06060104 CITY OF CUPERTINO art �ayrg�. *rrgs.•�`+
BUILDING DIVISION PERM! iCONW1, ^g•OR "0
BUILDING ADDRESS: WALTER & JOYCE PEREZ PERMIT"°.06060104
10541 RANDY LA
OWNER'S NAME: PERMIT ISSUE DATE
WALTER & JOYCE PEREZ 26 Z 2006
. SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
io LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 thereby affirm that 1 em liccnud under provisions of Chapter 9(commencing p
illwith Sued..70711)of Division 7of the Business and Professions Code,and my licenuu
infauforceandeffea REVISION TO ORIGINAL 06030069
C Dao:m LicClans Lick
:W ADD 2 NEW WINDOWS TO BEDROOM 4 , ADD EXTERIOR
ARCHITECTTSS DECLARATION CLARATION PLYWOOD & NAIL
>a Iundeaand my plarem.11 the used as public¢curds
rU
Liccnud Pndcssionai
�3 OWNER-BUILDER DECLARATION
Cont ION
1 Wraso .(Sect then 1 I.S.tempt from the ConbaaCcx License c Law for the
1 O fallowing mason. emit t TO31. Bulinus and Pmfrssiou Code:Any city of munty
3 t1i which requisu a permit r cones dac l aper.imfar such
demolish,or e.el any awmurc
:y
duprist
m its i licensed
pursuant
t to me:thovisio s te,of for Contractor's
m Ole a ria w(Cha mem
than Wencirinnd pursuanuo )of Disionor theCBummea'and Pro cam(Chapter Sq. Ft. Floor Area Valuation
(commas exempt Section7")and the
basis for
o(lWBusinevand Profusion Code)ear $0
[� Net W u exempt therefrom and the bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type .
Cho mese than Ove hundred dollars(M). P y yp
Luownak.the thesto y.eem matlmt ycea withwages uthekrole7044,Busisow
will Pr fewwls-and Ne swcw¢bnoti License Law
do rotted.set (Sec.to ad,Bmerof
and erly wh on code:h caamcmr[end
License law don ml apply b rt awns of Required Inspections
property who Wilds provided
"I such
therm r and wW ares sucM1wmk hposelforthmugh M1b
howOwn ever.the u,ping or thauuhad,is cmmtsamneout yearMedaro@red fn aalelr,
however,the Wilding or ern of proving
mmlb Bald he
non Wildofcwopledoo.the ownu-
pueder will have site moven of pur ring Chat W did rot Wild m improve for purpose of
sok.).
❑1.sk awnu ar the property.am aGuively conueafng with licensed mnuu,oas In
mnuuu the project(Bee.7814.Bum=and Profusion Cade:)The Conrembes U.
ccree law does not apply to an owner of property who Wilds or improves thereon.and ��Ly4/'%/1�1-••
who cmmcu for such projects with a cha ncbr(s)licensed pursuant b the Convector's
License Law. /jJ y y//in i! Gi/ 1.. �- D1-'r✓J
❑I tan exempt undo Sec ,B&P C for Nis meson �r✓r-��L�1" 71
Owner Date
WORKERS COMPENSATION OECLARATIONy—
I hereby a/rim under penalty of perjury caro of the following dalaraliou:
:m and will mnu
uin a Certificate of CnnunI tofelf-inwm for Workers Compen- f,
Calif. .u provided for by Section 3700 of the labor Cade,fm the performance of de V/s '4ace_�?--?"7
work forand rob permit is issued.
ve and
❑I hawill ode,for a performance
ante ofthe w Tumor which
h required by Seaton
d.
My of the Labor Code,far In performance of d wwk far which thio permit is issued.
My Workeh Compeuation luuana carrier and Policy number art:
Cartier. Policy No, s
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(This section need not W completed if the permit is foronc hundred dollars(SIM)
ter leu)
I Certify del in the performance of IW work for which this Permit b Wood.I"I not
c:nplOy any person in any mommum as to become subject to the Workers'Compensation
laws of Celifamia.Date
Applicant
NOTICE TO APPLICANT:If,after making Nb Cenincate of Exemption,you should -
become subject in the Worker's Compensation provisions of IW labor Code,you mesa
O forthwith comply with such provision n permitWce
this permit shall dmnd revoked.
CONSTRUCTION LENDING AGENCY
? l hereby affirm duct there is A counetion lending agency for the performance or
...
Car work for which this Permit is bsucd(Sec.3041,Civ.Ca
Q
Lms Name
z Lcnda's Address
Q 1 Certify that 1 hate lead this application and sate than the aWw information is
Hcome'.I agree to comply with all city and county ordinances and sum laws relating to
U building convection,and hereby authoma mptescnoaives of Nis city to enter upon the
above mmtioned.".property
ac for i.pauses purposes.'
Fu (We)after to save,indemnify and keep parreless the City of Cupertino against
FL liabilities,and Of
coact ex may any y g y
Vl J 6 passu which ma w ucruea alul said Cit
Z A APPLICANT
of DERST N of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicanvCanuacbr pate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Imme Wilding aavpantuom or handle bamdaus material
az derated by the Cupertino Munidpal Cade,Chapter 9.13.and the Health and Safety
code,section 25532(.)7
❑Yes 13 No All roofs shall be inspected prior to any roofing material being installed.
Will the applican,a future Wilding occupant tie,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
kora dons air cnnummen s as de0ncd by the Bay Area Air Quality Management all new materials for inspection.
DbVlel7
[:1 Yes 0 N
I have met the huaroce s mabrials requirenenu under chapter 6.95 of IW Califon
nu Health&Seely Cede,Section 25505,25533 end 25534.1 undersand that ifthc Wilang
docs not cturcndy have a¢nano Net it is my bsponihility b..ofy the amupent or the
rcgaircmenu which most be mel prior to issuance of a cautim,of Occupancy. Signature of Applicant Date
Owner Or mdbmi.d agem p,te All roof coverings to be Class "B"or better