05030003CITY OF CUPERTINO
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BUILDING DIVISION PEST
CONTia*e-IOWANFURMATI01�
. 5eAT-10
BUILDING ADDRESS:
.SANDRA DELGADO
PERMIT NO.0 cJ 030003
10739 SANTA LUCIA RD LOT
WNER'S NAME:
PERMIT ISSUEDATB
SANDRA DELGADO
03/01/2006
NF.
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby aRirm that I Am licensed under provlslou of Chapter 9 (commencing
with Section 7000) of Division 5 ofthe Busircas and Professions Code. and my license is
full toad and afr.L
SFDWL-2 STORY 3734' /GARAGE 630'
License Clea Lk. A
LOT 2
Dau Contractor
ARCIADECPS DECLARATION
I undersand my plans shall M used an public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from fie COntmctis License Law for the
fallowing reason. (Section TOILS. Business and Predilections; Cade: Any city or county
which requires a permit m conarean. slur, improve, demolish, or arab any wooden
Prior m its issuance. Alm acquires the applicant forsuch permit to file signed auument
Contractor's Uume Law 9
Sq. Ft. Floor Area
Valuation
that W is licensed pursuant to the provisions of the (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$500000
that he is exempt therefrom and the hub for the alleged emmption. Any violatlot of
APN Number Occupancy Type
Section 7031.5 by any applicants for a permitsubjAm the applicant In a civil penalty of
not mom Nan five hundred dollen (M),
❑ 1, As manner of the property, Or my employees with wages u their sou compeutuon,
offered per Aide(S. Ifuli Busitm
e wa. And don ummuse b net mended m rc
will do Nh
Required Inspections
and Pro(estions Cade: The Communes Liaise n law donot apply m an Owner at
9 P
propeny who Wilds or improves thereon, and who dew mch wok himself or thmugh his
Own employees, provided thalsuch improvements arc notinunded oroQered for die, If.
-
however, the building or Improvement is mid within one year of completion. the Owner.
builderwill have the burden of Proving that he aid not build or improve for purpose of
sale.).
jal, 1, As . of the pmpter, , am exclusively comminuting with BeeefW conommn to
cmnstroct the project (See. 70". Business and Professions Cade:)Th Cnntmmra Li -
came law does oat apply to an owmar of propeny.who buiWw or improv income, and
who contracts for such projew with a commeaer(w) licensed pumam m the Consomme,
License Law.
❑ lam pt under SeeB&PCf thlsmasm
Date
WORKER'S CO ENS NDECLARATION
I hereby aBunder penslsy a( pe ane of he fallowing decimations:
lrm
❑ 1 have and will mainuin a CeNOcau of Conserv m elf -insure fm WohefaCampcn-
sa0m, As provided fo by Session 5700 of the Labor Code. fm the performance of he
work for which thin pemnb is usual.
❑ I have and will mainuin Worker's Compensation insurance, u required by Section
5700 of the Ladner Code, for the performance of the work: for which this permit is stand.
My Workers Compenufion Insuma wrier and Policy number am:
'
Carrier, Polity NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(fhb«than need not he complewl true permit is Amore hundred dallus(S1001
or tete.)
I cenify that In the performama of the work for which Oda permit is issued, l shall net
nm maer W c rob m Workers'Com� nufian
employ an m y m 7
�
Las f CpiI
Nfop(IpgJ�
Applicant I /���
NOTICE TDAPPLICANT: If, after making thlsni cae of Emmption. you should
become object m the Wmkers Compcmatian proms ms of fie Labor Codeyou most
forthwith comply with such powisiuu w this permit WII W domed revoked.
CONSTRUCTION LENDING A0ENCY
1 herby )Rase thus then ls s construction landing agency for the portunnam:c of
(Sao.l30
the work for which this permit h issued (Sec. 309'f, Cir. C.)
lenders Nurse
LenaarwAaaresa
I modify that I have mad this application aM sum that the shoe infomaum is
comem l agree at comply with all city aM county Ordinances and sou law notating m
Wilding deswction. and herby autharire mpmaenmives of this city m enter upon be
above-mentioned properly for inspection purpa4l
(We) agree to save. Indemnify and keep harmless the City of Cupenim against
IIabIIWes,judgments. Costs and expenses which may In any way memo against mid City
In cmuryuume of the {mating of this permit.
r APPLICANT UNDER AND ILL COMPLY WITH ALL NON POINT
U
Issued by: Date -
S ENT
TIONS.
Re -roofs
Type of Roof
c A
Si Kum al'ApplicandContssemr Dam
TERIALS DISCLOSURE
HAZARDOUS
Will the applicant or roam Wi bg oaupantsmm or handle husrdous material
an defined by the Cupertino Municipal Code, Chapter 9.11. and the Health and Safety
dc. Seddon 25531()7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is Installed without firs[ obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipmml or devices which
'
amt, hummous air rnnWninmu As defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
❑Ya, AD!O
1 have mad the hamnlaus materials requirements underchapur 6.95 of the Califar-
Ain Heelto & Safely Code, Sodom 25505,75533 and 25534.1 undentsnd that if be Wilding
does l cureally ham • unan Nutt ls my mspourbility m Amity Ile accuPmt of the
re I In whichZ:to er ar aatuc ncertifiaaKar rep x
Signature of Applicant Date
All roof coverings to be Class "B" or better
owndarmm.P'agent