08050051 CITY OFCUPERTINO ay .e• 7X " '�- " '` �
BUILDING DIVISION PERMIT CONTRACTQR=INFORMATION,
PERMIT NO.
BUILILNo6QDRESy HAR LAP DR D & D CONSTRUCTION 08050051
1R'SS NAME; 1' PERMIT ISSUE DATE
CHARLES MA 1447 HAMPTON DR 05/14/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 666-5298
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
is � (�
Sop LICENSEDcumIam ONnRdunderACTOR'S DECLARATION lob Description
1 homey 0)of ivW am licensed Bu under provisions of Chapter 9(commencing P
wile Section ndc1ofDivisien3of the Business and Pretensions Code.urd mylkmtets TRUSS ROOF PLN ON EXSTNG PERMIT ORIG#08010101
a n— Licon License Class
and ClrecL
z Dam.clan ConLic.r .
Fq D.¢ Contractor
QQ 7W ARCudi be
DECLARATION
�W u 1 underwnJ my plans shall.used as public record
yLicensed Profcssienat
o
w3 OWNER-BUILDER DECORATION
.��E I hereby.(fiur rm that I scamept from the Contra or'.lice..Law for roc
C❑o following mason.(Section 11 L1,Business and Professions Code:Any city or county
$ what,mquires a permit to mmauect,all..improve,dcmnlish.or.F.I,any smac um
Friar b ttstsswnce,rico"moce the applicant for such permit to file asigned summon
G Net.islicensed pursumttot.provisions ofthe Contractor's Ilan.Los(Chapter9 Sq.Ft.Floor Area $0 Valuation
(cmencingwith Section70D0)N1.
Divuion3ofBusineaand Profe .. ode
C )m
5 9omduls,is exempt themfrao W eun
the basis for the alleged eaption.Any violation of
Section 703 L5 by airy applicant for•permit subjects the applicant o a civil penalty of
nm mpp7�Number Occupancy om lean Oww
hnmd dollars(1500). 32618026:tlU' T'Pe
Luowneroft.propmty,amyemploycnwinswagesu (S..ca .B"nen,
and dethewmk,Coat.swauusemes mrWedm Law
to
Budttets Required Inspections
and Pmlarty wh ons Cede:T.Covu.mn, cad who Vw ams m,apply if N rough of Q p
progeny who basIlds i improves dthat
such impu end who doessmh wort eimeelfilthrough his
own emr,the building
progded that such imProwmmts am cot,.bled moRcmn for sale If.
h ildlor the buildingurden of ons or complimproefo.dmowmr-
builder will haw the Widen of proHng chat he did not buile m improve for purpose of
ask.}
t7:1,as owner of Ne property,am exclusively contracting with licensed co sumemos In
Construe,the project(Sou IMC,Bunnm Ccl Profession Code:)T.Conbscmfs(i .
.Law don ea apply as an owmr of propmy who Wilds or impowt thereon.and,
who Conlncts for such projects with a conuvcmr(s)licensed parents,to 1.Comeactor's
Lt..Law.
❑1.uempt undmigC ,BAP C for this mason
ff11 >> Dale shql
WORMS
I hereby air=under penalty of perjury one of the following declaruionc
❑I have and will maintain aCeruGauof Conum to ulNmum for Worlues Compen.
.wion,as providW for by Section 37M of the Latour Code.for the peRormance of the
work for which this permit is issued.
1 have and will maintain Wmkels Comperm dem Tnvuatm,as tcquirW by Settle.
3-!110 of the Labor Code,for tiro pc dor .of tiro work for which this permit is issued. '
My WN.Ys Compermuhm lNunnm.nim and Policy.Thar am:
Carrie. Policy No.:
CERTIFICATE OF EKEMP 70N FROM WORKERS'
COMPENSATION INSURANCE
(rltu scrim need no,W completed Btbe permit is froom hundred donan(5100)
car less)
I wtify that in We performance or 1he work for which this permit is issued,l shell not
wnployany person in any manner. b q bjec,m 1.Workers'Compenedon
Laws of Califem(a Dau
Appficatt (jt
NOTICE TO APPLICANT.-Il.after making hu Certificate of Exemption.you should
become subject to the Werknls Compensation provision of the Labor Code,you am
.J,z forthwith comply with such provision or this permit shall.deemed rooked.
z O
r ST CONucnON LENDING AGENCY
F I.r which thi dutt.m ksue (Sec.3nknding agency,fuer the perfarman¢ur
!Yi dm wort far which leas persue u issued(sou 309'1,Civ.CI
Q. lanae(,Nam
= Z Iandeft AM.
U O 1 Conti that T have,mad this application W suis lea the show Information is
gy ^ conccL I agree m comply with all city and county on moms vM tau kws miming he
O building Connotation.Wthreby aulhoim repoeenuuvn of Nis city m cote,upon t.
(I.1 above-mm
enuod pmpeny fm iNpecum ^.
perp
(~ CL (We,)agree to taw,indemnify and keep harmless,the City of Cupertino agdn,
res tial lieu,judgments.emu and eapeoses which may in any way accrue agent said City
U in eortrgmrce of the swung of this permit
^ APPLTCANf UNO N WILL COMPLY WITH ALL ON-POINT
SOURCEREGUL ION SSUe by: Date
? Re-roofs
Srgowue of Appliwn Doti.or Dim
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tiro applieont or future Wilding occupantstore or handle haurdow mamdA
as defined by the Cupertino Municipal Code.Chapter 9.12 W dm Health and Safety
.Section 25532(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Ipo
Will tiro a lican,or future building occupant u. If a roof is installed without first obtainingan inspection,I agree to remove
pp 6 p Area
AJr Qu or devices which P g
cmtt hmANons air canuminants u de0nod by t.Bay Arta Air Quality Management all new materials for inspection.
Dv t1 P
❑Yes
I have mad tau las ardws mmerlatt onichommodu under Clupe r6.95of1.Calif.,
ria F(eaWA Safmy Code.Secums25505.25533 aud25534.I understood ihalrtim Wilding
deco no,cutrtmly haw a mNN tit' y re po Ntity m notfy tic e¢upant or roc
requirem.ts which m t ph rr
eanfacwrmamoraapcelT Signature of Applicant Date
r/
Owner or authomcd agcnt�' All roof coverings to be Class'%"or better
i Dam