07120274 CITY OF CUPERTINO x*' Wal' .x.at, u:.r ( " ��- N".
BUILDING DIVISION PERMIT �CC�P�It?,.�Tt7R'](NFOXLMATIQN�'���
BUILDING ADDRESS: PERMIT NO.
22332 REGNART RD TBD — TO BE DETERMINED 07120274
'S NAME: PERMIT ISSUE DATE
WALTER JOSEPH F TRUSTEE 02/12/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
lop LICENSED CONTRACTOR DECLARATION lob Description
u 1 In mby affirm that I am licensed under Provisions of Chapwr 9(commencing
Ith Secdon70f0)of Di"Ion Sof NCBudm(Numdprofeaiom Code,and licensed CONVERT 3 CAR GARG TO BDRMS/BTH & 3 CARPRT TO 3
^�H in full forteanl eRm
�qz LIC...class Uc.a CAR GRG—NO SANITARY REQUIREMENTS.
F Dao: Conlrotor-
ARCHITECTS DECLARATION
G I understood my plana slWl be used u public mcoNs
s
y C Licensed Prof.W.C.l
OWNER-BUILDER DECLARATION
<� I thereby te.(Er dent 11. exempt from the Contin Co License o Law for the
i.p o following masa..(Suction 7W 1.5, 4 after.
and Professor Cale:Antony or county
S$hens
which itsusu a c.almwconstruct.aler.Wprove,do eranit C,mo,.ir ed wunum
Prieadits iauance.a4u require theapplicw forauch perils file assigned wtemem
< met W islicensed protocol to the provision of the camuaner•s ucamc Law(Chapter 9 Sq.F FlFloor Area Valuation
?F 9 (commencing With SectiW7000)ofDivision 3ofineBusiness and prefessions Code)or $80000
S 9— mu he is esavpt tbem(rom and the access for the allged v.mptim:My violation of
Section 70515 by asry applicant for a peril subjects Out applicant in a civil Penalty ofNumber Occupancy Type
rot mom man five hundred dollars 36639005 ��
❑1,a awsc of tele property,a my wployces with wages as dutr solewmpemadon,
Madod work,anddwsmunmeunotintendedcarortamdfeasale(Sec.70M,Busi—
and Pmfesdam Cade:The CommodesCut d
License law dean t apply an owner of Required Inspections
pmpertymm Wills or improves lhemwn,and who doaauch weak himselfmtlwuga his
owes employees,provided matsuch improvements are notimended Unframed for rata If.
however,On Wilding or improvernent Y mid whole arm year of mmpledon.the owner.
builder will have me Wren of proving that Ise did not Wild tar Improve for purpose of
isle.).
❑1,as owner of the Inoperty,am eecludvely...=I.,with licensed Co.tranom to
ammtwl flat project(Sec 7014.Business and Professions Cade:)The Co.man o's U.
o.low,doe Cut apply in s owner of pmperty who Wilds or Improves mown,and,
who contracts for such pmjem with a anuanor(s)licensed punnnt to the Cantaetoes
License Law.
❑I am mempt under Sec ,B R P C for this mann
war Dad
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury as of me fallowing declarations:
❑I ham and will maintain a Certificate of Consent to self4emse for WorYees Camper-
Wion,as provided far by Section 3700 of law Lodor Code.for W perf.nnana of the
work for which this Permit is issued.
❑I have and will maintain Warmer Compemadon Imurmon,as inquired by Section
3700 of the labor Code.for the land..na ofdw work for which thin Peril la ivad. '
My Worka's Com mostoa IIna a Carrier and Policy number am: `�
Caroler: \✓rIEIi.VCV I� PoIIry No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section recd Out W completed if be lurk is feaone hundred dollars(SIM)
err lace.)
I comity mot 1.the perforce..of the work for which this peril in issued.l shall WI
employ any Woman in any manner an as to becomes subject o the Workcn'Compenadon
Laws of calii.row.Data
Applicant
NOTICE TO APPUCANT.If,after making this Certificate of Esemplion,you shoud
become subject an the Wohces Compensation provisions of oc labor Code you must
.J O forthwith provisionsshal
comply with such or this permit l W domed Invoked.
z y CONSTRUCTION LENDING AGENCY
[-^ IWmhy afar that them Is a construction lending ageWy far we Perforans of
LL'> the wart for whim this perp Is Issued(Sen.3097,civ.C.)
WM Q Lender's Name ,
z Lendees Addrena
V Q 1 ewfy that I have mad thio applicad^n and saw this the above Information U
LL P COMM I agree to Comply with all city and county ordinances and sate laws misting to
O U Wilding eonstrunion,and hereby mooria Inpmsenudves of this City w now upon don
Liz above-mcn meed property for inspection increases.
G (We)agree to now,indemnify and kap harlm the City of Cupertino against
rA liabilities.judgments.cats and eapermas which may in my my arta agalasmid City
Vz APPLIqucam of the UNDERSTANDS
of mien peril. „S
Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sou FGu1�T,Io�sf
_L1 v' I7 a J 171t Re-roofs
Sigaatuft of Aplicars/Contrudor Dole
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant item Or handle haasdom material
as defined by the Cupenina Municipal Cade.Chapter 9.12 and don Halm and Safety
otic.senian 155324)± \ I All roofs shall be❑yen �BNa inspected prior to any roofing material being installed.
Will we applicant car
future aeeup.nt mw wdpment car maw which a roof is installed without first obtaining an inspection,I agree to remove
emit harardnus air eemaminmts as defend by the Bay Am&Air QUal11Y Management all new materials for inspection.
District?
El Yen o
I have lead the muedala regtda(MOUa.derChaPmr6.95ofineCalifar-
rdaHcaW&Safety Cade,Se-timts15M.25533 and25534.1 understand Nati(du Wilding
Cala roteurmedy haw.mount.used it u my respiumbiihy w Wary Ne pan .f
rcipmemenu which must he met prior d issuance of a Carr.of Occu Signature of Applicant Date
O rm othorood agent Oa
All roof coverings to be Class"B"or better