06060133 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRA.GTnRINFORMATION BUILDING ADDRESS: DANIEL MACKEY CONSTRUCTIOm "fes 0.06060133
10133 PARISH
OWNER'S NAME: PERMrf ISSUEDATE
SCHIFFMANN MARY M 2593 HEBRO 31E: SANITARY NO. CONTROL NO.
(408) 274-6799
ARCHITECT"GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0o LICENSED CONTRACTOR'S DECLARATION lob Description
m 1 bcmby affirm Nal I am licensed under provisions of Chapter 9(commencing P
�i with Seeuon 7M0)of Division 3 of the Business and professions Code,and my Ike=is
m« in fmllfmmermdeife S y097 REVISION INSTALL FLUSH BEAM TO REMOVE 4 ' OF WAL
%'q= Lie.° las^ Lk'insurer« .s� 1 ORIGINAL #05090224 NO NEW PERMIT ISSUED
nF to Date ARCHITECTS DECLAI TION fG,SS( -- G
15:1 1 understand my plans shall W used u public memos
1.0
taH Loomed Professimmil
3 OWNER-BUILDER DECLARATION
I Mmhy.[Tete Nrt 1 am exempt from the Conuactmes License Law for be
00 following rtason.(Section 71B 1.5,Business and PPofestiom Cale:Any city or county
$tai which mquis a permit to Wentruet alter.improv,demolish,or repair any swemre
prior to its issuance.rise requis the applicant for such permit to file a signed patemcm
that he is licensed pursuant to the provisions of the Conlncwr's License,Law(Chapter 9 Sq.Ft.Floor Area Valuation $0
(commencing with Section 7000)M Division 3 of the Business and Prafessinns Cmk)or
i Nat he Is exempt Ncrefsom and the basis for the alleged exemption Any violation of
Section 7031.5 by any applicant for a Permit subjccu the applicant to a civil penalty of APN Number Occupancy Type
mat mom Nan live handled dollars(x500). 31644024 . 00
❑I,o Owns of Ne Propury,omy wployeo with wagu odes sole compasadon,
will do the wore.and the euuermte is not intended oroffemd formic(Sec.7044.Business Required Inspections
Nd Professions Cade The Comrae WYs LIRRR Law does Ml apply to an Cramer of q P
property who Milds mimpm sdmrramand who doessuch work himselfor through his
own employers,provided Nat such improvements are not intended oraRered formic.If.
however.the Wilding or improvement is mid within one year of mmpletion,the mi
Milder will have the burden of proving Out he did Owl Mild or improv for purpn¢of \
sak). - /s
❑1,as Owner.(the property.am uelusively convening with Hemostat mnusnou us
costumer the Preim(Sec.7044.Dirome s and Profession Cade:)The Contractor's U. \
cense Law docs not apply to an Owner of property who Wilds or Improves Merton.and
who contracts for such projects with a canuacmr(a1 licerued inherent to the Contractors
Licnsm law. -
❑IamexemplunderSee .a A P C for Nis moon
Owner Date
WORKER'S COMPENSATION DECLARATION
L hereby.Rim Order pensty of perjury arc of the(allowing declantelt.
1 have and will maintains Ccnifeam of Cmoem to self-mule far WOrocrsCompen-
ouon,as provided for by Section 3700 of the Labor Cade,for the ped...of the
wort for which this permit is issued.
❑1 Mw and will maintain Worker's Cosupcsualion Inuuntt,as mquirtd by Section
3700 of Oc Labor Cade,for the performance of the work per which this permit is issued
My Winker Compensation Inerrame meso and Poliry number art:
Cartier. LO Poliry No..
CERTIFlCATE OF EMPOON FROM WORKERS'
COMPENSATION INSURANCE
(fhisscerion read noboconplemd if IM permit is forome hundred doBps(SIM)
last.)
1 certify Our in Nc performanu of the work for which this Permit is issued,I shall not
employ anyperson in any manner m at an become subject to Ne Wori Comr".,tion
Laws Of Califmmia.Dow
Applicant,
NOTICE TO APPLICANT:If.after making this Certificate of EvmMion,you should
become subject in the Workers Compensation provisions of tM Labor Cada you must
.,O forthwith comply with such provisions or Nu Permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[-+� IWrobyaRrm that then u•constructionlanding agemy for Ne,perfurno.Of
!Y the work for which this permit is issued(Sec.3097,Ci,C.)
Alenders Name
D.
z lenders Address
U Q 1 anify Nat I haw read this application and cute Our the show infermauun is
D.P correct.L agree to comply with all city and county Ordinances and sum laws Miming m
OU building consuuction,and hereby eulhorim mpresenutiwa of this City to enter upon On,
v) above-mcnuancd propcny for inspection purposes
(We)ague to save,indemnity and keep harmless the City Of Cupertino against
iFwZ incoitia;juceofthecosuand npcua which may many wayacauc against sed City
t)z APPS NTUNDc granlingof DS AIs fammit.
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S C EGU O
(,
-2,t-OG Re-roofs
tare AppncamyComraerar Date
HAZARDOUS MATERIALS sCLosun l Type of Roof
Willy t e Cupertino
or forum Wilding e.Chap port or handle Health and Wang
u defncd by tite CupeninO Municipal Code,.Chapter 9.13,and dee Health and Safesy
Code,Section 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes TO
T If a roof is installed without first obtaining an agree to remove
inspection,I
Will Ne,applirvM1 of(utum Wilding oavpam tic e9uiPment o devices which P
'41-mh hazardous air cotmmimanu as defined by Ne Bay Area Air Quality Management all new materials for inspection.
Disuics7
❑Yes 41Na
I have read the huardecontumrials requirements under Chapmr6.95 Ofthe Califor-
nia Heal"SafnyCOdc.Scnions TSM5.25533 and 25534.1 understand dwifdte Wilding
des t curncn0 t,dav mens Na it u my as(woibility m noddy the Occupmt of Nc
coq trt ems. n r herrn on Ccmfeatemf Occupancy. Signature of Applicant Date
(O '
Owroe amhorircd agent DateAll roof coverings to be Class "B"or better
'