06020014 CITY OF CUPERTINO 4
WINFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS: STEVE ELICH PERMIT NO.06020014
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79S PENINSULAR AV
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WNM'S NAME: PERMIT ISSUE DAM
STEVE ELICH 02/13/2006
NE: SANITARY NO. CONTROL NO.
HITECTiENGINEER: BUILDING PERMIT INFO
BLDG PLUMS MECH
7 1=
LICENSED CONTRACTOR'S DECLARATION
to I hareby affirm'hat I min licensed under previsions of Chapter 9(commencing Job Description
with Section 70170)ofDivision 3 of the Business and Professions Code,and my license is
in fail fares and affect- REVISION ORIGINAL PERMIT #05120137
License Class—_Lie.N
Dam—Continent' ADDING 2 WINDOWS, CHANGING FROM STICK TO TRUSS
ARCHITECTS DECLARATION
I understand my plans shall tor,used"public records ROOFING, ADDING 1/2 BATH
ij t; Licensed Poilessi...I
M1 I hereby offirm
MM OWNER BUILDER DECLARATION
tat I am exempt from the Cimanistar's License Law for the
n C following reason.(Section)031.5.Business and Professions Code:Any city or county
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which requires;a Permit to construct.altar,improve,demolish,or repair any mocuum
yZi poor u)its ismanes.also mquims the applicant for such Permit to fi)c a signed statement
door he is licensed pumment in the Provisions of the Contractor's Ummic Law(chapter 9 Sq.Ft.Floor Area Valuation
ga (commencing with Section 7")of Division 3 of the Business and Professions Cnak)or
that he is exempt therefrom and ft basis for the alleged exemption.Any violation an of $0
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
m
not athan five hundred dollars
0 1,as owner of 1M pm,po%,,or my employees with wages as their side compensation, 32603027 . 00
will do the work.and the structure is not intended or offend for sale(Sec.7044,Business
and Podlesumot Code:The Contractor's Licausto Law does Out apply ha an Owner of Required Inspections
PrOpany who builds orin,moves thereon,and who doessuchoork himself or through his
owncreploysics,provided that such imprawnrunds are not intended oroffemd!forsake.If.
however,she Wilding or improvement is mid union one year of completion.the owner.
builder will have the burden of proving that the did rum Wild or improve for purpose of
sal
C)1,as owner Of the pro,art,am eactuaively contracting with licensed contractors to
construct the project(Sec.7044.Business and Priselloseemons Cock:)The Contractori Lt.
rentic Law does not apply in in Owner ofpmNny who Wilds or Improves thereon,and, a.-
whocon�mxnafim"`h 'ccos with a contractor(s)licensed pursuant to the Contractor's
License _ B&PCf 0 an
(:3 1 am at,taw.
r
Ow... Data
ORK
S COMPENSATION DECLARATION
I hereby affirm under cossilty of Nduty,one of the following declaration:
in to
I have Will will maintain a CimiVicum Of Cmuart to saff-troome for Worker's Co.,.-
in
tusumn,as provided!for by Section 37M of the labor Code,for this performance of the
work for which Nis Permit is issued.
d' On , ,
0 1 have end will maintain Worker's Compensation Insurance,as required by Section
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37W of the Lelia,Calc.for the Ocriamit an.of the work for which this mu,is issued.
My Worker's Campossation morainic,carricir and Policy number am:
Center.—Policy No.;
CERTIFICATE OF EXEM MON MOM WORKERS'
COMPENSATION INSURANCE
(Thisscefica need noWcompmedifft permit isformuchundred dollars($1013)
or kii.)
I certify that in the performance of the work for which this aunut is lamed,I shall not
employ an,'em...JMZ;;be2mc ml,�Vt4 AftWPr1jOmpsmsmIio
taws of California.D
Applicant
NOTICE s�Tb)A P A making itis COmificam or Exemption,you srmuld
ti Compensation previsions of the Labor Cocm,you must
aii�kcrx ran
become mM Or1mr
low. numv with
siac�
z nmPIY With such Provisions or this Permit shall to deemed revoked.
z C
to CONSTRUCTION LENDING AGENCY
1 hereby affinn that them is a construction lending agency for the performance of
the work far which this pmaik is issued(Sec.3097.Civ.C.)
Lender's Name
Z)z Lender's Address
U 0 1 certify that I hat read this applacation and mim th.,the above informed..is
it, correct.I agree to comply with 01 city and county ordlimmucs and sham laws relating to
0 U building cumulation,and hereby aunhorm,representatives of this city to enter upon the
W Wvc-mcationed prolixity for impaction purposes.
cli. (WO)agree to son,indemnify and keep barmlins the City of Cupertino again"
liabilities.judgments,costs and cap..which may in my way ax. Ssunat said City
Z in consix,tance of the granting.
'A S"7W il L L PLY WITH -POINT Issued by:
SOURCEREGUL:W Date
APPLICANT UNDERST
A
/3 0 Re-roofs
'c�i'.hac. flithainflem, Date
LM '_`J"B`aNAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding occupami store car handle hazardous nuiten.1
dclSection
25532(a)?
11,C,Cu(.c)njno Municipal Code.Chapter 9,12,and the Health and Safety
0y. 32 , CllrAll roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as refined by the Bay Area Air Quality Management all new materials for inspection.
District?
Ely. 11��
I heve naid the haxArd.x materials m,lummucras under Chapter 6.95 or thr Califor
nice lm.1th,kSgic, Code'Somon"nY)5.25533.42534.1.n�..d�aifftWIldiI
does not .1 or On
torran have that - ymsprafthility o...1,the occup
require. im, Pat hauar. ititheitic or
�' � ;gcupxae. Signature of Applicant Date
owners milo;.dagent D= All roof coverings to be Class "B"or better