08060137 CITY OF CUPESIO NO PERMIT COI�t'TR'e1CTQR INFORM TIO
BUILDING DIVISION ..��,i�a _�_� � _� � -r•�,�,��,r i�•
PERMIT NO.
""`TVrT4'%NDY LN TBD — TO BE DETERMINED 08060137
NER'S NAME: PERMIT ISSUE DATE
NAPPO JAMES J AND BARBARA C 06/19/2008
77A"1CH=fENGINEER:
NE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG EI�Cr PLUMB MECH
upLICENSED CONTRACTOR'S DECLARATION Job DOSCrIpnOn
1 hereby amt.IWt 1 am IiccuN umkr provisions of Chapter 9(commencing wthScctimn7IXN1)mtoivision3orNCBusir¢uandPmkstionsCadc.memyriccvcu RMD 3BTHRMS, RMV&RPLC ALL TILE&FXTRSJRECONFG
tin in full faro an(d eifett
jPg ueen,a Clss}T ��I Lk.. �/' o MSTRBTH&GEST SPC,MOV FURNC TO ATTIC WALL APP
_(t/ Contractor
ARCH=SDECLARJlTIQN DRAIN, PANS, FIRE& CONN. ADD STRWELL ATTIC ACCESS
W,
1 understood my plans shall W cant as public.cords
6
gC N Licensed Pmfrssianal
OWNER-BUILDER DECLARATION
Z 1 hereby aRrm Nal 1 am exempt from Ne Contractors License Law for the
O o following mason.(section 703 LS,Business and Professions Cole:Any city Of county
$ff which rectuires a permit o rnmLmCt,alter.minora.demolish.Or repair any Mae.
z prim b its issuance,also requlrei dM applicant for such Permit to rile a Signed stawmenl
Nat W is licensed pursuant to Ne provisions of the Conuxmr's lions Law(Chapter9 Sq.Ft. Floor Area Valuation
x�$ (Commercial,with Section 7")of Division 3 of the Business and Profeu(ans Coit)of $60000
Nat he Is exempt therefrom and Ne basis far the alleged exemption.My violation of
Section 7031.5 by arty,applicant for a permit subjects Ne applicant to a Civil penalty ofNumber Occupancy
not roma Ins.five hundred dolwa(SM 31623070. Pane Y Type
I,ssowner of the Pmpmy,mmy emploYcea with wagea ssNeir sole emnpewtion,
will do Brework,andthe structureunotintendedarow ex
faraelcpply In owner
arc mywhiom Cade The Conoacors and
law dao rot apply lf rt owmr of Required Inspections
pmpenywho bismidiorimproves IhiMp andwhodoessucnwokhroff orthrough hu
own em,ftW,provided Nmsuch impswldwi are not intendedmpk6edtheowm R.
however,Ne Wil ding aimpmvemantVhathwithinme Mev or completion,thepwe of
Wilder HB have Rhe blWan of proving dist he did rot Wild a improve for purpose of
ale.).
D I,an mwner of the property,am exclusively contracting with Itonmd contrxsora of
co muCt dr project(Sec.7061,Business and Profession Code:)The Contractors V-
cense law docs not apply to an owner of property who Wilds or Improves thereon.and
who contracts fm such Mjcm with a conuactar(s)licensed pmaa.t an the canumtar's
Licensela'.
❑l am exempt under See .B B P C for this mann
Data
WORKER'S COMPENSTnON DECLARATION
I hereby alarm under peealty of perjury One of Ne following declarations:
D I have and will maintain a Certificate of Convent in self-insure for Worker's Compeer.
sero.,as provided for by Section 37M of the Labor Code.for the performarce of the
work for which this permit is issued
D 1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this pemrit is issued
My Workers Compensation laox5rance carrier and Policy number an,
carrier. Start- F A Policy No.: 0 0 / 6 y 7 6 007 . .
CERTIFICATE OF FXEMPTON FROM WORKERS'
COMPENSATION INSURANCE
(Ihlssection reed not W complesd if Ne Permit is intone hundred dnBars(SIM)
or kca)
1 am C,that in the perfpm enc.of the work for which this permit is iaved.I shall not
employ anypohan in my mannerm as b become subject to Bre Worker'Compmuation
Laws of Caltfomie.Data
Applicant
NOTICE TO APPLICANT:If.after making Nu CMificau of Exemption,you should
become subject to the Worker's Comptoon on provisions of tee lab.Cade you harm
.J z foMwiN comply with such provisions or this permit shall W decreed revoked.
Z O CONsTEucnON LENDING AGENCY
'tied1 hereby&M m that them is a construction lending agency for the pcdom mance at
tYi - Nc work for which this permit is(ssod(Sec.3M,Cie C.)
A Lender's Name
z lenders Address
U Q 1 certify that I have read this apPliesome and sate Inti the show information is
LL F coria 1 agree on Comply with all city and County ordinances and state laws miming to
0 V Wilding construction.and hereby mNorim representatives of this City to moor upon the
Er"ya Ww-mentioned pMNny for inspection purposes
(We)agree to an.indemnify and keep hma ell the City of Cupertino agaimt
III liabilities,)udgmenu,ease andc.pnua which may in any waymeme against said City
C) z A consequence of the RSTAzooming of this permit. 6 y^
'--'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale `.
SOU REGU TI / p
sienam.arnpprranVCom� 6V2? Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or Into.Wilding occupant amrc or handle haaram.motorial
an,defined by the Cupertino Municipal Code Chapter 9.12,and the Health and Salary
or.scetioa 25532(.)7 All roofs shall be inspected nor to an roofing material beim
&Cres 9Na P P Y 8 g installed.
Will the,applicant or future Wilding occupant trha If a roof is installed without first obtainingan inspection,I agree to remove
caril PP 6 P ea Air Quality
or devices which P
DmulcO Anus air contaminants ss darned by Nc Bay Area Air Quality Managcmem all new materials for inspection.
Dy.
I have rad Ne hvvdousmaoriala.quiomau underChapac,635 of the Califor-
Oak Hcalthh SafctyCodc.SecUau2551f5.25533 md2531.I mMmund Naifdr Wilding
does not currently have a rnmL Nat it u my mapeoxhility,to notify the ocopmt of rhe
rvqnui.me BwhiCnh anm Iprim,to issuo of.Cenircane or Occuparcy Signature of Applicant Date
En1� LflIO 8 All roof coverings to be Class';q"Owneranuthori>xd agent �to' — g /�. or better