06040157 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;�cONTRAGT.O'rRINFORMATION'
BUILDINGADDRESS: EMILIO FRANCISCO PER "'06040157
10130 SANTA CLARA AV
ERSNAME: PERMIT ISSUE DATE
EMILIO FRANCISCO
PRONE:
SANITARY NO. CONTROL NO.
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
O l� E O
�Op LICENSED CONTRACTOR'S DECLARATION
m❑ 1 hc¢by affirm Ilett 1 am licensed under previsions of Chapter 9(commencing Job Description
iW with Section 7")of Division 3 of Oto Business and Pmfnaioe Cede.and my licensee
'c„ in full force and effect. HOUSE DEMO & DETATCHED GARAGE
z License Class Lie.a
;Fp Da¢ Comranar
ARCHITECTS DECLARATION
i 1 understand my plans shall he used as public records
iyU
°Q
Licensed Professional
OWNER-BUILDERIamexempt
fr DECLARATION
<f 1 hcrthy.(Sc, m 1 1. ucmpt from Nc Contractors License Law for the
e O following mazoa Permit
t Ro L3,Business and Pmfaeiom Code:Any City or county
%w which requires a pmmil to construct,aloe improve.dcmnlW,or repair any swcluse $5000
s—to nonfat its issuance.akurcquins thcappliarat fmamhpermit tdfk]signed s,aumcni
'z'' that he is licensed puromint to the provision of the Confrobasm's Licams,Law(Chapor 9 Sq.Ft. Floor Area Valuation
i�
(commencing with Section 7”)of Division 3 of the Businmand Pmfassiom Cada)or
s $ Nat he is eumpl thcreftnm and the basis for On alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant in a civil penalty of
not tome than Tim hundred dollars($500). r Occupancy Type
Luoes,ak the pmpmsy, re is wish wagaa Heir role Business will do Ibcwak and the OS Canis nolintended Lt. ofofferedfar side(Sec.in am
and Pm,whin tet code:Tue Conuacmrs Dame Law don ml apply m ri revile is Required Inspections
pmpeny,who builW orimprovu Nemon,aMwho tlousnch wmt h'm..,for through his
hw
however.
building
uiimpromment ]renal year
c oroRded rm ala IL
however.Neavc ngaimpmmmcntg mid withinoil Wild Mimpro tifrpu combat-
builder will ham the buNen of proving that nil did not build m improve for purpose of /
ala). /
❑1,an owner of the pmpcny.am exclusively contracting with licensed contractors to
construct Ne project(Sec.7014.Business and Professions Code:)The Contractors Li. w�j
came Law does not apply m in owner of property who builds or Impenitent Neeson,and `
who contracts for such projects with a contractor(s)licensed permant b the Contrsetors J
License law.
❑ IS map,un 'See .B&PCnfor N�u/smason /
in
WORKER' Old SATTONDEC ON
I hereby affirm under penally,of perjury,one of the following dechnti erne
I ham and will maintain a Cerufiaa¢of Conunl Io ulf-insure for Workers Compen-
mian,as provided for by Section 3700 of the labor Code,for the performaen of dm
work for which Nis permit is issued.
❑ 1 have arta will main)Workers Compensation Irw.,as mquimd by Section
3700 of dm Labor Code.for Nc pcRormantt of the work for which Nu p:emitu issued, '
My Warkers Cmmpemation Insuane,carom and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(Thu saeu nnandnot hesomplcud ifflue permit is rorenc hundred dollars(91010
of leas.)
1 certify Nm in to perfar'nanee of the work for which this permit is heated.l small not
employ any person in any manMfm an to become Subject b the Wmkm3 GompeaWdon
laws of o is 0
Appli an
NOTICE APPLICANT:If.of maul Nis Ccnifiesin of cmption,you should
become subject m On Workcri Co partia n previsions of the Lanor Cade,you must
,J O forthwith comply wit such provisions Or this POMOL Shall be damcd rooked.
'z try CONSTRUCTION LENDING AGENCY
'r• I bemhy affirm Lou On.its ciar.inn lending agency for the Icrfernaee of
On work for which this permit In issued(Sec.3097,Civ.C.)
00., 0 Lander'.Name
z Lenders Addmss
U 0 1 carify that I have mad this application and suN Out the above info rnau m is
D. U contact.1 agree to comply with all city and county Ordinances and stain laws relating to
� building conswction.and hereby somorre morescatativcs of this city to enter upon the
above-¢enhancepmperty for epenses purprwhich as
m.
y (Wc)agree in ave.Indemnify and kap harmless me City of Cupertino against
In inaim.apjance of ,emu and Zrariffing of thinesmit. may in any wayassets against and City
C.1 z in
UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date E.')J-'Z
��tIRCE ItEcqyyyLATIONS.
N_GV'.cK1ro T• /tom " — Re-roofs /
Signaurt of Applicant/ ntmor Data ' !/
N ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant smrc or handle b ica dous material
as dcrined by the Cupi nino Municipal Code.Chapter 9.12,and the Health and Safety
•da.Section 25532(1)?
❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will 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
emit hsramnus air cur amimnts d defined by on Bay Area Air Quality Management all new materials for inspection.
District?
❑Yen ON.
1 have mad the hsrardcros macrialsmquiamcres under Chap ar6.95 Of the Califon
ria Health&Safety Coda,Sccuous 25505,25533 and 25534.1 understand thoadma Wilding
docs tett iniono ly have a¢nam,that it is.my responsibility m nodfy the Occupant of the
aireme whkhmitel mpde meaanaoraeenifieathafac.pancy Signature of Applicant Date
ta0 Oa ar" DaD-O All roof coverings to be Class "B"or better
Owner Or aomorircd a tet