06030069 CITY OF CUPERTINO
BUILDING DIVISION PER* *lim+��a �*. ��t� j'j' "+s 4 '
'1 qONy RA( TORI �A'-O O y-
BUILDING ADDRESS: PERMIT NO.0 6 0 3 0 0 6 9
10541 RANDY LN '
OWNER'S NAME: PERMIT ISSUE DATE
MOWN,
WALTER & JOYCE PEREZ 2006
:
SANITARY NO. CONTROL NO,
ARCHITECT'ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
a0 LICENSED CONTRACTOR'S DECLARATION lob Description
U m Ww Fj T hemby affirm 1 am licensed under provisioof Chapter 9(c nnowmint
w with Secdon'/WO)of Division Sof Nc Busin=udProfessions Codc,aMmyliccnuis
„ in fail force and effect. ADDITION 1538 ' -2 BATHRMS/PANTRY/FAMILY RM/KITCH
tqi License Class Lie'"
Dam Co MASTERSUITE-INTERIOR REMODEL 200 '
DELL ARCHITECTS DECLARATION
i 21 understand my plans shall h used u public record,
ayV
'LLy Lianua Pnsfcssiona
D Oat I am cUILDER DECLAR
ATION
1 a C burets maso .(Erre that 1 am,Bump,s an the Convu ors :Any c law for the
:p O following moon.Permit
b 703 LS,Business and w,de am Cade:Any city m county
:$(L which its ssu a permit re cnnWwl,alter,improv,h permits or a repairany structure
-iy
prior miuisswnce.anu requires;she provis ouof for awhpcnnftmfticaSLaastammcnt
: p Nalhencingwitpursuant 70M)ofDivision3NcGnnuaemYand rmlaw(Chapter Code)9 Sq.F[.Floor Area Val 'dIB851
1 (commencing wiNSccdods,andof,Division tof hat Business and ProfessionsCode)of
$ Nn be u 31.5 b any applicant ren and the bats for the alleged esempddto My l Penadn of
Sation]0515 by anyleddllfora permit mbjecu the applicant a civil penalty of p�NbTber Occupancy Type
not mom than Bw nanama dollars(ssoo). 3�6 0 2 U S 4 . 00
❑1.u mvwr of tnd proprny,re my otimances with wages a amu rule compcnrium
will cloPr Nework.and NC That,
munnume License Law
ed dos Out c(See applyo an
Required Inspections
and cnywhlow Cattle:The Canuaclon,and
Uw does mf apply m an owner of q P
gingerywhobuildsarimpmwa Neiman,ahawho acessackwork or aelfa ithrough M1f,
own cmr,me uiprovided Nal such im ismemenu art not intended mmeti n.far owner.
however,Ne building orfmpmwmenl'umide did au year or completion,Cm owe of
builder,will have the buNan of proving Nat he dice not build m improv far purpose of
1,es awwr of the progeny.am uciwively contacting with licensed contncton m
command the project(Sec]Obs.Business;and Profecdua Code:)The Conuacmr's U.
order law does not apply m an owner of property who builds or(repro ms thereon.and,
who contracts for such projects with a con rretor(s)Reacted pursuant to Ne Conuanar's
Lmcwe Law.
11
❑lam tae a v' B&PCfa Nn mann
er ori - 6I �
ORK- 5 OMPENSATIONDECLARATION
I hereby afli, undo Ity of perjury anc of the following aeclaradons:
❑I ham and will maintain a CerdGa cof Covem to sulf-fame for WodeYsConpen.
inion,u provided fm by Section 3700 of Ne Labor Code,for the performance of that
Work for which this permit Is famed.
0 1 hast and will maintain Workers Compensation Insurance,a vesperal by Scedon
37110 ofthc labor Coac.for Ne pertormarme ofthe wart for which No pemthis bawd.
My Work s Compensation Insurance artier and Pole,number art:
Carrier Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mussectian wed not be compicmd iftbe permit is for ruse hundred aollus(SIM)
or less.)
I anify that in the Performance of the work for which this Permit is iseued,I.hall aot
employ any permn in anywfm NC Wastrels'Compensation
Laws of Califgmia.Dam
.Nay(QYl mann m m ccdme mbj
NOTICE TO APPLICANT:If,after making this Cckr--
of oa,you should
become subject to the Worker'a Compensation provisio he lark c,you most
.,O forthwith comply with such provisional of this pcnnit.hall be dwmcd cd.
Z�) CONSTRUCTION LENDING AGENCY
sN. I hcmby affirm the Neu is a construction lending agency for the performance of
E
> am work fur which this permit u issued(Sec.3097,Civ.C.)
GQ L.OW's Name
:D z Larder's Addtcu
V Q 1 call that 1 ham read this application and sum the tM about information is
U, H cor¢oL 1 agree to comply with all city and county ordinances and state Tawe relating to
U building consuuc,iun,and hemby authorim representalws of Nis city to enter upnn the
r W Boal, es,judgments.
progeny fariaspeeddn purpose:.
F0. (We)agree m saw,indemnify and kcep hamlkss Ne City of Cupertino against
'fA liabilities,judgmcnu,costs and upcnscs which may in any way eccmc against said City
V z APPL C w STAN of AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 61%- Pe
SOUR R ONS
Si area pplian a Date Re-roofs -��
HA ARDOU ATERIALSDISCLOSURE Type of Roof
oma lion, Curt (dingescupmtscamorhvWlcha owmaterial
u defined b apenmo Munfdpal Code,Chaim,9.12,and the Health and Safety
od,Section y. ONO 25572(.)?
❑Ya All roofs shall be inspected prior to any roofing material being installed.
Will thea locant or future Wilding dam nt tame m If a roof is installed without first obtainingan inspection,I agree to remove
Ire B W equipment or Mara which P g
emit haraNnus air contaminants u defined by,hc Bay Ama Air Qualify Management all new materials for inspection.
DiWltt?
Q Yo ON.
1 have mal Ne heard.numriais requirements tank,Chapmr 6.95 of the Cabins.
nice Hcall"Safefy Cade,Sccdow25505.25533 am12553 .1 understand thaifile Wilding
dues not currently haw a tenant.that it h my responsibility to unity the escaper,of the
reyuire me, uiadenannccrdfiamoraa ancy. Signature of Applicant Date
(a f ZOO
Own ,tat rnedas n, Dam All roof coverings to be Class "B"or better