the City of Consoled against
Z incosequeneof0.gini expenses which regioanyway ecrnmagainst said City
U z A APPLICANT
of He granting of His D WI
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N- OINT Issued by:S �6& Date
SOURCE REGULA'T
7 Re-roofs
.ours of Applican Contac m
H ARDO TERIALSDISCLOSURE Type of Roof
Will On applica ser tutu Idling oce.pamnom w handle hazardous material
as ncfned by to Co,'" impel Code.Chef.,9.11,and the Health and Safety
sae.sedan zss3za)I All roofs shall be inspected nor to an roofing material beim
❑Yrs t� P P � Y g g installed.
Will theapplicant or fwd buddies occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
1g P
hazardous air contaminants as defined by the Bay Area Air Ouably Management all new materials for Inspection.
vic17 L
❑yes )b Nu
1 have mad Ndthe haraoesmaterials requirement under Chapur695 of He Calirm,
.is Health&Safety Cede,Societies 25505,25533 and 25534.1 un@rstand Ha if the building
does not emoomly have a moan.that It is my reapo ull ility in notify the Yup 1 n the
requirements whit us I dorwi duce of a CeniRcamaf Gmu; Signature of Applicant Date
r dr adtnetdsedegent , All roof coverings to be Class "B" or better