05070089 CITY OF CUPERTINO +xra q,a;snx�x+ xs"�}�+ � nfwaEr
BUILDING DIVISION PERMIT dCONTRACTOR IIYF,�UMr1.TIQ�i
BUILDINO ADDRESS: YOUNG' S CONSTRUCTION PERMIT"°05070089
911 PICT-TWOOD DR
NER'S NAME: PERMIT ISSUE DATE
D 05
NE: SANITARY NO. CONTROL NO,
(408) 377-6839
ARCHITECf/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
+IO Zp LICENSED CONTRACTOR'S DECLARATION Job Description O O
I hereby affirm Net 1 am licensed under provisions of Ch,pwr 9(commencing o
1thSection 701k1)of DlWslon 3 ortha Busiltanand Profesown Code,sM my licensers
��- iifull.m. asderra ADD 1050 ' -FAMILY RM/LAUNDRY/` IED �®
z Dowwseclan LContractor t. REMODEL 1392 ' -KITCHEN/BATH Rb MSVE✓��L
Dau TSDEC
ARmaMuse DECLARATION
'� I undertunJ my ptsns,lull be sired As nubile near"d .a'7 7 Licensed Professional t 3 "`T LOOU
OWNER-BUILDER DECLARATION
+� y I hereby affirm That 1 am exempt from the Conoacurs License Law for the y
O O following won.(Sudan 71131.3,Business and Profession Cade:My city or aunty
which requires a permit to construct,altar.Winnow:.demolish.or repair my structure
f �^ prior to its issuance,also requires the applicant formch permit w Me a signed,tstemcm
z< Net he is licensed ruserent to the pmv6910m Of Conuacur's Licmvc Law(Chapter 9 Sq. Ft.Floor Area auation
C (commencing with Section 7000)of Division S of the Business and Profession Cade)or $395332
3 Nu he is exempt therefrom and the bosh far the alleged exemption.My Nolad,on of
Sudan 7071.5 by any applicant two permit subjects the applicant an a cMl penalty of APN Number Occupancy Type
.1 more than five hundred dollars(S500).
P Y YP
Las owner of the property.or my employees with wages As their able comp uslaw",
will do the it and aniamcmu is not mudid moflcled fertile(Sec.70th,Bmwase 00
Required Inspections
and Professions Cade:The Conmeors Liam-law does not apply in on owener of q P
property who build,ne improves themon.and who does such work himself ar through his
own employees,provided that such Improvements eta not Intended or offered rue We.If.
however,the building or Improvement is sold within one year of completion,the owner.
builder will Neve The burden of proving that he did nm build m improve for purpose of
V1,1,u owner of the property.am exclusively contracting with licensed conuxemn in
construct the pmject(Sec.7060,Business and Professions Cada:)The Contractors Li.
cense law does not apply in an owner of property who bu0da or Improves thereon,and
who conuaes for such projects with a contracu(s)licensed pursuant to the Contractors
License law.
❑1 am exempt undo Sm B At P C for this renown
er Dau
WORKER a COS ENSATION DECLARATION
I hereby affirm uncle ly f pesjury one of the following declarms m:
137.aOO
haw and will maintains CeNf.m.rfConant maelbimure far WMk sCompen-
n,as provided fm by Sadat 7700 of Uta labor Code.fm the performance of the
for which this permit is intend.
hew and will maintain Workers Compensation Imuran,u required by Sectio
of we Labm Code,far the performance of the work for which this permit is issued.
Workers CompensNan Insurance artier and Policy number sm:
er. Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(11111 ecetim need nalbecompleud if see permit isforone hundred dollars(SIM)
or lest)
1 certify that in Ne perfomun of the work for which this permit is issued,I Mall not
employ any person In any meaner an t b to}u bjecTtodaworkerecompensidon
Laws of C6lifamle. e 1
APPIican,
NOTICE TO A ANT:I after na1'ng this Cci ifiateof Exemption.you should
bacon,subjem u dta work s Comllematim provision of the labor Cade.you nuc
3Z
foMwith comply with such provision or this permit shall he diamond rin alled.
Z"' CONSTRUCTION LENDING AGENCY
N.
F lhemby aRnm the,titan laaedSo—construction0 lending agency fm the performance,of
a..; the were(m which this permit ts issued(Sec 3097,Civ.C.)
W�0 Leader's Nome
z Lenders Address
U O 1 certify that I haw mad this application and mu that the above information is
Ig.^ comtt biro w comply with all city and county mdinana and sue laws rotting to
O SlJ' building construction.and hereby euhorim representatives of this city in cnw upon see
W above-mentioned pmpcny fm Inspection pugwseat
�"(L (Wc)agora to sew,indemnify and keep hatmlec the City Of Cupulate against
w In liabilities judgments,costs and expenses which may in my my accrac again,said City
U7 in eomegmn of the grmfq of this pmmiT.�i APPLICANT UNDERSTANDS AND WILL COMPLY WITH All NON-POINT Issued by: Date
ir—
SOURCE ATIONS..
r
IM 1A Re-roofs
IZf a
St{uoatum a App1 Xim br ata
xAZA Us MATERIALS DISCLOSURE Type of Roof
Will the appilcut or future building occupat it..or lundk hevnNon material
ex defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
lDishriu?
sateen zss72(a)7 . All roofs shall be inspected prior to any roofing material being installed.
❑Ya X190Will the applieal car more building Occupant use equinmem m devices which If a roof is installed without first obtaining an inspection,I agree to remove
hmardomair conualmeas ss dermad by the Bay Area Air Quality Management all new materials for inspection.
❑YesI have mad the hazardous matedab r quirenmts under Chapter 6.93 of the Cal lor.
al g:SafetyCode,Scctimts 25505,25573 and 25574.1 anticretsnd that iftie building
not currently haw a anent that It h my responsibility to nodl'y the occupeat of theirements which msec be met prior u issuance or a Cenifuau ofuPOCY. Signature Of Applicant Date
All roof coverings to be Class"B"or better
Owner m au,hari ed e t Dau U