04080003 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �� - R INF' RM�' � �
rs
y a 9u1LDINGADDRESS: JEFF & DENISE OLIVER PERMIT No.04080003
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY OLNO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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yoo
LICENSED CONTRACTOR'S DECLARATION Job Des
u 1 hereby affirm that 1 me licensed under provisions of Chapter 9(commencing
'^�to Scedon 4IXM1)afDwi.km3ofda.Deai...end Pmfcasima Code.and my license is HNALED
in full fo...nd effttt.
5yz LlanaClasa ldc.g ELECT. PANEL UPGRADE
Data ConDECLARATION
ARCHTECTS DECLARATION 'JAN zir 2005
I
I undcraund my plans.hall he used As public rtcnNs
�yU
ick Licensed hereby affirm
BUILDING.
p 3 OWNER-BUILDER DECLARATION
E�I I hereby.(Siem Not 1 em exempt from dm slosi aloes License law for the
EM O following mason.(Scotian RD I3,Business end Professions Code:Any city or county
x m which requires
a perm,to construct,the alar.Improve,h pormil u or repair any structure
Fiy
prior mits issuanec.eln requires the applicant farsuckpermitw rile asignedamemenl
Z< that he is licensed pursuant to the provisions of the Contrutur''sLicense Law(Chapter 9 Sq.Ft. Floor Area Valuating 409
on
t0 (commencing with Section 700))of Division 3 of the Business and professions Code)ur
i 3 tltet he u exempt therefrom and the basis for the alleged exemption.Any violation of.
Section 7031.5 by any appliantfor a permit subjects the applicant to a civil penalty of 3}1��1y1p1¢erpp Occupancy Type
not more Nan five hundred dellen(5500). r
❑I,an ownu ofthe property.or my employees with wages u their sole compensation•
Will do the warl4 and thestsucue n not intendedoroffertd forsale(Sec.7044•Business Required Inspections
and Professions Code:The Commoor's License e Law does not Apply to an owner of q p
property who builds or improves thereon,and who does s uch work himself re through his
awn employees,provided that such improvements Are,not intended or offered for We.If,
however,the building or impmwment is said within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
We.).
❑1,as owner of On property,am"elusively contracting with licensed emuscl.R n
construct the pmjcct(Sec.7044.Business and Professions Cade:)The Contractor's U.
cove Law does not apply to an ownu of property who builds or improves Neuron,and.
who contracts for such project,with a contractor(s)licensed pu su ,in the Contractor'
License Law.
❑Ism cm rapt un (3 .B k PC far due; n
Owner Dek 2
`1�A K' OMPENSATIONDECLARATIO
v I un cr pena0y of perjury one of the following actuation: .
I have and will maintain ACcnifieak of Consent to self-insure far Workers Compete.
sation,u provitletl far by Section 3700 of the labor Code,for the periormance of UN
work for which this Permit is issued.
❑I have and will maintain Workers Compensation Insurance,u required by Section
3700 of the labor Code,Ids the performance of the work for which this permit is issued.
My Worker's Compeneatian b nerncc artier And Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu action need not M1c completed if the permit D for one hundred dollars,($100)
or Its..)
1 certify that in the Performance of the work for which Nis Permit is issud,1 shall not
employ any person ii.A;9nuner ss,utter naubics'd to Ho Worker'Compensation
Laws -
Applicam
NOTI T A A 1 y c�meking Nu Certificate of Exemption,you should
becomd t t print compensation provisions of Ne lahor Code,you must
.J O foMwith comply with sudr'prminc ns or Nis permit shall M Loomed revoked.
z CONSTRUCTION LENDING AGENCY
f' Iloom, from that thea is a convection lending agency forth,Performance of
(y'- doe work for which this permit is issued(Sec.3097.Civ,C.)
W�Q Lcndcrs Nam.
Z)z lender's Address
U O I certify that I have rad this application and soon that the above information is
IL F COMM I agree to comply with all city and county oNthafees and son IBM relating to
Obuilding Coagulation,and hereby Authorize rtpMMMALIes or this city to enter upon Use
V
Uabove-mentioned pmpcfty for inspection purposes.
L}r,LL (We)agree to save,indemnify and keep harmless the City of Cupcinin"ageimt
tv) Ilabilitlexjudgmenarcosts and expenses which may in anyway accrue against aid City _
U F77 APPLICANT UNDEuienco of the RSTANDS Aof IN�'WI OMPLV WITH ALL NO-POINT Issued by: Da
sou LICA T TI
mu?�
z 6 Re-roofs
Ates f is o bOUSMATERIALSDISCLOSURE D Type of Roof
the man'.rfnura building occupanumrc or handle hansom.material ,
u defined a Cupertino Municipal Cadc,Chapter 9.12,end the HceIN d Safety
Code,Sec Ban2a333(a)?
❑res P. 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
it haeardous air contaminants As dcfincd by the Bay Area Air Quality Management all new materials for inspection.
Iatric'?
❑Yes �pu
I have mad the henNrms noneialauquirtmentt under Chapier6.95 OF the Califor-
nia HcaW&Safety Cade.Sections 27505.25533 and 25534.1 understand thatif the building
do"root currently haw s tenant Net it i aponsihility k really the a<upant of the
requirements w ' m mel prior ec.f gen cap Y Signature of Applicant Date
wnero set Aga - Dole
All roof coverings to be Class"B" or better