08030178CITY OF CUPERTINO
BUILDING DIVISION PERMIT
Uif1" a"gRTl!1'IfeT,LM`�.TIUI�i, '
BUIL5,1y „T SAN JUAN RD
////�tiS .S UU
TBD — TO BE DETERMINED
PERMIT NO.
08030178
NER'S NAME.
PERMIT LSUE DATE
11 ::
08/26/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHI7ECTIENGINEER:
BUILDING PERMIT INFO
CARPORT 515'—NO SANITARY BLDG ELECT PLUMB MECH
O O O
{ LICENSED CONTRACTOR'S DECLARATION
1 heroby efmm tial 1 am licensed under provision of Caapter 9 (commencing
Job Description
with Section 7000) of DiA.Wa 3 of the Business and Professions Code, and my Bcenm is
in full force and effect
License Ciao Lic. is
ARCHITECTS DECLARATION
' 1 understand my plans Nall Ie used as public rands
_
Licensed Profutsmeal
OWNER-BUILDER DECLARATION
I hereby ofarm that 1 am exempt from to Contractors Lianas Law for the
following reason. (Section 703 1.5, Business and Profession Cade: Any city or county
which requires a permit to consuu:4 alac improve, demolish, or mpmr my aha cum
! prior in is issuance, also requires the applicant for such permit to file a signed statsmem
that he is licensed pursuant to the provision of the Commcter's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
1 (commencing with Section 7000) of Divuian 3 of the Business and Profession Code)at
that M is exempt therefrom and the assets for the alleged conception. Any violation of
Section 7031.5 by any applicant for A per sh objects the applicant to a civil penalty of
not mom that, t 0w hundred dollars ($500).
APN Nb
Number
Occas anC e
Occupancy Type
itis w1E1 Wren or theyisle ampaWBnm
wilL o he.,of
thesum aimmedn
and do the work, and me aronare ts noes Licame err a w de d not a(Sec. 70th, Buose
and Professions Code: The Conhe mra Law don not apply m an ower m
Required Inspections
propertywhahalitis
W ndwM
andwhodoesash wok woffe errthrough his
rh.t
idol himp
awn employs, provided dirt soh improwmots art oat inunded aroReme, for We. a,
bowewe Nebue uimproproving
inonyear of mpo efor thehoss
'
the,
builder will Nw 0a burden of proving that he did not build m improve for purposa of
that he of
uleJ.
14 1, as owner of the properly, am exclusively contracting with licensed ronlndan m
construct the project (Seo, 70/6, Business and Professions Cade:) The Contractor's Li-
cense Law ds oat apply to an owner of property who builds or improves thereon, and,
who contracts for such projects win aconuacmr(s) Iiceesed pursomm m the Contracmrs
License Law.
❑lam exempt under See ,B B PC for this mason
nuc _ _ . _ Dam P/ger L /lag
W ER's COMPENSATION DECLARATION
I hereby maim under penalty of perjury, ons of the following desk adore:
❑ Ibcwand wiB maintains Ceniftatsof Conned maelf-Wart forWorkcra Compeo-
satin, as provided for by Scene. 3700 of da labor Code. fm Ne performance of the
work far which this permit is issued.
❑ 1 harm and will maimam Worker's Compensation loo ence, u required by Section
37W of the Labor Col for dm performance of the work for which thts permit is issucd.
'
My Workers Compensation Insurance artier and Policy number me:
Cartier. Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu accountsread not be complamd If the permit Is Were hundred dollars (S 1011)
or lean)
1 cedfy that in the performance of We wart fn which this permit ie issued. 10.11 not
employ any person in any manorm as he bxume subject m the Wadm s' Corepcnetion
Laws of
Applicant _ _
NOTICE TO APPLICANT.-aff. tsr making this CcAifate of Escapees, you should
become subject W the Workers Cmnpenuion previsions of the Labor Cade you must
Forthwith comply with auh pravismn m this Permit shall be domed mocked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for the performmce of
the Wark for which this Permit at issued Isco. 3097, Civ. C.)
Lenders Name
Lenders Address
I certify that 1 Mw mad this application and sato that the above infoommon is
correct. 1 agme m comply with all City and county mdinann and ants laws rolsting to
building consu cdon, and hereby Authadre mprmenutbn of his city m enter upon Ne
above-men0oed propeay, for inspection purposes
(We) agrn to save, indemnify sed kap hamlets the City of Cupertino again(
liabilities, judgments, costs and expenses which may in any wry acne against said City
in consequence of the granting of this Form .
l
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
8D�«8
Sip&of Ap UConuactar
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII tho applirnn or Annum building occupant staff or handle hasardous material
as defined by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
de, QYa 25532(e)7 jKNa
All roofs shall be inspected prior to any roofing materl i installed.
WIII sec applicant or fumm building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I ag
emit huartims air cotsminnu as defined by the Bay Area Air Quality Management
Damm?
all new materials for inspection.
❑Yea ghlu
I haw mad the hasaduesmatsriab roquiremen0 under Clumnli.95afthe Califon
nu HMI" SafctyCade, Seedon 15505.25533 uul25534.1 undersand thasifthe building
don rot cuncolly haw • mnana 0w it is my maponibllity, m notify the occupant of the
requimmcnu which out be met poor W Waseca of a Certificate of Occupancy,
Signature of Applicant Date
- B/''� P
�orivm—d
All roof coverings to be Class'na' or better
Owner err auth agcm pace '