06080054 CITY OF CUPERTINO i�-"r`tk sc�":,hn"T«s '" t�b: 4c.ass•°' ','
BUILDING DIVISION PERMIT �ONTRACTOR�'INFORMATION
H3.°f;xut i?�$"" .,.4aF.,s: •d =.'u 1: '
B UILDING ADDRESS: MIROSLAU DRAGOJEVIC pERMITND.06080054
955 PEAR
R'S NAME: PERMIT ISSUE DATE
MIROSLAU DRAGOJEVIC
[AROCHMCT(ENGINSER:
NE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG EUCT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION O O O
F 1 hereby a1Rrea that I am Incensed under provisions or Chapter 9(commcn m9 Job Description
;¢ with Secdmi7")of Division 3 of the Business and Prafcesiuns Code,ad!my license is
« I.full forceandeff«I. REVISION TO ORIGINAL PERMIT 06060033
Datc Class Lk.a REVISE ARCHITECTURAL - STUCCO, TILE ROOF, CHANG
o Da¢ ComDECL
ARCHITECTS DECLARATION
wndemane my planamu Wnsed sspaM1Oe mmrds � � ENTRY, AND SIDE SLIDING DOOR
Rau
C Licensed professional
5 OWNER-BUILDER DECLARATION
if I Wmhy.(Sero Nal 11. exempt from IM Contres;Cod :A.,c Law for Ore
-❑o following mason.(Sado.103 1.5,Business and Pm@ssions Code:Any cityS county
$w
which t reyuea issuance.pmmit re convm4 pplic improve,tle ermit i ri mash any swnuro
.zs that het itsensedporti requires Novisiosofant for Such permitm Gane,le a Law(Cha ned mem
Nat Lam is licensed pursuant to Ran of Dision3 of ConummrandlifLaw(CMper9 Sq.Ft. Floor Area Valuation
(cd their(commencingwithtSmdm 70nd of basis For
rth glan eed examp on.m vi Code)m $274822
Nel W u exempt IWre(rom and tW basis fm the alleged exemption.My violation of
Section 7031.5 by any applicant far a permit subjects the Spit to a civil penalty of APN Number Occupancy Type
not mom than fine,hundred dollars(S50)).
Lupeanuk.Nm beamty,mmyotimanceswiNwaga un,Sei:. .Bhusition,
will dofewort ande: he Contranot NtenMtl Lawddsnot.(Sec.70th,Business
end artywh bu Cade:The minnocent,
t License Law dots not apply lf rt owner of Required Inspections
own am who Wildsmireprevvchimpoandwha are no,am ended altrer@mugh his
awn employ building
Nm such impmvemmts are not inmced moBemd(male. r.
however.Nebuilding mcen of mml is Sold withinarcyear ofmmpkeforNeownm-
builder will love Ik burden o!proving that W tlitl nm build m improve for purpose of
Sale.).
0L.td,—
er of IW am ucluivelY conuaming with IittmW ronuxiors to
conswnprop c.] Business and Prefesdons Cade:)The ConuaemrS U.
L, Tat ply m an of propcny who Wilds or'unpava IWseon,anewhoconn for sir RejecN Na cormaebKs)licer@d pursuant in Ne Contractor's
Liceuamin
tun ,Bit PC fm thisrecto
Data
ER'S COMPENS TION DECLARATION
J'�iclbad
by affirm rpevlsy of arc of be following leclaradoon:
❑Ihawill main in a Certlficautof Corue.tinself-insure far WorkefsCompen.
satin., fm by Section 3]00 of Ne LaWr Code,fm Ne perfmoutn.of Ne
.arkfokNispermitisissued.
0 1W will maintain Worker's Compntsadon Insuran..as reyvirN by Secdon
3700 of the Labor Code,f".perform...of be work for which his permir is issued.
My Wmixt',Compensation Im.a ..mint and Policy number are:
Carrier, polity No.:
CERT GTE OF E% PITON FROM WORKERS'
COMPEN TI INSURANCE
(TTusedon enol been
plmetl if permit u(mane hundred dollwai(SI00)
or kssJ
I cmdfy Nat in Nc o e o Ne Int which his permit I.issued.l shall nes
employ any person in u o o e u 'en to lW Wodrzn'Compeaaion
Laws of California
Applicant
NOTICE TO APP 1 :If,aR .king this Ce (scare or Exemption,you should
become subject N the orker's Co nsadon provisions of the Isbor Cade-you moa
.JO foMwithcamd with nth pmvida or dupermit shall W deemed mmkcd.
z2 ONSfRUCTON LENDING AGENCY
(--� Ihemhy affirm that Ncre iso coatmctinn leading agcnry for the performantt of
CL>
the work for which permit u issued(S.,3097,Civ.C.)
0.Q Icndoes Name
0, z ress
Leder.Add
V C) I wary that 1 have ro Wes application and suN that Ne also information is
correct.I agree to comply w all city and co Ninances and sate laws relating m
O C.1 Wilding conscuction.and yauthorin pnSm imsafthiscitymenterupnn Ne
ahove-mcntiuned property f r t spection pt 1.
F G (We)agree to save. J reify and p harml the City of Cupertino against
(n li.bilio.J.dgmcnts,c.as n e .secs kh yi. .,act.ag,iiStaid City
of he
U APP ILCANTCUNDERSr D NSDpar
IL C L WI ALL NON-POINT Issued by: Date
SOURCE REGULATIONS
Re-roofs
Sigrid
n rotor
xazA ru MA DISCLOSU Type of Roof
WHIne.ppifcamou uturc Wilding pant store or hack harslmd,material
used by the Cupertino Municipal Cade,Chapter 9.It-and Ne Health and Safety
Soedan zss3z(,)7
❑Yes No
All roofs shall be inspected prior to any roofing material being installed.
❑
If a roof is installed without first obtainingan inspection,I agree to remove
Will theapplicant or future building occupant use equipment or Wvims which � g
emit It.P.n
s air conuminan defined by Ne Bay Area Air Quality Management all new materials for inspection.
Disvict
QNo
ad dmhu ausmamria n uimmcnuundcr Chapu:r G95oftWCalifor.
.is Nest ctycole. to Z55505.25533 and 25534.1 undennand thin if dm Wilding
does Inst ly hoes t to my Hili,to notify Uc aavpant of Ne
require tit tit el to of.Geminate Signature of Applicant Date
Gwn.ra ,uthori>edag t N All roof coverings to be Class "B"or better