04110027 CITY OF CUPERTINOK '
BUILDING DIVISION PERMIT '. MN �:
119 ���.
BUILDING ADDRESS: CRAFTSMENS GUILD INC PERMITN'04110027
OWNER'S NAME: PERMIT ISSUE DATE
311A 2Q0F,
7D.1,
NE: SANITARY O. CONTROL NO.
HITE MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0LICENSED CONTRACTORS DECLARATION Job Description
1 hereby affirm Net 1 am licescd under provision of Chapter 9(commencing P
Section 7")ofDivision Softhe Buaima aM PfofeRlUN Comand my genarehlforlxsx err '07 /S r SFDWL-2 STORY (3470 ' LIVING)
nClau IJc.Nr CHI7ECC1'aSDECLARATION GARAGE-580 SQ. FT.
� n
o Iunderstand myplan still bemud as public cmds G''0(`0(NG ADD PLLONGRNGR FEES (03/02/05)
0
i��m Leaned Predicament
y OWNER-BUILDER DECLARATION
1 bereley aRrm that 1 am exempt from Ne Conuattofs License Law for the
0 o following mason.(Section 7131.5,Business and Profusion Code:Any city or county
$ which requires a permit to contract,alar,montane,demolish.or repair any aurum
fZi prior N im issuance,also require Ne applicant forsuch Permit to file a signed comment
p C Nal he is licensed PurumtoNeprovision ofthe Contractor's UmmeLaw(Chapter 9 Sq.Ft.Floor Area Valuation
pa s (commeming with Section 7000)of Division 3 of the Business and Profession Code)or
that he u exempt therefrom and the bull for the alleged easmptlon.Any violmion of $600000
Section 7031.5 by any appnant for a permit subjects the applicant to a civil penity of APN Number Occupancy Type
mol mom Nan five aMret ta1Ws(M).
❑I,uowneof Nepmpaty,mmyemployeuwiNmr-suthhmlecampewuon,
will do the wodc and the stmcmm isnminuMed ionated permits(Sm.70th,Buamis Required Inspections
sed Profession Cede:The Curbstones Limme Law doe not apply b an ower of q P
properly who buildsor improves thereon,and who docs such work Minutes through his
main employes,provided dual such Improvemenuare not Intended mortared forum.if.
however.the building or impnevereant is sold within one year of completion,Ne owmr-
buildm will Wve dte burden of proving that he did net build or improve for purpose of
ate.).
❑1.as owns of the property.am exclusively contracting with licensed cenuw.7on on
conWCl she pnjem(See.7044,Barren aed Profession Code:)7h Cmtraemfs U.
cone law does not apply an an owocr of property who builds or imptawnt Hens.and
who conuan for such projects with a cormurm(s)licensed pannnn un the Contractors
Licence law.
❑1 am exempt under Sea. .B A P C fm this rasun
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ore of Ne following deciarationn
v
have and will maintain a Certifiam of Commit on pelf-inure for Wokels Compeo-
n,u provided for by Section 3700 of Ne labor Cade.for Ne performance of the
for which this permit is issued.
❑1 have and will maintain Workefs Compensation Insurance.as Rquired by Section
3700 of the labor Code.for the pantomuna of lime work for which this permit is mind.
My Workers Coope ation lwrana eerier and Policy number�g/m�y�
Grier. Polity No.:L0�" /r 7
CERG�PMON FROM W 0RIC ERS'
COMPENSATION INSURANCE
(This manna need robe completed If time permit is form=hundred dollars(SIM)
or les.)
1 cerify that in to perrarm ontt of the work for which Nit parrot,is loud.I mall not
employ any person in any manners as an become subject to the Worker Compenunlon
Laws of California.Data
Applicant
NOTICE TO APPLICANT`.If,eMr making this Certificate of Exemption,you should
become subject as the Wohees Compensation previsions or Ne Labor Cede,you muu
`J.. foMwinh comply with inch prevision or this Permit shall he tamed revoked.
Z O CONSTRUCTION LENDING AGENCY
[r I hereby affirm thus Nem is a couvucdnn lending agency for Ne performance of
xNe work for which Otis permit m issued(Sec.3097,Civ.C.)
:L'Q Li n ler's Name
�:)z Lender's Addma
U0 I certify that 1 have and this application and sum that the above infotmavon it
W F correct.1 agree to comply with all city and county ordinances and sum laws relating to
0 U budding construction,and hereby aumorn rep emnutives or this city to enter upon the
W 0mve-mentioned properly four inspection pugtoms.
gy (We)agree 10 un,indemnify and limit Montreal the City or Cupertino again,
rat
liabilities,Judgments,costs and eapene which may In any way acme against mid City
U7 in consequence or the grinning of this Permit.
F7 APPLICANT UNDERSTANDS AND PLY WITH ALL NON-POINT Issued by: Date
SOURCERE 70N5, �����
SmMe,ur App1=VC or / Dem Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building occupants eon or aMlc henAon meterisi
as defnd by the Cupertino Municipal Code.Chapter 9.12,and dm Health and Safety
Cade,Section 35532(a)7 r,zNt� All roofs shall be inspected prior to any roofing material being installed.
yea
WIII the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
AM[,haGur'rdmas air contaminants as deeded by the Bay Arca Air Quality Management all new materials for inspection.
❑Yea OAII(
I he.mad the baaodnn materials requirements under Chapter 6.95 of the Califor.
ria HcolN&SatctyCdc,Sod on Jand$534.1 undmnondlalif Nc building
tau nm c Salcy ave tat.Nn u rcapanihiliny m nMfy tie eaupnt of the
myuimme n once` a ncamofOcc nay. SignalureofApplicant Date
Ownerera gent are All roof coverings to be Class"B"or better
G