05030004CITY OF CUPERTINOY
IN -.
BUILDING DIVISION PERMIT
CTOR ORMATION
'QNTI
BUILDING ADDRESS:
SANDRA DELGADO
PERMIT NO. O 5030004
10739 SANTA LUCIA RD LOT I
ER'S NAME:
PERMIT ISSUE DAM
SANDRA DELGADO
03/01/2006
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BO ELECT PLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affirm that l am licensed under prevision of Chapter 9 (commencing
with Section 7") ol'DlvWon 3 of be Business and Professions Code, and my license Is
Imfull (am and effect.
SFDWL-2 STORY 3544' LIVING/GARAGE 659'
License Class Us.0
LOT 1
Dae Contrscor
ARCHITECTS DECLARATION
I undersand my puns Mall be used as public record+
Licensed Professional
OW NER-BUILDER DECLARATION
I hereby affirm that I am exempt Fresh tie Contractor's Lime Law for Me
following reman. (Section 7131.5. Business and Profesalons Cade: Any city or county
which requires a Permit to commute. alar, improve, demaluh. or repair any structure
prior to its Issuance, she roquires theapplicant for such Permit to rile signed+moment
Contractor', Lic Law 9
Sq. Ft. Floor Area
Valuation
thss he is littned pur+uamir, the provision of the am (Chapter
(commencing with Section 7000) of Division 3 of Ne Business and Profeuians Cnde) or
$470000
Nat he is exempt Any vloladoexempt therefrom and De basis for the alleged en of
APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than fico hundred dolt. ($500h
,
❑ I. as owner ofthe property, or my employees with wages as their sole compensation.
ME do Mewok and Emmuctureis net Intended ar.fferedfonale(Sm.7044,Business
Required actions
and Profession& Code The Contractor's License law does not apply to an owner of
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property who builds or (mprewet Mason. and who don suchwork himsel f ar through his
own employee. Provided that such improvements art notinended oroRerW fosse, If.
however, Ne building or impmveenew is mid within on year of complame. Ne owner.
Wilda will have the Wrtlen of proving that he did not Wild or Improve for purpose of
.1. 1.
am awns of the property. am eelumexly contracting with leaded contaao s to
construct the project (See. 7014, Business and Profession Cede:) The Contrac7oYa U.
«rte law doe not apply an an owner of property who WIWI or Improve, Mamma. and,
who centrmcu fm such prejeeu with a mnwcar(U licensed pursuant he the Contracea's
License Law.
❑lam pt oder Sea .B&PpCf�o �this�,y�,
Quacrom Dam-'-af-f--I-a-a�
WORKER'SCOMPE(pSA ONDECLARATION
I hereby affirm under penally afpp,fr'mm am of the fallowing decimation:
❑ I have and will maintain a Certificate ofCon+enl to self-InureforWorknesCompn-
marine, as provided for by Section 3700 of the labor Code, for the performance of sue
work for which this permit is issued.
0 I have and will maintain Workas Compensation Insurance, as required by Section
370D of the tabor Code. for the performance of the work for which this permit is Wood.
My Worker's Compensation Insurance carrier and Policy number art:
'
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihusecllm neN awbacompeed ifthe Permit is two. hundeddnllan( iffl)
'
.less.)
1 akfy that In the palumumro of the wal, for which this permit is issued, I &hall not
.
employ any person in any man.o t h c embjecttoriewaf recompensadon
Laws o(Califo
Applicant
NOTICETO CANT: IL &for makingCeniRale of Exemption, you should
=vision,
become subject to the Warker'a Campcnsetiof the Labs Code, you must
forthwith comply wib such pmvishhz a this permit hall he deemed revoked,
CONSTRUCTION LENDING AGENCY
1 Wray affirm Nat there luconmnmtfnn lending agency for the Performance of
Me work for which this permit is Issued (Sec. 3097, Civ. C.)
sander's Name
lander'm Addrest
I ceNfy that 1 have need this application and sum that the above inforromon Is
correct. I agree be comply with all city and county ordinances and &iso tows totaling be
Wilding construction. and hereby su horin rtPrtenlnives of this city to enter upon the
i above-mentional property for inspection purpmes.
(We) agree in save, indemnify and keep harmless the City of Cupertino &pint
j liabilities. judgments. costs and expenses which may In my coy mcaC against said City
in Consequence of the 1=1 ng Of Nla PmhiL
APPLICANT UNDERSTA AN WILL COMPLY WITH AL.L ON -POINT
Issued by: Date 6
Re-roofsstifi
Type of Roof
MTONRECU
ME=
sure afApplic HAZARD US TERIALS DISCLOSURE Dsm
on=Will
the applicant car Tutu bus .ng occupant store orhandle h&sakous material
ss defined by the Cup., Mon ' 1 Cade. Chapter 9.13, and the Health and Safety
. Section 35537(o)7
[]Y.�o
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment a devices which
emh hank... air cenu rimds. &flood by Ne Bay Arta Air Quality Management
all new materials for inspection.
District?
❑Ye e
1 haveread the hmakousmmerialsrequimments underCMper A95of de Califon
nu Health& SafetyCods, Seca=25505.25533 arx125534. 1 undemnnd Was if the Wilding
does 1 curmmly have a onset it u my toporoibility a entry Me accupant of the
roq ntswhichmus to'ran' a cekfeaz"f
Signa tureofApplicant Date
AI I roof coverings to be Class "B" or better 01
caner or mmorirnd &gem Dam