06020137 CITY OF,CUPERTINO » �'�{�
BUILDING DIVISION PER NIIT � CONtT"qTd Y
BUILDING ADDRESS: PERMIT NO.06020137
19231 PHIL LN
OWNER'S NAME: PERMIT ISSUE DATE
VAN TRAM 05/03/2006
E: SANITARY NO. CONTROL NO.
ARCHIECf/ENGINEER: BUILDING PERMIT INFO
BD 0 PLUMB
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;op LICENSED CONTRACTORS DECLARATION lob Description
I hereby affirm that 1 am Ilmued under provisions of Chipper 9(mmmcecin{
uT1 with Section 7000)of Division 3afthe Business and Prafauium Codie,aaL my It"=I.
❑N In full mrenand affect. ADD 1290 ' & REMODEL. 970 '
Liceua ChssLk.a
DauffCSANITARY/SUNNYVALE
'
ARCHECTS DECLARATION
f 1 understanJ my pt m shall housed u public recnNs
yQ Licansud Professional
7 OWNER-BUILDER DECLARATION
2 n i hereby.(Sero than 1 1. exempt faro the Ceadons Co License Law far time
o O whichfollowingre reuan.(Section 7(D L4 Business and demolish.
e ons Cale:Any city or county
3$ which its inu a permit re ennswet slue Improve.h permit t nr mash ed umnum
_ pdormiu iuuancoossums todue the isionsocam for mchpetmit mimarm aw(Chumem
Nat he is IimnscJ pursuance Ne provisions of Na Contractor's Limnsc lave(Chapter 9 Sq.Ft. Floor Area VahjaiiBy4 2 6 4
KS @ (commenting with Section 7000)of Division 3 of the Business and Protestants Cade)or
L that he is exempt therefrom and the bash for the alleged eaemptian My violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of pPN Number Occupancy Type
net more Nan five hundred dollars($500). 3 7 540047 . 00
w
wiB do the work.and theswmure4notlnteMedmoReredi forsete(Sec.RM/,Busineu
Required Inspections
and Profeam ns Ceder The Commutes Lune Law des not appy m an owner Of q P
property who Wildsmimprovea thermn,andwhodaausuch work himWfmlluough his
awn employes.provided that such improvements me not in', or offered for sale.H.
however,the building or improvement is mid within We you of completion,du owner-
builder will lave she Wrden of proving that he did rot build m improve for pmPum of
7F
L u the pof the Sao.7 ,am umesively conussums with Communes
U.summon cite not (Sec. r an weer of and property
who Wilds
Cade:)The Cmtracmr'a M-
ahn Law doss not apply je an owner of property rho Wilds m ores to am comon,rod,
who contracts for aucb projena with amntracmr(s)Ikemsmd pursuant b the Canoutah
Licenm law.
❑Ion ucmpm undine Seavc,,,,tt /,��, I .Bl PC(or�yNu moon
mer-M�ttxi P 1 lti 2a \/"J—Data s7 J
WORRER'SrCOMPENSAYYAON DECLARATION
1 hereby aRrm under Family of perjury one of the following declarations:
I ham and will maintain a Ce Rma of Consent m self-insumfor WorkersCompcn-
-"on,u provided for by Section 3700 of the Labe,Cade,for tic performance of the
work for which this permit is Wood.
❑1 have and will tai
and Compensation Insumnoe,u required by Section
3700 of the labor Coda,for Ne pribor anm of the work for which this permit is land.
My Worker's Compensation Routanm artier and Policy number ase:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE /
(Thhaectlan=it not to completed Bthe permit is fmane hundred dollars($100)
or leas.)
1 cenify that In the pnfamanm of the work for which this permit Is f sscd.I shall oat
employ anypermn In my am rm I oma subject to Ne Warmus'Compeaaadm
Laws of VOL
AFFliO
mnt 1 K tto
NOTICE TO APPLICANT:If.iRer making this Certificate of Exemption,you should
bamoe subject m the Worl ur'a Compensation provisions of the labor Code,you mut
.J O fi Mwith comply with such provisions or this permit dull W dimmed rooked.
Z"' CONSTRUCTION LENDING AGENCY
Fr.yrs I kmby aDirm des tkrt is amutmctian kadin{agency for cite Mrformenmaf
fY the work for which Ws permit is issued(Sec.3097.Civ.C)
6Ui Q Lender's Nurse
z Larder's Address
V O I oartify that I lave mad this application and rote Nu tite above information is
(y F correct I agree to comply with all city and county ordinances and state laws relating to
�U building construction,and hereby mtharisempremourdwsofthis city toOmer upon f
LV above-menlionad pmperty for impecuoo purposes.
L4 (We)acme to save,indemnify and keep humleas the City of Cupertino against
„spy InibilhJujudgmarox,min,and expenses which may in my my scene ajdastmid City
U`z in eonmgeance of the grating of this permit
rti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3,U6
SOURCE RE UL TIONS.
�n C,l'VJ'0 Re-roofs
Signature ofAplicant/CmtmcmrD�Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding dompant some or handle heuNous material
as defined by Ne Cupertino Municipal Cede.Chapter 9.12.and the Health and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu VN.
Will ft applicant or future Wilding Occupant use equipment ordcAcns which If a roof is installed without first obtaining an inspection,I agree to remove
mit hmminus air contaminants as dcOmd by tic Bay Arca Air Quality Management all new materials for inspection.
District? JJ
QYca (`Nu
I haveread thehuA mm=HslsmquimmenuunderChapurd.95ofdteCalifor-
nHnslNk SafdyCmu,Sttvmu2S505.25533vW2553d.lundeautral nifde Willing
dnot currently have a tenant thea it h my responsibilityte notify the occupant of use
L
requirementsI which most W met pdormivummofj Cunifrcau of ^ry. Signature of Applicant Date
'til.(NVUVNEzA V/f+v S 41 Dow _ All roof coverings to be Class"B"or better
Owner or agent
m Dau'