08050164 CITY-OF CUPERTINOa
BUILDING DIVISION PERNIIT ONTRAGTQRINFO�RMAT,IDI.
BUILD DRESS: PERMITNO.
� '�� PARK VILLA CL TBD - TO BE DETERMINED 08050164
NEWS NAME: PERMIT ISSUEDATE
FLFISHER OSCAR T JR & BEVERLY 05/21/2008
PHONE SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
tTtOp
LICENSEDCONntd umicr provisions
Chap Job Description
4 ION
1 Mreby affirm than 1 am li¢nscd under provi4ons of Chapter 9(¢mmercing
W
mDawith scdon]O(111)orDivision 3ofdo,Bu mus and Prof.. FIRE RESTRN SAME LIKE & KIND,KTCH(144SQ)
^<e
in full forte and erred
3 ZE Li¢n¢Class Lk.g BTH(40SQ) &OTHER(918SQ) . DUNRITE CONST PD FOR BUS
oW Da¢ A CHITEC S DECLaRAOU C 5/21/8
aCC 7
31U ash1 undersnd my plans all be rued as public mcNor
yoga Llccn.d Pndcssio ural -
3 OWNER-BUILDER DECLARATION
to
E I hemby a1(rn that 1 am comp,from the Connnors License law for Nc
y O O following mason(S dun 7031.5,Business and Pmfeasiou Cods:My city or county
5$ which requims a permit to consmas.almn improve,dcmolub,Or mpair any swnum
prior to its issuance.Wu mquims the applicant for such robot to fila a sigosdaucount
M< diathculiceruMpunuanttothoPmvisimuofteConoxWr'sLuc= aw(Chaptn9 Sq.Ft. Floor Area $180000Valuation
[1.9 (commencing with Section]OW)of Division 3 of the Business and Professions Cade)or
e r3
that In,u ec mpt therefrom and the basis for the allcgcd exemption.My violation of
Seniors 703 M by any applicant for a permit subjects the applicam,to.civil pc..try of /,.ya�.ta�wf Number Oceu ane
nut mart Nan B.m hundred dollars(ISM). 35610027 .VV P yTYPe
I,u owner of ase propsry,m my employer with wag.u Nelr sok compewdon,
will do Ne work,and the stotum Is notinunded oraRered for fele(Sec.7044,Business
and Professions Curie Th Contractor,I;^"a law does nut apply to an oven of Required Inspections
property who bui Ida or i meows thereon,and who doss such work himself or through his
awn employers,provided that such inprovem¢ts.n notimeMed oroRated for sale If.
haw<vcr,the building or impovemun Is sold within one your of¢mpleuon,the owno,-
builder will have f human of proving ibat M did rot build or improve for putpme of
ule.).
❑1,a owosr of the property,am eulusively contracting with Bcansed¢mnctors to
construct the pojen(See 7044,Bnsinrs and Professions Cade)The Conuacwrs U.
cease law docs not apply to an owner of prolany who builds or improve Nemon.and.
who contracts for such projects with a eomranar(s)licensed pursuant to the Conmxtars
Li¢ns law.
❑I an,eacmps under Sae .B k P C for the mason
osr Data
WORKER'S COMPENSATION DECLARATION
1 be.by aOltm under penalty of perjury arc of the fallowing d¢lantions:
sa1naas and vent for
Section
of Conserve Coca.fumIreWroactuCompen-
auan,r hick thi for of Section 3100 of the Labor Code.(m the perrormume of the
wort for which this permit u issucQ
El 1 have and will maintain Wallets Campevatian htsunn¢,as mquimd by Suwon
3700 of Ne lab¢Cade.for the performan¢of the wort for which this permit is issued.
My WorkaraCmnpeuai l �inntt camior and Policy number ars: r� ,p
Carrier: 5 ,�_PoI' No:�h 3altfC`/iiTC
CE IFICATE OF EXEMP 70N FROM WORKERS'
COMPENSATION INSURANCE
(This secdon mod not be complemd![ft permit Isfaronc hundred dollen(SIM)
or kat)
I nobly,that in Nc performance of thc work for which this prmi,is isucd,l shall out
employ any person in any mannerso as in become subject to ua Walken'Comperuauan
Laws of California.Dat
Applicant
NOTICE TO APPLICANT.If,&Rcr making this Cenificam of Excerptio,you should
become subjcm 0 Nc Warners Compensation provisions of Ne Labor Code,you mus
.J O forthwith comply with such provisions ar Nu permit mall be cheered mrvoked.
.Zi yr CONSTRUCTION LENDING AGENCY
F— l for which
ch thi Nu d�rt is a al!(Sc
nlnn knding agency rm tic performati¢of
Rvi dm work for which Nis permit Is iitosd(Sec.3097,Civ.CJ
z lander'.Name
� z Lenders Adder..
V O 1¢miry that I have teed this application aM sac¢that the above nfomutim u
ti.^. cotmd I alma In comply with all city and county urdinan¢a and satws latotaling In
.O IgJ� building construction,and hemby auNorim mpmsuutivca of the city sh onto,upon de
W) alcove-menuanro popeny,for nspenian Puryeses
G (We)agt¢to save,indemnify,and loop hu Mess the City of Cupertino against
W) ..1,iuesquic mfLho use&ox penseywhich may in anY my a¢me Kdnst said City
V z A consequence of the granting of this permit.
APPLICANT UNDERST AND WILL COMPLY WITH ALL NON-POINT Issued A7by: Date
SOURCE REGUL0
a Re-roofs
Signals.o pplscatucontractor Data /I—
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuuue building occupant roue mlundle hrurdoes material
as defined by the Cupenino Municipal Code.Ch pot,9.13.and die Hemi and Safety
Section
r]Y. hAll roofs shall be inspected prior to any roofing material being installed.
e
Will Ne applicant or fuum building a¢a ut ora If a roof is installed without first obtainingan inspection,I agree to remove
PP i W equipmentar M.nl which P g
District?
mous art conaminanu u dcfinctl by uie Bay Arco Air Quality Manegcmcnt all new materials for inspection.
QYes u
Ib&Sdct the amand25534.1uancoss dconand.95ofthe ralding
d.no NhSmety Cade,Sections 25505,25533myr and 25534.1 wdcrsf t Nuif Nc building
dao oat curmndy Mve a 6 duu it u my respansihiliry to twufY iM occupant of the
.galmmnn than n etpdartoissuatmcofaccriftesmorOc¢pancy. Signature of Applicant Date
Owner or authorized agent Dam- All roof coverings to be Class'%¢"or better
r