08050054 CITY OF CUPERTINO �wa�>*aw€..ri �f�" � '��- .
BUILDING DIVISION PERMIT , '�QN'T.Rel-CNTQR t RMA.' IQRIN
fig.
BUILDING ADDRESS: PERMTf NO.
7!)34 RAINBOW DR TBD — TO BE DETERMINED 08050054
( NEWS NAME: PERMIT ISSUE DATE
PI•;-.1�-1.r.1NG CHANG 08/14/2008
HONE; SANITARY NO. CONTROL NO.
ARCHITECTrEhIGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3oa LICENSED CONTRACTOR'S DECLARATION Job Description I batch, in.Wlicenced a 1 am ced under provisions of Chapter 9(rommercing
with Sacha 700)ot"DTvhion 3 of the a".and Proleamu Come,and Cry license I- 750SF ADDITION/REMODEL INCLD NEW FAMILY ROOM,
niin full mroecMarea - POWDER ROOM, RELOCATE KITCHEN
o Glut Lle.Y
�IIF�2 ll Dam Condonsor
3 ARCHITECT'S DECLARATION
2 I undcroand my plans shall W used as public records
5 G ov Licensed Paul evleast
OWNER-BUILDER DECLARATION
i 1 hemhy affirm Na ur I suempt face the Conuanaes License raw for the
0 o following mason.(Section 7031.5•Business and Proreaiou Code:Any city or county
1�i which acquires•Permit an coeawct,alar.Improve,demolish,Or repair any anucturo
_ STI Prior m its issuance,sato es tis requirapplicant for such Permit m file a signed statement3F< Had he is named pursuanl m the provisions of dhe Comtrsemes Liao iaw(Chapter 9 Sq.Ft. Floor Area Valuation
Sha (commendnswithSection700MofDivision3ofteBusinessandProiasiomCode)or $100000
Y that Its Is asempt Wemrrom and the basis far the sileged esempdon.Any violation of
Section 7031)by any applicant for a Permit subjects the applicant to a civil Penalty of — Number Occupancy Type
ant fume than five hundrtt dawn(55001. 3 6 61104 4 .'Ulf'
0 1,u owner of the property,or my moploym with wages as their sole compewtion,
will do the wore,and the structure 6 rat Intended or offered roma(Sec.70th,Business
and Professiou Cada The Comtrame,License Law does not apply to an owner of Required Inspections
Property who builds or imparts dhermn.and whe does such were himself m through his
awe eaplo,m,provided that such iap.cms art tat Invaded maffertd for tale If,
however,the Wilding or improvement Insole within ane year of completion,the owner,
builder will have tie Wrden of proving that M did no,Wild or improv fm purpou of
ask).
Cl 1.u aahher a tiro property,ma aadmively contracting with licensed rontrumss In
Construct use project(Sec.7(104.Business to Professional Code)The Contractors U.
cera law dean not apply m an owner of property who Wilds or improves thereon,and,
who commscts for such projects with a contras or(s)Iieensed pursuant m the ConuMor's
Lan x law.
[Ilan as ph undo Se .138E(P7Cm rdes muoo
nu DamT
WORKER'S COM NSATIO LARATION
I hereby affirm under scally of perjury a of the follewall declantimc
❑Thaw end will msintsinn CeNfiaa ofCament to tile-imurtfarWorkeraCampen-
salon,u provided fm by Section 3700 of the labor Code,fm the Performance of the
wart fm which this Permit is want.
0 1 have sad will mamem Worteft Compeuation Insurance,u reported by Section
3700 of the Tabor Came,fur the performance of tW wok for which this permit is luwd.
My Waukee,Cmnpmtsation to.artier and Policy number arm
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this orlon reed net becmnplead If the perch In fmana hundred dollars($100)
lir leu)
I anifv that in the performance of the work for which this Permit at issued.I shall not
employ any pen ' nymanncravm Wron hbjectio Wo rken'Compenadon
law,of Csii mile, a
Appliant — —D
NOI7CE PP ANT:If,after 'ng tip{ tinam of Exemption,you should
become,able Na Waiters Compemlto isom of the labor Code,you mum
.JO forthwithcomp with such provisions or this Permit shall W deemed revoked.
z- CONST ucnoN LENDING AGENCY
9 4 I hereby IMM ME cert is a Construction lending agency for the performamx of
a> dte work far which that permit Is wued(Sac.3097,Civ.C.)
14A Lenders Name
CIE..1. z LeMers Address
U Q I certify that I have mad this applicsdon W tum that the IWw infocudu t is
LL, ;^ cores 1 agcy to comply with all city and county ardinances and atste Ian matting to
Q rV" Wilding construction.and hereby authmlre mpmaenuuvu of this city to enter upon Ne
slow-mentionW property for inspection purposes
(We)agree to asp,inmemafy,and kap hamlets lie City of Cupertino agsinm
rn tdail10es,juegmceW eons and K.which may in any way amus against aid City
APP (CANT ofNERSTAIf NDSf AhNDri L COMPLY WITH ALL NON-POINT Issued by: Date r4—o/--
SOU CER QULA ONS. 14
—/ —O� Re-roofs
SI{nau pptantConuacmr Data
xAZAaOouSM ALSOISCLOSURE Type of Roof
Will the spoliator m future Wn ST..pNt mom or Inner.assistant materia
u defined by the Cupertino Municipal Cade.Chapter 9.13,and tW Health and Safety
Section 35532(')' IlN� All roofs shall be inspected prior to any roofing material being installed.
❑Yen Q>
Will the applicant or future Wilding aceupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cart huardom air cantaninants u de red by the Bay Am Air Quality Management all new materials for inspection.
Disvic°
❑Yes Nu
havwv the heallousmamdaInrtquimmenu under Chapter Q95oftW Califon
ria thkSafcty Smo.25M5.253331md dB4.Iwdcnwiditifft Wilding
does n i currently Ww mnsnt,that It is map jI I111Y In notify the OccuPant of Ne
require nuwochm ,W=1Prior t suss. raCertificate ar�YnpaKy. Signature of Applicant Date
OMy-
7
44
Owncroutharimd gent Date
All roof coverings to be Class'A"or better
a ' ' — — ,a