06080055CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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�CONTRAtTORINFORMATIO,N '.
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BUILDING ADDRESS:
CRAFTSMENS GUILD INC
PERMIT No. 06080055
19967 PEAR TREE CT
OWNER'S NAME:
PERMIT LSSUEDATE
. MOORE RONALD
10566 S DE ANZ& BLV
OR/08/2006
WJE:
SANITARY N0. CONTROL NO.
(408)366-1000
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job D05CrlphOn
1 hereby salon that 1 am lieensctl under previsions of Chapur 9 (commencing
with Section 70(18) of Division 3 of the BusinmaM Professmem Codl my licence u
in full fora andeffen.
ADDING WALL AROUND EXISTING COVERED PATIO
License Clans Lie. lf
Does- Commor
ARCHITECT'S DECLARATION
I underwnd my plans shall he used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby afErm Nat I am sacni from Nc Conv ors License law for de
following moon. (Section 703 1.5, Business and Prafmions Calc: Any city or county
which ruquires a permit to conNum, slur. improve, demolish, or repair any slacmm
$4000
prior al of Issuance. also RqulTy the applicant ror such permit to rile a signed suammcm
he is licensed of theComactofs lJansc Law (Clupn9
Sq. FL Floor Area
Valuation
Nat pursuant m theprovisions
(commencing with Section 7fl(f0) of Division S of the Business a" Professions Code) or
that he u eumpt Nesefsan and he basis for the alleged exemption. Any violation of
r
Occupancy Type
Section 7031.5 by any applicant for a pesmf subjects the applicant m a civil penally of
not more than Eve hundred dollars (5X10}
❑ 1, u owner of the pmpeory, or my employees with wags as their sole compenntion,
Required In eC[IOn$
will do the work, and the swaure is Ml huraded or offered roraale(See 7044. Business
and Prefassons Cade: The Cin uxmrs License law does ore apply i an corer or
9 P
property who builds a improves Neeson, and who doca such work himself or through his
ownemployeet. provided Nat such improvements ase ImtinleMW moffesed for sale. U.
however. Joe building or impm emmn is sold within one year of completion, the owner.
Wilder will have ft burden of preving Nat he did Mt build ar improve for purpose of
sale.).
Q 1, as .. of the D.,n,. am exclusively ... �uting with licensed anuxcmrs he
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construct the project (Sec. 7W, Business and Professions Cade:) The Conuxcmri Li.
cense law does sot apply to am owner of p.pen, who builds or improves thereon. and .
who contracts far such projects with a eonuucmr(s) licensed pursuant to the Contractor's
ll /
Lkersse law.
(,O
❑ lam excmpt under Sec. ,B&P C for this mason
mer Data
WORKER'S COMPENSATION DECLARATION
1 hereby of irm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Cer ifinu of Consent self-i.sure for Worker's Com ion-
astion, ss provided for by Section 3700 of de Labor Codc. fm de performance of the
work for whim this permit is issued.
❑ I have and will maintain Workces Compensation Insurance. as required by Section
37x0 of live Labor Code, far the perf.rmanee of the wart for which (hit permit is Wood
My Wmkce, Comlmefnts-..� huura se airier and Policy number am:
Carrier: S�/JiLC= FCR+ • Policy No.: Cs d'O gadbo�_
' CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mos section mind nut Ec compluud aide permit is fmone hundred dollars (SIM)
or less)
1 certify Nat in the perrom erns, of the work for which this Permit u issued• I roof oat
employ any person in any manner M u m become subject to NO Workers' Compensation
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If, afar making this Ccnifcau of Exemption, you should
become subject m 04 Wooer's Compensation provisions of the Labor Code, you ..at
comply with such provisions or this Permit shall h damcd mvokcd.
CONSTRUCTION LENDING AGENCY
I hereby M. Nat then iso comwcti.n lending agency for Ota per(o..rise of
dm work for which Uses permit H issued (Sec. 3097, Civ. C.)
Name
Londees Address
'
1 cenify Nat 1 have read Nis application and suer that the above information is
conte(. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise reprascnutivcs of this city m enter upnothe
ahove-menuonedpmpenY for inspection
(We) agree m save, indemnify and keep harmlm the City of Cupertino against
whichpurposes.
which may in any wayattnu agaimtsaid Ciry
of
egjnce
inof thecmtsand
th a
grating of Nis omit.
A
APPLICANT UNDc
APPLICANT UNDERSTAIJp COMPLY WITH ALL NON -POINT
Issued by: Date '
SOURCE fi6jtl�A F3�' .,
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Re -roofs
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Signature ofAppliaumr Date
HAZAROUS MATERIALS DISCLOSURE
Type of Roof
Will Uu a m forum building anmaurid
nand llet1h h
as dcfSed Cupertino e, Chaptsmre
Health
Ne Cupertino Municipal Code. Chapter 9.13. and Ne Health and Safety
Session
❑ra �
lif. Section ]3532(x)?
All roofs shall be inspected nor to an roofing material bei.
P P� Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to
Will the appliam or future Wilding occupant use equipment or devices which
remove
emit hmardaus air conmminanu u derived by the Bay Area Air Qualily Management
all new materials for inspection.
District? _'/
O Yes Mx,;
I have mad Ne huaardousmaterials mquiremew under Chapur 6.95 of Ne Uhler.
Ma Health&Safety Cao, Seeumts25505,Z533 am135534. 1 unJerstaM thin i(the building
Jas nor curcmly have a unen it. my responsibility 1. notify the mcupmt or he
regaimmemswh mel isaammeof. Cinficia, rLk
Signature of Applicant Date
All roof coverings to be Class 'B" or better
owner. Nod.