07080120 CITY OF CUPERTINO �}o-
BUILDING DIVISION PERMIT ONTRAC'�QR ^f �-'
BUIL 1 A RFSS: PERMIT NO.
��LS�� SAN JUAN RD THOMAS HUTTON 07080120
R'S NAME: P@11.41T ISSUE DATE
HOMAS' HUTTON 22820 SAN JUAN RD 02/07/2008
PHONE: SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INTO BLDG EIFCf PLUMB MECH
30p LICENSED CONTRACTOR'S DECLARATION
ig1 Manby affirm tint 1 am focused under provisions of Chapter 9(commencing Job Description
with Section 7")of Division 3 of Lhc Burins.and Profcuiuns Coco,and my license is ERECT ANTENNA TOWER FOR AMATEUR RADIO USE
:,ne in
Cass-efrecL Lle.g 2/4/08 EXTENDED PERMIT APPLICATION 2 MONTHS UNTIL
7 F
Colo.Coninanuor ARCHITECTS DECLARATION 4/13/08 .
IN�y Qq�
1 understand my piens shall be lused u public meant,
g sea Licensed Professional
5p OWNER-exempt R DECLARATION
0<f 1 botchy,Teti that 1 1, exempt from the Coows Co :An,c Law for the
O O following recon.(Section 715 onstr t.Business and Prone ole Code:Any rosy or muure -
$ whish its u issuance.permit re cares et.alter,hnprow,demnluh,are asig end unmum
Z pH, priors.itstsendIncoequina provision of fordo SuchCom permits.cente gacdmmmenl
�< that he islicensedSeton tatha of DivmnoftheeBushcmmdPreee Uw(Chapter
ook)or Sq.Ft.Floor Area 3000 Valuation
B that a is axe pt t Sectio 7nnd of basis
3 of the egad exe and on.Any
Cntle)of
that io is 31.5 b themlrom and the bub for be alleged a PIMOIL .Any violation of
Sectio than
fiveamappskanars(S mlB>ubjeaume.ppnc.ntm.civil pan.Brar ��prk�IvtNumber Occupancy Type
not mom Nov few hundmd dollars(530%. 34221025 .�17V'
❑I,as owner ante property,a my employs.with wag.as Use Win compenvdan,
ami Pretenders
rtand timmumumurwtktemkdt Law
does
a4,Husins.
and Pmf.sian Cade:The Contractors License Law ds.not apply to rt owns.
Required Inspections
pmpertywho oru therngod whods.,wh work . orthmugh his
wnemploys.s.provided Met
Smchimpmwmeienot undad. .flaved Acoustic.If,
however,the or imptrowmot is mid within wee you ofcompleon,thaver-
builder will have the burden of proving that he dial nal bulk or improv for purpose of
oak.). -
❑I,as ower of the property,am=elusively contracting with licensed contractors th
contrum the project(Sec.7014,Business and Profession Code:)The Comramors U-
mass law done not apply in an owner of property who builds or improwa thereon,and
who conlmcu for such projects with a conuactar(a)licensed pursuant an the contractor's
Llemmm Law.
❑I oro exempt under See .B&P C for this Monte
Dam Z-07-)6
Wr WOR C a AXION DECLARATION
1 hereby a07rm cr penalty of perjury one of the fallowing declaration:
❑1 hsw and will nmem e a Ceriftesm of 0mom to self-intim fm Worker,Compen-
sation,u provided for by Section 3700 of the,=bar Code,for the performance of tie
work for which this permit is issued.
❑1 haw and will maintain WmkeYs Compermt In..as winner!by Sector,
370D of the labor Codc,for the performance of the work for which this permit is issued. '
My Workers Comp om aloe bnumeo canis.and Policy number am:
Cartier. Policy No.: .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusectlon Send of be completed If the permit la forme hundred dollars(SIM)
or leu.)
1 certify Nm in the performance of the work for which this Permit is issued,l shall not
employ any Worn in any motors.u as bcmmc object m the Woricn''Cmnpenution
Laws of Califamit Di
AppBeand '7' �� .
NOI7CE TO APP I Nr:If,after making thisCcrtificam of Exemption,you should
bmmne Subjmt m the worker's Compensation provisions of Ne labor Cock,you most .. -
z forthwith Comply with Such provision or this peanlL shall he deemed invoked.
0
[A CONSTRUCTION LENDING AGENCY
(-m I hemhy affirm that Nem is a construction lending agcmy for the performanm of
LX the work for which thu permit is issued(Sm.3097,Civ.C.)
QUndoes Name
Z)z Lenders Address
U Q 1 certify Nn I have mad this application and Sum that the above information b
LL!^. comes.1 agree in comply with all city and county ordinances and state laws reading to
C) rV^ building construction,and herby tuthmire MprmmWiv=of this city to enter open the
W above-mentioned property for inspection purposes
pw (WO)agme to Save.indemnify and keep hatml.s the City of Cupertino against
rue liabilities,judgments,costs and expenses which may in my way,acerae against mid City
V in consequence of the grouse of this permit
^� APPLICANT UNDERSTMD&AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -'�
SOURCE REGULA B .
•"0 Re-roofs
Signuecof Appli=M ummr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Smm or handle hazardous material
ec0ed by the Cupertino Municipal Code.Chapter 9.13.Soul tic Health od Safety
Suction 25532(x), All roofs shall be inspected prior to any roofing material being installed.
❑Y. p[B'
Will the applicant or future building omupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
each ha%ardes air contaminants as dnfimd by the Bay Area Air Quality Management all new materials for inspection.
District,
❑Yes gwb
1 haw mad the harndous materials mqumen ass under Chapter6.95ofthe Califar.
nia H.lth&Safety Cade,Section 25505.25533 and 25534.I undsom nd Marine building -
does not comedy have a=nem,that it al my responibility m noth'y tiro occupant of Ne
requlmmenu whish be nM 'a atm ac wrmamoronmpamey./ f Signature of Applicant Date
2 / CJa
Owner or amhorirctl ages. Dom All roof coverings to be Class"B"or better