05090139 CITY OF CUPERTINOff
BUILDING DIVISION PERMIT k +C1NRA.C 'nRRRRTNFORIMATIIQN a;
BUILDING ADDRESS: PERMIT NO.0 5 0 9 013 9
2262n RICARDO RT)
ER'S NAME: FERMITIS UBDATE
LOUISE & DAVID SCHIE 09/21/2005
PHONE: SANITARY NO. CONTROL NO,
ARCHITECrIENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
yYoo LICENSED CONTRACTOR'S DECLARATION lobDescriti n,
1 hereby"Ons tut 1 un licensed under provisions of Chapter 9(commencing P
MO Section 70018 ol'Dividren 3ofOn Busiwss shad ProfcWum Code.and my Hearst is tIcn wit\\ I A
n; in funfo=andaffen ADDING BATHROOM TO EXISTING IfTPLI7`,Yi
ueenaClAss ue.g_Contractor ROOM/ADD WATER HEATER a l" `''0 t6"� �
3 Dem ARCHITECTS DECLARATION
I undersand my plans shall W used as public records g
g G Licensed Pm(dtlonel
OWNER-BUILDER DECLARATION
i I I hereby.sum that 1 am exempt from the Contactors License Law far the n
p o
following mason.(Seetiun alcor.
Business and Professlmma w Code:Any city county
which requires a pormit to construct, lot ci ilsh,oc mPPir any Mount.
pow m is issuance.also Inquires deappliesm for such permit to rile a signed statement
ggg Cthat heislicensed pursuant toOnprovisions ofthe ContarsLemenlaw(chapm9 Sq.Ft. FloorArea _ Valu la0 0
tra'
$ (commencing with Swoon 7000)of Division 3 of the Business and Professions Cote)or
Out he is ssempt men from and the bub for die alleged exemption.Any violation of
section 7031.3 by aro'applicant for a permit objects On applicant to a civil penalty of APN Number Occupancy`type
nor mom Nan five hundred dolWs(M). 35601056 . 00
❑1,u owner of the ptopeny,or my employed with wages a tinelr sole compensation,
will do the work and theavucmm b not Wounded or offered for sale(Sm.70U,Business Required Inspections
and PIaRViae Code:The Con sumers Licams,Law Ones MI applY m a Owner of 9 P
propenywho Wilds orimproves Nem wand whodmsuch work himselforthrough his
own employed,provided Out such Improvements ate not Intended or offered forsale.If.
however,the Wilding or Improvement Is gold within tum year of completion,the owner-
buildor .will have One burden of proving Out M did not Wild or Improve for purpose of
sale).
❑1.as Owner of the propeny,am exclusively contracting with licensed mnuncton to
construct the prokes(See.7044,Business and Professions Code:)The Contractor's Ll.
come law does not apply to an owner of property who Wilda or improves thereon.Md.
who canuacu far such projeon,with a canuactar(s)licensed pursuant to the Crenuanara
License Law, t
❑lam use 0 er See .Bk PC fo this on
Dam
WORKER'S COMPENSATION DEC RATION
1 hammy afriom under Penalty of perjury one of to following declarations:
❑i haw ores velli mainaln a Cemfiesmref Cneem to alRleure for WortrhCampen-
su ch,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation I...u required by Suerim,
3700 of Om LAWr Cade,Lor the performance of One work for which this permit is issued.
My Workers Compenauton Insurance carrier and Policy number are:
Cartier. Policy NO.:
CERTIFICATE OF E)(EMMON FROM WORKERS'
COMPENSATION INSURANCE
miss sections reed not W completed if Ore permit is foronchundreddallaa($100)
or kis)
I cenify that In the perfnrmanm of to work for which this Permit is Wood,I shall not
cmployanypcnanymennerm 10 the wadmn'COMPenaON1
Laws of CaOfq�[ryryDam
Applicant r^'�i�/a n
NOTICE TO A PLICA .I, roaeling this CeniOcam of Esemption.you should
became subject 0 the Worken's Compeeadon provisions of the Labor Code,you mum
.,0 forthwith comply with such provisions w this permit dull W counted maimed.
CONSTRUCTION LENDING AGENCY
F-r 1hamby efOrm the Nem Is consuct lending gency for the Performance of
PG> the wart for which this permit is lasted(See 3097,Co.C.)
fj Landers Nwe
Z LenaersAddress
U Q 1 comfy that 1 have mad this application and tum that the above inform-Out is
;-•' correct 1 agree to comply with sit city and county remittances runs sae laws misting to
t7 kS.'J' Wilding construction,and hereby authodn mpresenativu of this city a enter upon lM
�Lg7 shove-mendoacd property for Inspection purposes.
Q. (We)agree to ave,indemnify and keep harmlw tie:City of Cupertino against
„y 197 Ilabl;,CA�RNIIISTAIDs
Ju,ewand espenssa which may in anyvnyamue againstaidCity
M PIhN W L UOMPLY WITH ALL N N-P INT Issued by: Date
SOUATIONS.
Re-roofs
Sigrmu (ApplicmVC tractor Oa Of ROOF
HAZA DOUS MATERIALS DISCLOSURE Type
WIII tine aPpliant w future butlding aaupatuom w handlehanrdous mamnal
de0md by tie Cupenino Municipal Code,Chapmr 9.13,and the Halthand Safety
.Section 15732(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or future Wilding Occupant use equipment or devices,which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hayamnus air mnamimme,as deMcd by IN Bey Area Air Quality Management all new materials for inspection.
DisuicG
QYca
I hew eel the It xdrmsmamnabmquimmenuunrkr ,Chapwr6.95af0mCdifor-
does lth e1Pty Caac,Sceriov 133113. �ej 3an ]N.I unticnand thatiTthe Wilding
Jud not rte(ly have•mnane Net It i re m nsOi@y 0 rely the ot,mpanr Of the
require n khna"bemetpnwto an faeenee.mO(Ocm, cy Signature of Applicant Date
Owns authofieda spent pa b All roof coverings to be Class "B"or better