08040019 CITY OF CUPERTINO .ath '�u+,Tdr���.'�a. �v�, /-,+� *za`�" ��}s,�♦� �`T*<�'`+ '
BUILDING DIVISION PERMIT C�<l'rJ.. 4�VJTk �y1llYAATa <'
PERMIT N0.
BUITSO�aOpttPFSy EPPER TREE LN EAGLE ELECTRIC 08040019
S 1
OWNERS
NAME; Y PERMIT ISSUE DATE
CHANDLER EDWIN G JR AND JEAN P 0 BOX 2482 04/03/2008
PHONL? SANITARY NO. CONTROL NO.
(408) 241-9956
RCHITEC7/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
moo LICENSED CONTBACfOR'S DECLARATION CrI IOb Description
a 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
with Section 700(B afDivision 3 ofthe Business and Profcssiom Co etylicemeb NEW KTCHN CKTS TO OTLTS&DW/DISP SVC UPGRDINSTL 6
in full face and eBectG, /,
FLUORSCNT LITES IN KTCHN&INSTL 10 INCDSCNT LITS
Dam —cmnmeclor ce r'G
ARCHDECrS DECLARATION IN
S I undersu al my plana shall be tired as public records DINE/FAM RM
� U
le era 1n Licensed Pmfcsaional '
S
OWNER-BUIIABR DECLARATION
1 hereby alum Not 1 em exempt from me Cum sksor's Licanm Law for the
C 2 o following mason.(Section 71111.5.Business and Profmiom CWc:Any city or county
m I which requ(ma a permit to contract.alar,improve,demaliM,or repair any suucture
i`ya prior In its Issuance.dNo Inquires the applicant for Such pencil to file a signed statement -
SSC that he is licensed purmanitaNepmviaioneofthe Canuocmr'sLima.Uw(chapter 9 Sq.Ft. Floor Area [. Valuation
m
F$ (comencinswithSecdon70l10)ofDivision3oftheBusinessmilPm(msionaCuts)at 914000
—
that he ts exempt dominate and the basis for the alleged esempedon.Any violation of
Soudan 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty atNumber Occupancy Type
not roam man fin hundred dollars(55001. 35912 011:V U
❑I,as owner of Ne property.or my employes with wages u then ante compenzation,
will do the work and theamuctue is notimended oronered Imstd,(Sec.7044,Bemsea Required Inspections
and Profetsiom Code:The Connector's Limine Law doenot apply to an owners, of tl P
property who buildsorimpranesthereon,endwho ditssuchworkhimici ar Waugh his
own employees,provided that such improvements arc not intended completed formic,If.
however.the building ter improvement tssold within ane year of co spmdan,the owns-
builder will have Jur burden of proving that he did not build or improve for purpose of
sale.).
Q 1,as owner of the property,am exclusively comracdn5 with[Named ronwcton to
commuct Jur project(Sec.7044,Business and ProRstiom Cade:)The Comructofs U.
came law data not apply in an owner of property who builds or improves Damon,and,
who cava Sts for such project,with a numismatist)licensed pursuant to the Contractor's
Lice.Law.
❑I am exempt under See .B d P C for this mann
Owner Dam '-
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of Jte following declarations:
I ban and will maintain•Certificates of Consent m self-maum for Worker's Commo-
p
West,m provided far by Section 5700 of the labor Code,for the perfom rine of W
Work for which this permit is Named.
I have and will maintain Worker's Compensation Insurance,a required by Section
W of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insummo carrier and Polity number are:
Cartier. ! Tf /�UNa Paltry No.:OP,�oDS�Oo°23/' 7
CERTIFICATE OF EXEMP170N FROM WORKERS'
COMPENSATION INSURANCE
(This section wed sot hecomple ed tribes Permit Is faom hundred dollars($100)
or tem&)
I certify that in the perfotmace of me work for which this pemm is issued.I shall not -
employ anypersen in any manmrso as m become subject m me Workers'Compenation
Laws of Califomia.Dale
Applicant
NOTICE TO APPLICANT:If,afar making this Certificate of Exemption,you mould
become subject m the Worker's Compensation provisions of the labor Code,you most
0 forthwith comply with such provisions or this permit shall be decreed revoked.
.Zi CONSrRUCT10N LENDING AGENCY
I hereby aim that there is a construction lending agency for me Performance of '
l�> me.,it fur which this permit I.urucd(Sec.3097,Civ.C.)
fgl A Lender's Name
Z fender's Address
V tp 1 certify that I ban mad this applimicn and sea that the above information is
4, F common.I agree to comply with all city and county ordinances and mute laws relating to
0U building construction,and hemby studhorse representatives of this city to enter upon the
above-mentioned property for inspection purposes
E (We)agree to ave,indemnify and keep harmless the City of Cupertino gaimt
v.v gn Iiabilina.judgments,costs and expenses which may in any way mane against said City
V Z in consequence"a granting of this Permit.
.. APPLICA NDERS A S AND WILL COMPLY WLONN AUR ALL NON-POIssued by:, Date
Re-roofs
Sib u APplicanV Oau AP-
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building occupant atom or handle haardoun material
as deed by me Cupertino Municipal Code.Chapter 9.13,and Jur HNN and Safety
coda,.sSection 15532(a)7
C3 Y. ``//No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or/fJutit�t'ure building o2upant tax equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hsarmus air canunnVana as defined by the Bay Area Air Quality Management all new materials for inspection.
Viet?
❑Yes No
I have 'h boom smaudabmquimmenuunder .Chapmr6.95ofine Califor.
oiaHmlm Sty Code,Sadom M5D5,75533aod3S.53a.l undemand meifW Wilding
Dom not �y hon a tenant.mu it it my mapovihiliry to notify tie occupant of the
aqui salad.h timet psior m' mo fa Cemficsm 01`0c ancy.—o Signature Of Applicant Date
O ro utharis0 agent Date'
All roof coverings to be Class'�W'or better