06070101 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
.sem
BUILDING ADDRESS: HART ING STEPHEN W AND GE MIT' 06070101
8015 RAIN13OW DR
OWNER'S NAME: PERMTT LSSUE DATE
HARTING STEPHEN W AND GE DIN
E: SANITARY NO. . CONTROL NO.
ARCHI EC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
1011 LICENSED CONTRACTOR'S DECLARATION lob Description
1 Inanity affirm that I am Iiconsed under provisions of Chapter 9(commencing
with Section 70010 of Division 3 of the Business and Profewiuns Code,and my license is
m o y in full forte and erre a o .g ADD A PANTRY
1 License Ctua 4d Lk.p f
!Fn Dow Comsat"
ARCHITECT'S DECLARATION
i U I undeutanJ my plana shall be coed as public mmrde TQ
C.
C Licensed Professional
'y� Oat I An A rept from
DECLARATION
10 i I hereby.sect on I e1.exempt Gam the Contractor's
ssions o License Law for dm
.p o fallowing ree5on.(Section 7 o stn Brains and aw,deaou Code:Any city or county
$ which requlrru a permit to eonmncL aura.improve,demolish,nr mash anyed ummicon $26400
?iy Priormits issued pursant also MS he the applic of for wchPermit'suikasiLaw(Char cm
ss� that he is licensed Punuantrothe proviaiou 3theeBusinessnd Noll law(C Coca)or Sq.Ft.Floor Area Valuation
2F (commencing with Section 7")of DI
that
of the Business and Prafeainna Cade)"
ti: that be is exempt IMaefrom and the but for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit aublums the appiicanL10 a civil Penalty.( F vv Occupancy Type
nen roe than five hundred dollars(5500).
0 I,an Owner of the property,or my employees with wag.AS their sok manpeuidem
will do the work,and the swetum is not intended or offered(or sab(See.7044,Busions. Required Inspections
and Profession,Code:The Contractor's License Law it=not apply m anwne
or of q p
property who buildsorimprov.tt,ncon,and whodassuchwarkhimalfor through his ,
own employers,provided that such imprewereanu are not immnded aoBered formic.If,
however,the building in impnewa ent is mid within one year of completion,the owner.
builder will have dm burden of proving that he did cot Wild or improve for purpose of
ale.).
1,as mvar of the Property sur excluaively conducting with licensed conbmrom to
conunect the project(Sec.7044.Business and Profession Cade:)The,Contnemrs U.
cause Law door not apply to an swam of property who Wilda or improwes thereon,ad,
who contracts for such projeets with a convacmr(s)licensed pursuant to dm Convenor's
Licence Law.
0 tom campt seder See ,B&P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of dm following d.lantiou:
I haw and will mound"a Certificate of Consent to selyinsum for Warker'a Compere
sari..,AS provided f"by Section 3700 of the labor Code,for the pr(ormma of the
work for which this permit is mind.
I have and will maintain Worker's Compensation Insurance,u required by Section
700 of the Labor Code,for the performance of the work far which this permit b issued.
My Worker's 77Com amfir�.wnmcg�/artier and Polity nu�myrrbsserain
Grtier.�TCL Q`t[�Ntee Polity No.: X I D 2—
CERTIFICATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need car be completed if d,Permit is forum,hundred dolbn(SIM)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in my mnnnerm a to become subject w the Wahers''Compeuadon
Laws of California,Date
APplicont
NOTICE TO APPLICANT.If.alter making this Certificate of Exemption,you should
become subject he the Workers Compcns don provisions of the Labor Code,you most
.JO forthwith comply with such provision a this permit shall be domed ranked.
ti CA CONSTRUCTION LENDING AGENCY
I—i IWreby affne that there Is a couuuctinn lending agency for the performance,of
FL 7 the work for which this permit is issued(See.3097,Civ.C.)
ILa Q Lender's
res
Z Lender's Adds
U 21 certify that I have road this application AM sum Net the above information is
Lt. F. correct.)same m comply with all city ad county aNinances and sum laws elating to
pU building construction,and hereby amhodve rcpresentamiva of this City to enter uPnn the
W shove-mentioned pri,rty for Inspection purlwses.
(Wed agree to save.indemnify and keep harmless the City of Cupertino aOWL
py req liablliti..judgments,cos,and expenses which may in my way earn against said City
U'Z in consequence or the among of this permit
^•r
APP LIC NT jlNDE!ST NDS AND ILL CO PLY WITH ALL NON-POINT Issued by: Date
SOUR E mULATIOq
/�i+1 74e / � Re-roofs
Signre atuofA inndConuxmr Date
- HAZARDOUS MATERIALS DI LOSURE Type of Roof
Will the applicant"future building oceupanlsmm"handle haardou material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Section 25532()? All roofs shall be inspected prior to any roofing material being installed.
Oyes _11 .drNo
Will da applicant or future building=.Pa.,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t huarolms air contaminants a dcfrmd by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes �No
1 have mad the huxdousmawrialsmquimmendundcr Chapwr6.95 of the Califor.
nia H.IN&Safcty Codc.Samcm25505,25537 and 25534.I understand thatifdm building
it=An current y hos a tenant.that It is my rospomibility to noul'y the occupant of the
require n khmas mIprior toissuammOracerurl roc er. Signature of Applicant Date
owl r.atho red resent oar All roof coverings to be Class"B"or better