08080186 F
ITY OF CUPERTINOT�a,�r ��.{�s`BUILDING DIVISION PERMIT �C0NTk .cTQ )K .LDING ADDRESS: PERMIT NO.
101.00 PHAR LAP DR TBD — TO .BE DETERMINED 08080186
ER'S NAME: FEMM L41rE DATE
Id13RT FRESCURA 08/25/2008
NE: SANITARY NO. CONTROL NO.
ARC11=1ENGINEER: BUILDING PERMIT INFO
REMODEL MASTER BATH, HALL
B� O PO O
o e LICENSED CONTRACTOR'S DECLARATION BATHReeM
0 1 hereby affirm that I at Ilaomed under provisions of Chapter 9(ammencln{ Job Description
with Smdon TOM)of Division 3 of the Bwunm ad Professions Cost.ad my licen4 is
^n in full forte and effect.
eti Z Liam Clara Ln.0
SS Dam Cofinectorn
ARCNRECI-S DECLARATION
1 understand!my plain Nall be used as public records
J
g ud
Lamed Professional
N
OWNER-BUILDERexptfr DECLARATION
1 hobo aRrm that 1 Business
from tho fesmncmh License city
o far the
I O which
reason.permit
1 7031.5.Buslim and Rrfcesiuns h.or Any dry m county
$� which esquires s permit m crostme4 alar,improve,demnlah.or repair aY Nmmm '
Z prior m its issueoee.ala requires me applicant for such permit m file a signed farmout
�< mat he a licensed Woomeram the provisions of the Cmuamie.Bans Law(chapta9 Sq.Ft. FloorArea Valuation
9 (commencing with Section 1000)of Division 3 of the Business und Profesiens Onto)or
that he is exempt therefrom and the bon for the alleged comp ton.Any Wolman of
Section 701.5 by am'appllant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dolours(5500).
❑1,"manor of dm Property,sur my anployces with wages as Neo ole ampeesadon,
will do the work and the auction Is not intended ar offered for Wes(Sec ION,Bun mus
ad Professlom Cade:The Connectors Liam Law does aux apply in an owes,of Required Inspections
property who bis Ilia or improves themon,and who does such work himmlf ar through his
own employers,provided that such Improvements an not intended oroffered forsele.If.
however,the building a improwemat is mid within am year of ampledon,the cannot.
buildn"
anm-
buildct will have the burden of proving that M did not Wild or Improve for purpose of
sal..).
1,u wam of the property am exclusively contracting with licensed contracts m -
a mct then pmjea(Sec.7044.Bminm.m Profmaiom Cade:)The Commas LI-
come Law does oot apply to a owner of property who builtla or impmws Merton,ad
who conracu fa such projects with a anlramor(s)licimed purmnt to the Contractors
I.iceuze Law.
❑Tun,�r ,ado,See .B h P C res this resect
i/j{br a AOI rte� Dam
WORKER'SC MPENSA� TIOND�ATIO
I hereby alum under penslty or perjury am of the following declarNom:
I have ad will mai n in a Cerunan ofCansent m self-Le rme fa WorgersCompo-
udo.,u provided for by Section 31011 of the Isbor Code,for the performance of the
wort for which this permit is Earned.
❑1 have and will maintain Worker's Compensation Imunnce,as required by Schon
3700 of h labor Code.for the performance the werk for which this permit is issmd. '
My Workers Compensation htsuraa artier ad Polley number are:
Carver. Policy No,:
CERTIFICATE OF EXEMP[ON FROM WORKERS'
COMPENSATION INSURANCE
(Guatemalan and at h completed if the Permit isres oro hundred dallam(SIM)
or ass)
1 cinify that I.the perform.of the wart fa which this permit is latmd.1"I rot
employ any perm.in mymamr ameytMftI to Warkere Comperea0an
Lawsaf Calffomi /f1
Applicant
NOTICE TOAPOeWod , omm �h�inant prion,you ushould
m
bmorne enbjca y id Workers Compemda pmHuons of the taloa Code,you mm
OforthviN amply with such proviuons or Na permit Nall be homed rooked.
ZC CONSTRUCTION LENDING AGENCY
.�. Ihemh alum that Wert its comwNnn lending agency
F r { ^"res the perfamemo ur
�ithe work fur which this permit a issued(Soe.3099,Cl,Q '
{L7 Q Lenders Acid
Z Lenders Acid
U Q I certify that I haw and rids application ad sum that the show information is
LL^. contract.I agree m comply with W city all county aminanma ad Etas laws relating to
O SU^ building construction.ad hereby authorize opencraiiwes of Nis city to under upon the
[Ll above-mcndannd property I.apeman purpose.
gy (We)agree to ove,indcmNry ad lump hamlet the City of Cupertino sgainst
Vto Iiabilides judgmem,cons,ad expenses which may in airy way snece maim old City
7 in consequence of the granum of this permit.
a APPLICANT UNDERSTANDS AIM WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR�a,REGULATI, S.
M ,fir Cf/L! ��i Re-roofs
Siva.of ppllma/c.a. Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuuua building ampatsume or handle hauvtlam material
AgjLd.II by ds Cupertino Municipal Cade,Chapter 9.12, ad the health ad Safety
Scalon 2.5532(.)? All roofs shall be inspected nor to an roofing material bei. Installed.
❑Yes `RI No P P Y 8 g•
R911 the applicator(future building emotions uc equipment a dcvio-s which If a roof is installed without first obtaining an inspection,I agree to remove
it hauaNnw uir cl=moms as de0md by dm Bay Area Air Quality Management all new materials for inspection.
bare'?
❑Yes 2yNu
I hew real the houdWms materiats rt pdrancnts voter Chapter 6.95 of the Califor.
niceNml"Safety Cede,Smums 25X15.25533"25534.I unlmub thaifthe building
dam rot curremly Mw a moat.Mar is a my rtspom amity m unify the o¢Want of the
squirt uwhihmuu roes ' rmiarusnmofaCenifica rtleeupaey. Signature of Applicant Date
7- All roof coverings to be Class'n"or better
Ownerofaaha urdag.ra Dos'