08040017 CITY OF CUPERTINO �'
BUILDING DIVISION PERMIT R�IN RMATIION zll
BU11D N ADDRESS: PERMTI
1.9700 PALOMA CT #15 HANKINS CONSTRUCTION INC 08040017
AskR'S NAME: PERMrr LSSUEDATE
CROWLEY, LARRY & MADELEINE 38227 FREMONT BLVD 05/16/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 795-9654
ARCHITELTENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
3amz LICENSED CONTRACTORS DECLARATION IobDe$Cri [ion
iF 1 Wreby affirm WI 1 am licensed under provisions of Chaper 9(commencing p
W with section wnu)nrnividon7nrthat Bwsincvs and Profeuw�nj..w� is 5 ' 0"X8 ' 0" HNDICP RAMP,ADD 1HNDICP DOOR
<<�y in full torte and creat
Liccn Ll.• '
ffDECLARATION
� 1 tinders d my rive shall so W can used v Public records
�yu
5 r Licensed Profocu nal
N3 OWNER-BUILDER DECLARATION
E I hcroby&from that I am eaempl fours the Contractors license Law for the
COC following macon.(Suction 703 1,5,Business and Professions Code:Any city or county
$ which mqulma a prem it to consuuct,alter.improve.dcmolim,or¢pair any swcwm
Prior to its issuance,shut nodims de applicant or such pramit to file a signed salemenr
pp < duet he is licenmd pursuant to the provisions of he Conmcmr's L.icemm law(Chaptor 9 Sq.Ft. Floor Area Valuation
y�s (commencing with Section 7000)or Division 7 of the Business and P moors Code)w $10000
f 5 that he Is...mpr therefrom and the basis fm ds All eaempum.Any violation of
Semon 7071.5 by arty appliryn for a permit mbjecu the applicant on a civil penalty ofNumber Q
ncr mart Nan five hundred Miss(SSWI 34254999Af Occupancy p y Type
L,aowneroftWpmpwtywmyernploycuwithwg utheirvelecomlevadm,
wiBD thewwisandthesw umisnotiwendedwofr f.0 (Sec.7W4,Buvnom
and Pmfasima The e Contrucrone rs Leolaw doss rom own,r t apply an or Required Inspections
Profanity who build,wimprows Nwean,and whodwssuchwwk him¢Irorthrough his
Own ernplayas,proNhd Nat such improvements am not intended woRerrd forsale If.
howtvv.the Wildingor improsemat is sold within On,year of completion.the owncr-
builder will have she human of proving that M did rot build or Improve for puopore of
sal.).
❑1.an,owner a IW propenY,am eacluivelY contacting with licensed Conuanass to
compact into project(Sec.7044.Borrows and Professions Code:)The Conmeer's li
cove law dors ml apply in an own,r of property who Wilds w Lmpmvea demon,and,
who contacts for such pmjects with a con=mr(s)licennd pum tint to the COnuactors
Lieens Law.
aon under Sec .B k PC for this maven
or
Data
WORKERS COMPENSATION DECLARATION
1 hereby M.under penalty of perjury Oro Of Ue felluvring declarations -
(]1111 and will maintain aCemfieate or Covent to self-insum(or WoehreCOmpen-
s,dan,at provided for by storm 7700 of rW Labor Code.for de poformana of the
wort or which this permit is iuued.
❑1 have and will maintain Workers Compensation Ivoranve,u required by Section
7700 ofduc labor Code,for the peofoomuee Ofthe work for which this permit is issued. '
My Workers Com eu`aua era n¢v and Polity
No.: o
numbCr
Cartier. Polity
CERTIFICATE OF E PILON FROM WORKERS'
COMP ATION INSURANCE
(ThisszUm mcd rot W owmpked it Ne pumiHs(mane hundreddoBan(g 100)
or Was)
1 ratify N,1 in the porfound.of she woh for which this permit is Wood.I shill our -
cmploy any wnsm 1.my mmmner m as to WCome subject to doe Work,'Compensation
Laws of Caframis.Dam -
Applicant
NOTICE TO APPLICANT:If,alter making this Certirae of Exemption.you should
become sdbjen to the Workers Compeodation provisions of de labor Code,you most
�.JQ forthwith comply with such prons visioM Nu permit shall W deemed o:voknd.
z yr CONsrilucrION LENDING AGENCY
r
(~ Ihor whNirm thudert isaed(Scc.30 loading agcnry for the performanCo of
a> Ne work for which this permit ts ivucd(Sec.7097,civ.C)
W Q nder's Name
jz UL<ndera Aadm..
U O 1 cvtiry,dual 1 hast rad this app iicatim and sue Nu IW Wow irJwm,tion is
1.4— comm-II&gra m comply with all City and County ordinames and state laws ml,ting to
p t Wilding construction,and bomb,wNori.reprommadves of this City N ata drum the
r W aWve-menu nad gmems.any fwinsic.purposes
(WC)agree t0 save,indcmoify and loop harmlu de City of Cupertim agatul
Z Iiabilown; gmenLLcron ango does which may us any way,averse agilvrsild Cly
U� in Conzq of the granting o(Nu permit.
... SOPLI NT GUND'RSTAN AND WILL COMPLY WITH ALL -N-P INT Issued by:9 Date �b
Re-roofs
ire of Apel' hector aW
HAZARDO S MATERIALS DISCLOSURE Type of Roof
WllldreapplicantraI bulltling oaupantnomwhandlc haustlov ma¢nal
finc l by the Cupenina Municipal Code.cWpWr 9.11 and de Hnhh and safely
Se nam zss7z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya �Na
Will the applicant or fulum Wilding occupant unc equipromi or&vim&which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardov air comxmioants at deRnnd by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Ya r17(Nu
I have mad deha ardasmamnils equimmew undocim erd.93ofdeCalifor-
nuFWal hsafctyCnde,seniov505,33577 and33334.1 understand duui(de Wilding
does no urrtndY haw an tad it u my maCdddihility W mdfy the occupant de
mqui w h m four issusncc of a Contras of Oc
Signature of Applicant Date
n,rwanl ,m age ,W - All roof coverings to be Class'%}."or better