04050179 CITY OF CUPERTINO 7777777
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT"04050179
10214 S Pnr)`T`�T A17
OWNER'S NAME: PERMITISSUEDATE
JAMES W GUTHRIE ng/97/2004
SANITARY NO. CONTROL NO.
ARCH11ECTIENOTWER: BUILDING PERMIT INM
BLDG ELECT PLUM MECH
00 LICENSED CONTRACTORS DECLARATION
I hereby affoom that I Are lictrosed under provisions of Chapter 9(commencing Job Description
Arab Section 7")ofTivision 3 offt Basin PfcW,,.aC.&..d 8
in full fame Vill 13ATH REMODEL/CABINETS & LIGHT
ta. 'a
'p- LI ---
Dam Contractor CONTRACTOR: J.D. GUINEY & CO.
ARCHITECTS DEC ION
Adar
"'t4dersimbi my p1m..h.11 the..d As I;:2mctmtts
Licensed Professional
MWER-BUILDER DECLARATION
I homy affirre that I am exempt from the Contractor's Licanto Law for the
E 09 following memo (Section 7031.5,Business and Professions Cact:Any city at county
which requires,a Permit in construct,alter,improve,demolish.or repair my strucium
ZZ, imortaits hatmatC,A]SO anytime the applicant forsuch parmi,tofile asigned statement
that he is licensed ptursim"t to do,provisions Of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Vaol
(commencing with Section 7000)of Division 3 of the Business and Prolossima Code)or _ttpli 0 0 0
that he Is exempt therefrom and dam hands far are alleged exemption.Any violafi,on of
Section 7031.5 by a"applicant for a peraft subjacts the applicant to a civil penalty of
net...then five hundred dollars($500). APN Number Occupancy T�pe
0 I.mownaofthepmpmy.ormyemployomwi0mgmu0cirsokcmpenution, 36909007 . 00
viffid.th.work.gaultbamramiurciarmthamanded Qff..d
And Profteshms Code:The Contraccurr's License Law does not apply to in marom of Required Inspections
property who lmdld�orimproves thancon.and whodoessuch wmkhimwiforffimugh his
own aneoployces.provided that such improvements Am notinuabled oroffeared forrade.If,
however,the Wilding or improvement is sold within am year ofcomplegon.the owner.
builder will have than human of proving that M did not Wild or improve for purpom of
sal..).
0 1,as Owner of the property,am exclusively contracting with licensed coramcbms,to
construct the project(Sec.7W.Business and Prolissions Cockc)The Conummor's U.
cards Law does not apply to in Owner of property who Wiltat or improves themon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Coramcubs
License Law.
E]I son Attempt order Sec. B&P C far this reason
Owner Data—
WORKERSCOMPENSA�GNDEC�RATION
I thereby affled uncierfamaltyafixedury one ofthe following declarations:
Ave and will maintain aCenificamm'ConsuaL to"If-finsure for WarlmesCoonpon-
mono,As provided for by Section 37M of the Labor Code.for the performance of the
w work for which this Permit is!wood.
n I haw and will maintain Worim's Compensation Watursance,As oupdred by Section
37M of the Lab.,Code,in th Puffa of the work for which this permit is istrated.
MyW ke C fie samen And Policy
C C.. Policy
an- "I:-TO N.,iM V 3 a?_—
CERT FICATE OF EXEMPTION FROM WORKERS'
COMPENSAIDON INSURANCE
(Thissection need not bacomplered highs,parnall Is forma hundred dollars(SIM)
,um.)
I ccrdfy that in the Performance of the work for which this Permit is issued.I shall not
employ any person in my mentruar an a he become subject to tho Workers'Compensation
Lam of California.Dam
Applicant
NOTICE TO APPLICAN71".If,after making IW,cestirmate,or Exemption,you should
became subject to me Worker's Compensation previsions of the Labor Cods,you mum
z forthwith comply with such provisions or this Permit shall Im deemed retained.
z 0
r7 CONSTRUCTION LENDING AGENCY
I thereby Air,.dam dore I.A construction leading gancy fro,ho pe,f.....x,of
the mark,I.,which this permit is issued(Sec.3M,Civ.C.)
Leaders Name
IS� r
z Under's Address
U 0 1 tartly last I have road this Application ad also that the Abu.information is
IL r correct.I agree to comply with all city ad county ordinances and&Mae laws relating,to
w
0 Wilding construction.and hereby authorbas mpresentatim of this city In enter upon me
above-mentionad property for inspection purposes.
(We) Sam to Arms,indemnify and keep hourelass the City of Cupertino against
tn liabilities,judgments,costs and expenses which may in my my we=againstmid City
Z in consequence of the g g 9 "S MILL COMPLY WITH ALL NON
AppZ T an'' th"ITILL COMILI -POINT Issued Date
10 ---�N I I S a
��R;Altl N by: Date
S
I 111GUNDI.OYNS.
1_ n� \'�-2 7-2�6�Re-roaofs G7
Whaturnbi'Appimam"' assam Dam
nUC
HJ AR11U1 MATERIALS DISCLOSURE Type of Roof
,a.
Will the appli ann or future building Occupant store or handle hazardous mamnai
As&flood by the Capetian Municipal Code.Chapter 9.17.and the Health And Safety
de.Sactiort 25532(.)?
0 Yes 14�N. All 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
hazardous air contaminants As defload by the Bay Area Air Quality Management all-n w materials f in ly ct on.
0y.
lhava mad�chmdousmawrialsmquimmen�underChapmr6.95aftheCalifo�
�4'r,or g
a ardin
rdaH,adth&SafctyCodc,ScxtkAA25S 05.25533and25534.1undermandthatifts,hilding
does n;,tc�mwnn,,L, I ithillLyi.emlyfficoccupartar a
An
In
�xi W
kni hi to `l1nOnnm`*1,m`.r.'1tmyX�f"C ME A�fe.pkh
e ignature pplicant Date
0 A a '22 0 —_ O?�
Z�hmm,td agent All roof coverings to be Class "B" or better
Own ho,,cd aam, Data