04080063 CITY OF CUPERTINO `�• +�"'�^' '•�""' � ��°` I.`:••';
BUILDING DIVISION PEIMT ONTR`AC;TOR INI®R�IATTION t
BUILDINGADORFss: YARON & NANETTE VIDAN-PELE PERMrNo04080063
R'S NAME: PERMIT ISSUE DATE
YA -
ONE: SANITARY 0NTRoL N0.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
0 I� PLUMB
I� I�
a 0'z LICENSED CONTRACTOR'S DECLARATION Job Description
y� 1 Mmby affirm that 1 are Homes under provisions of Chapter 9(commencing
i with Section 7M)ofDhA,lam 3 of Ne Business and Profession,Code,and my limns,is
< in full farce and effect.
� b License ClassLk.gADD 400 SQ.FT. (DINING/BEDRM)
ckt. Date Contractor ORIG. #k04040127
36 ARCHITECTS DECLARATION
I understand my plana Nell W used as public retards
3=lad lYwcd Pndcuionai ,
OWNER-BUILDER m the RATION
C-Maco
E<q I Mmby M.that I cern eumpt from the Cantrands e:Any C taw for the
my
S o O whicfolloh re uires a emit t 71n L3, t, later.and n,deduti Cala:Any city m county
a�$
which coquina a permit re tens the elm,Wprove,demolla11,or e.sig any ehucmm
F� then in itsIssuance,mem to Me led apions of Lou sucCo mon'permsroiense Laedsmmmcnt Val
< Nethaulkcnmd pursuant NNc of Divions of NeCmusinum'adProf haons(Chapter 9 Sq.Ft. Floor Area 304
xp$
(commencing aIsxe exempt
Section7")and f basis n 3 of thp e0ineu pdon.Any vi Cala)Lir
3�
that he k exempt Nen(rom and Ne basis for the alleged cump0on.Any violenbn of
Section 7031.5 by any applicant for a permit ubjects the applicant in a Civil penalty of APN Number Occupancy Type
trot come than five hundred dollen(5500).
01.as owner of Ne property,Or my employees wit wages as theiranlc compensation, 36908022 . 00
will do the work,and Nestrunum islet intendedm'oRered march(See.7061,Business
and Professions Cam:The Cantranofs License law dors tet apply a an owner or Required Inspections
property who battles compactors;thereon.and wbo does such wank himselfar Ihmagh his
own employees,provided lhal swh improv=emu am not mounded moRered fmsale.It.
however,the building or improvement is mid within one yen of<ompledan,Ne owmm.
builder will have she burden of proving that he did mol build or Improve for purpose of
,ale.),
❑I, a owner of the property,am euludvely contracting with licensed cunaacton to
construct the es project(Seapply
in in Business and property
who ns Cade:) pro Conhereons LI- . NDy
const law dope not apply m an ower es property wba Wilda Cor ode:)
thereon,and
who contracts for such pmjeeu with a contracmt(a)licensed pummul m the Contnno/s
L ve Law,
lames undo .BAPCCf MM n w ?OOc
Data
WORKER-SCOMPENSATIONDINQLAEON
I hereby aRren under penury of perjury aro of the following declantiuns: _ '/�J!/ j gl
❑
R
I haveond will maintain a Certificate Consent to stir-Imum for W=rkni Compen. T`tJ
"tart,m provided for by Section 3700 of the labor Cade,for the periu m occ of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insunna,as required by Section
37M of the Labor Code,for the perfarmanue of the work for which this permit is issued. '
My Workefa Compensation Insurance carrier and Policy number am:
Center: Policy No.: .
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu smdm recd not W complewd If the permit isforone hundmtldollata($100)
to Ins)
1 certify Not in tie perfmmance Lir Na wo k for w ich Nis resit Ice issued,I shall not
MITempI f,nyperson' n manna»V c �lal Workers'Compensation
., ifs i —
APpQpIIam
POA CANT:IL after making pr Cc ons of the
Eumptio d you should
becom rubrep a the Worker's Compewdon provisions Mai ofd a 4ntr Coda you must
.JO foMwiN"reply with such provldnmmthis permit Mail be demount revoked.
z .y.. CONSTRUCTION LENDING AGENCY
[. I hereby affirm that them is a connmetinn lending agency for the performance of
rY.> Nc work f0 which this permit 4 issued(Sec.3097.Civ.C.)
W�Q Undoes Name
]z coact'. Address
V Q I certify that 1 have read this application end mm that the above information u
O F carmen.I agree to comply with all city and county ordinances and sum laws Missing t e
OU 4howngconstrunioq and hembyauNodmmoses. utives of Niwhymcnwrupon the
W above-(We)aned property fin imnify an keep
py (Wo)agree m sew,indemnify and keep muteness the City of Cupenst s aurml r
T4 liabilin consequence
costs and ea pens permit hterpin anY wYamme 4dut said City /
() A APPLICANT
of thegranting of this permit v
APPLICANT UNDERSTANDS�{YND II C P Y WITH ALL NON-PO NT Issued by: 4ate
SOURCE ULAT110I //
v( i Re-roofs
sig a of AppliesnUConlnctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of ROOF
Will the applicant orfutum building OmgtMtuorc erhandle hazardous material
7DwricL?
o0ud by the Cupenine Municipal Code.Chapter 9.It and the Health and Safety
c.5m do.255320)? All roofs shall be inspected prior to any roofing material being installed.
Y. Wise
Will the applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t 114440.0 air cumaminsnu u dclin d by the Bay Area Air Quality Management all new materials for inspection.
❑Yes Na
I hove mad the hazardous materials requirements underChapmr6.95 ordw Celifor.
HcaiN&SefcryCadp.Sections757 1533an 5J4.Iundcrmand thatlfNc building
a of currently ho 4te theyihiityawtily the mcupanl of Nc
i is whichet a nCortificamafocmpan . j Signature Of Applicant Date
o raraathamadas=rel All roof coverings to be Class"B"or better