06050118 CITY OF CUPERTINO �k,� r�aaa. '' �i
BUILDING DIVISION PERMIT ��L�-�,� Q,�,>INFORM �I� N
BUILDING ADDRESS: LARRABEE & ASSOCIATES INC PERMIT NG,06050118
10183 RIEDEL PL
OWNER'S NAME: PERMIT LSUE DATE
ROBERT HARRINGTON 36 RAILWAY AVE 05/15/2006
E:
SANITARY NO. CONTROL NO.
(408) 364-9000
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EIFCf PLUMB MECH
iota LICENSED CONTRACTOR'S DECLARATION lob Description
to 1 hereby Aman Tint 1 am licensed order provuirns of Clmpter 9(commencing
EZ�y with Section PNU)of Division 3 ofthe Business and Professions Code,and my license is
>'yi ntfcilro ndeff t. CB Lwg S]S'973 REPAIR HORIZONTAL FRACTURES IN FOUNDATION
y,& Doc Contracmr Ate_ C
nse
As mail he
DECISI�TCom— �'��® ■
1¢a I understand my plain shall k user as public retards FINALED
IyV
O Licensed professional
OWNER-BUILDER enDECLARATION
I borehY aRrm Uat I on exempt from the Contractor's License law for the ,,yy.sa♦
3 0 c (ollowing moon.(Section 7031.5,Business and Profs ions Code:Any city or county JUN o• 2006
which requires n pwmlt 10cmeatrucL alcor,improve.demolum,or mpair any structure $6000
It .,min issoanco.alwrequims the applicant for such permiuo Be,a signed alalcmcm
�a that he is licensed pursuant tiro provisions of On Coruncwri Limuc Law(Chapter 9 Sq.Ft.Floor Valuation
[ (commenting with Section 1")of Division 3 of the Business AM PmfeamoM Codc)or
At he u exempt thamrmm and On buffs for the Alleged eamptiom Any violation of C'1
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of 0 0 �' Occupancy Type
not more than fine hundred dollars($300}
❑1,u owner of tk pmpusy,or my moployces with wags u Netr cele comp mdm.
WIII dO the WOOL and Ne h,C.0 n nal Nxnded w Law
do row et Apply A An owner of Required Inspections
Nd property,
who
builds or
The COnVSe mYS and
hW disci net apply m An OWMr n( l a'
own
cnywho Wilaor insprowsthmeon,andwho Am not ihworkh xled rofferedforage hu
hmcwnithe Wilding r bomovem such imps mid wit in not year onompiQemd(or sic.r.
builder ill WildingerMprowmentuxthedidnmmyesrofcphownfrtheowner-
builder w01 haw the buNm+of proving Wt k did net build w improv[w purpose of
sale.).
❑1,a aunt,of the property,am ueI.iwly eonuaping with licensed mntramop to
costrup On project(Sec.7064.Business and professions Code:)The Conmcmrn Li-
no.Law does..,apply man owns of progeny win,Wilds or impmvs tbomon.and.
who contracts for such projects with a cenuxtoKs)licensed pursuant m On Cormaeuses
Licence Law.
❑Iamuemptundm See ,BAPCfor Nureoon
Or
Da¢
WORKERS COMPENSATION DECLARATION
1 hereby of ion under penalty of perjury one of da,following decla,stirs:
❑I haw and will maintain a Cenificule of Consem to self-insure for WorkeriCOmpen-
sation,As pro kind for by Section 31M of On tabor Code-for One perform.of Ne
work for which this permit is bound.
❑1 baa and will maintain Worker's Compenudon I..As required by Section
3700of Ne Labor Crde,for Can purformarec of the work for which Nis permit is issued
My Wrrk,e.Cran,ustion Insom.artier and Policy mark,am:
Cartier.ICg47-s—F:Ofss1P Policy No.: 97 —SYS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sceien recd nothecomplemd Brie permit Is Bonne hundred dollars(SIM) r
or loss)
1 certify Nat in On performance of One work for which Nis permit is issued.l shall not
employ any person in any summer an As to become mbjst to On Wohe,s'Compewdon
taws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
kcome subject m the Worker's Compensation provisions of the Labor Code-you mot
.J O fwNWith comply aids such pmvidrns w Nu permit shall k dttmnd mwkcd.
z Vy CONSTRUCTION LENDING AGENCY
(-+ Ihereby a(Brm Nat fart ua rnutruction lending agency for On ler do..of
K.> the work for which Nis permit As issued(Sec.3091,CN.C,)
1 Q Lsndcis Name
z Lender's Address
U 0 1 ceniry Nat I haw read Nis application nM sou No On aka informatiur is
U.P correct.I agree to comply with all city and county ordinances and state laws relating to
DU building construction,and hemby authorim mp,ucnotiws of this city to enter upon On
,r W moon mentioned pmpcs forinspccoon.purpowhich m.
(~
91. (We)agree to saw,indemnify and keep homeless the City of Cupertino against
rA liabilitis.judgmcnn.crw mdcapcnss which may in any way attmc galnsasaid Cry
U z in conxgocnce of the gran. p.iL
APPLICANT U ANDS D WIL OMPLY WITH ALL NON-POINT Issued by: Date l f 61
SOURCE LADONS. �6�UC
Signal manuConwnrr "DamRe-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding occupantsmrt orondle haardou material
As deStmd by IM Cupertino Municipal Code,Cbapter 9.12,and the H-dth and Safety
Qy�zse. s3z(a>? 1\4 No
\4No All roofs shall be inspected prior to any roofing material being installed.
Will Nc applicant or future building occupant tax cyuipmcvt w devices which If a roof is installed without first obtaining an inspection,I agree to remove
-mit harardnus air comaminants As retired by he Bay Arta Air Quality Management all new materials for inspection.
District?
0Yes No
I have rerd On hvardaws materials requirements under Chapter&95 or the Calif.
ria HcalNg:SAlmy Cade. .25533 and 25534.1 understand thin if N-building
Jas not cis Y ha u:nmq u u my mspooihility m notify the occupant CC On
re tswn I ter tpnrr rraCcnir¢amarOceapamy. Signature of Applicant Date
y Dart! All roof coverings to be Class"B"or better
Owner or mNomed agcm pate
no 'u�
s w
'may
+�4
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b0,
30C
e�c
CITY OF CUPERTINO �k,�
I�'�i
INF0R �MN
BUILDING DIVISION PERMIT
> �= -�,� Q,�,
BUILDING ADDRESS:
LARRABEE & ASSOCIATES INC
PERMIT"06050118
10183 RIEDEL PL
OWNER'S NAME:
PERMIT I SUE DATE
ROBERT HARRINGTON
36 RAILWAY AVE
05/15/2006
E:
SANITARY NO. CONTROL NO.
(408)364-9000
ARCHITECl/ENGINEER:
-
BUILDING PERMIT INFO
BLDG EIFCr PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby arm Nat 1 am licesco under provisions of ChaPler 9 (commencing
u cion 3ofNc Business and Professions Code and my license is
with
uls(mc ,ndfr t. 525'973
Csa
REPAIR HORIZONTAL FRACTURES IN FOUNDATION
ueennna Lic.
Dale Conuacmr Ate_
C
�'��® ■
FINALED
DECIXi records
As mail h used
I unticrsunJ my plain shall W useJ as public rein ds
Licensed Pnffissionnl
OWNER -BUILDER DECLARATION
I hemby aRrm that I am comp, from dm ConlrMlarS License Law for BC
following moon. (Section 703 L5, Business and Prefeaalnu Codc: Any city or county
N d 2006
which Cultures Permit 10ennatru-L alter, improve. demolish, or mpoir any someone$6000
JU t
prior at its issuance. Alm inquires the applicant far such permiuo file a signed stammcm
Conuoctori Llmmc Law 9
Sq. Ft. Floor &Egih
Valuation
that he is licensed Current o the provision of the (Chapter
(commencing with Section 1") of Division 3 of the Busines AM Foressiaus Code) or
Nat he u exempt therefrom and the buis for the alleged exemption. Any violation of
C'1
Section 7031.5 by any applicant for a permit subjects, the applicant in a civil penalty of
�' Occupancy Type
not more One ftw hundred dollars (M).
0 1, u owner of the pmputy, or my soploycea with wags u thetr sole comp mdm.
Required Inspections
ands: ;e,un stet wORf of
does of Apply. owner
and Profession.he COC law dos not apply lf an owner of
Nd Coot: The Contrxmra
q p
nd w1m his
Property who bisiia or ireprowschjurpr and who daostiltwork
sty who oelfed
or for We
ownemr. Wilding ed not dW aroQsed for sic.
r.
withinoneyearofcompktion,theowns-
rIthin Improvement id wit in year
ft got Mprovementu sat
builder
builder w01 haw the buNm+ of proving Oat he did not build or improve for puryaz of
iii haws th he
sale.).
0 1, a awns, of the property, am exclusively contacting with licensed mnuxton, m
costrum the pmject (Sec. 7064. Business and Pmressions Cade:) The Conuacori Li-
ccnss law does ..,apply man owns of progeny who Wilds or impmws thereon. and.
who contracts for such projects with a mnuxroKs) lienn sed pursuant to the Conuaemes
Licence Law.
0 lamsemptunder5ee ,BAPCIontis o me
Date
Or WORKERS COMPENSATION DECLARATION
1 hereby affum under penally of perjury one of the following declarations:
I have and will maintain a Certificate ofConscru to aelf omeforWorkLriCompen-
sation, As presided for by Section 31M of the labor Code. for the perform. of the
work for which this permit is bound.
d.
0 1 bow and will maintain Wwkera Compensation Inver . As required by Section
3]W of the Labor Crate. for the ixedur narrce of the work for which this permit is issued
'
My Workers Compeoation Inwrsnce canis and Pulley mmOc, am:
Cartier. Imi-s—F:OfAry Policy No.: 97 —%SYS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sceian need notbccomplemd if the Permit IS Intone hundred dollars (SIM)
r
or Int)
1 ccrify Nat in the performance of the work for which Nis permit Is issued. l Nall not
employ any person in any manner an As to become subject in the Workers' Compeusadon
taws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject in the Workers Compensation provisions of the labor Code. you mot
' forthwith comply with such Pmvidam w this Permit shall he discount mwkcd.
j CONSTRUCTION LENDINGAGENCY
• I Isn.by then se a rnutmc.i lending agency for the lerfennau¢ of
which duathas
0
' Bm work for which Nis permit u issued (Sec. J09T, Civ. C.3
pe
LCMcC, Name
Lenders Address
,
j 1 Certify Nat 1 haw mad this applievion nM sum that the above information is
' correct. I agree to comply with all city and county ordinances and sole laws minting to
building construction, and hereby authorim mp,senutivs of this city to enter upon the
L
move ros.judgdpmpcst for ioPccuon. purpowhich
(We) agree to saw, indemnify and keep harmless the City of Cupertino against
m.
i Incilids,judgmc coward hpcuus which may in any way attmc agalot said Cry
• incomc9uenee of the 6rsi' permit.
the
• APPLICANT U ANDS D WIL OMPLY WITH ALL NON -POINT
Issued by: Date l f 61
SOURCE L/�ONS.
Re -roofs
Type of Roof
stg manuCantracuor �
HAZARDOUS MATERIALS DISCLOSURE
Will Ne applicant or future Wilding mcupantsore whandle haerdous material
As dCBnnd by the Cupertino Municipal Cock, Chapter 9.12, and the Health and Safety
\4No
0y�zss3z(n>? 1\4 No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to
Will the applicant or Lown building occupant u¢ cyuipmcvt w devics which
remove
-mit harardnus air conuminants An defined by the Bay Arta Air Quality Management
all new materials for inspection.
District?
DYs No
I haw rest Ne hvardtos mamChula inquiremcnss uMe, Chapter&95 or the Calif.
nim HcalNk Safmy Cade. .25533 and 25534.1 uncirand that ifth- building
ams not cn Y ha u:nmq u u my mspooihility o notify the occupant of the
re tswn I rot tpnar eraCenirmnearaeapamy.
Signature of Applicant Date
y
Owner or mthomcd agcm pate
Dad
All roof coverings to be Class "B" or better
g