05010028 CITY OF CUPERTINO Tg�,. >/�s ,^^ry. +, �n + ` ' i,:�" k';1
BUILDING DIVISION PERMIT TsIn0L�T 11kA T,0RANF A'' ATIpN'`�� .
, lkk�`xk fi,e:'N s k@1N.,h •,av� ram-%•rd a�' .,�
UILDING ADDRESS: ANTIQUE TERMITE & PEST PERMIT NOO 5 010028
723 SANTA T.lJrTA RT)
NER'S NAME: PERMIT ISSUE DATE
MAXINE BECKER 1913 STONE AVE oi /or /�loos
ONE: SANITARY N0, CONTROL NO.
(408) 995-6300
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
l00 LICENSED CONTRACTOR'S DECLARATION Ib Description
�+ 1 Mmby afarm that 1 am IiceuOeSCrIp
ed under previsions of Chapter 9(Commencing
i with Section 70001 of Division 3 of NC Business and Professions Code,and my license is
infull-ore enseClesudercec'' TERMITE REPAIR
L
lyag icensemLica
et• Dam Contractor 4
C ARCHITECTS DECLARATION /
i I understand my plms shall he used u public records
cep
Licensed Pmfcssionel
OatNEm exempt
DECLARATION ^
J0y I Wmhy affirm that 1 1. eaempl from the Contractor's License Law for 1W
00 followwhichinguiresa permit
7lDLS,Businai and improve,
de use Coot:Any city structure
which myuimaae,Also requires construct,since,Improve,ticermitt,orrepaira signdatmcture
zy priermits iensedpaluantto res provisions
r applicsor forbe,such ConpermtuLicense Law(Chapter
2 •c that heencingwJpuuuan70the 00)ofDiviounflWComnctuu.ndProfsJon%CodlCr9 Sq:Ft. Floor Area Valuation
j,SpyS (commis exempt
Section7000)the
Division nflWBed exemption.
Any
Cadc)ser
3�
that
he is exempt Nemfrom and Ne buts for Ne alleged esemptlan.Any violation of
Section 7031.5 by any applicant our a permit subjects the epplicanl to a civil penalty of 344�N`?t"crO 0 Occupancy Type
not mom Nu five hundred dollar,(5500). -
❑L u owner of the property,ar my cmplaycu with wage u Heir axle compenution,
will do the work.and dmanew.is net intended Oroifertd fanele(Sec.7144.Buineas Required Inspections
and Professions Cade:The ConuacroYa Lictue Law docs not apply to m owner of q p
propeny who builds orimprowa thereon,and who daasuch work himselforthrough his
own employer;provided that such Improvements see not intended oralfered ferule.IL
however,the building or improwmenl is sold within one year of completion,the owner
builder will haw the burden of proving that he did not Wild.improve for purpose of
tile.).
has owner of the property,am exclusively contracting with licensed COOMICLOCS 10
Construct the pmject(Sec.7004,Business and Professi9u Code)The Contractor's Li.
esus law ties not apply m m owner of progeny who Wilda or impmva thereon.and
w 0 contracts for such projects wit a conuanar(Q licensed punuanl in she Contractor's .
on.Law.
s�a(/e/myy ujnnd�dy�eery/r See.
.B PC for that tomo
r T /a/'M 111 C//a Gi'Lbr'1',; am _
WOMER'S SAT( TIO
I hereby affnm under petWty of perjury aro of the following declanriou: '
1 have snd will maintain a Cenlfiam of Continua wlf-insum for Worker'SCOmpcm
aside,u pmvid of for by Section 3700 of the Labor Code.for Ne performance of the
work for which this permit is issued.
❑1 have and will maintain Weaker's Compensation Insurance,as required by Section
TOO of the Labor Code,for the performance of Om work for which this Permit Is Issued
My Workah Camisemation Insurance carrier and Policy number art: '
Cartier. Policy No.:
CERTIFICATE OF MEMP71ON FROM WORKERS'
COMPENSATION INSURANCE
(Tbla section need not W completed If the permit is forone hundlnddollara(SIM)
ort .)
I ceni( Nu in the Performance of one work for which this
Y pc is Issued.l Nall not
employ any person!ninny menncrm u m become
Wcome subject to rW Workers Compcua0an
Laws of Cdifomla.Date
Applicant
NOTICE TO APPLICANT: r'aftermakingthat COnonsof of Exemption,you should
Wcomesubjecth comp y it Worker's Com s or Oil Permit
sou of the m Wr Cnde,you must
�O forthwith comply with Cosh prnvulnu or Nis permit Mall Wdeemed mvnked.
ti CONSTRUCTION LENDING AGENCY
1 hereby alarm that then its Conatmedim lending agency for the performma of
x a the work for which this penult h Wired(Sec.3097,Civ.C.)
33 Q lender's Name3.
z Ltnder't Address
J0 1 unify Nat I ban mad this application and sum Net the show information is
y CORCCL I agree to Comply With all city and county oNlnalues and stem laws muting to
building construction,iogand hereby tuNorimmacess. tiws of this city to enterupon dm
It7
above-mentioned agree
pto onysaw for indemnify
an purposes
(WO)agree to sew,indemnify and keep harmless
� Omy Cupertino against
in0e hcosts expenses may in my wtcenss agena send City
conIuenefte this
APPLCANTUNDERSTANDSAND
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE�RR//EGULATIONS.
iaiae2 '1 r'6 n �r_d✓N i-/'t l 0� Re-roofs
atypnurc ol�an tactor Dam
IUSMATERIALSOISCLOSIIRB� Type of Roof
Will Nc applicant or future building occupant stow nrltmdb�avuduus material
e0nOd by the Cupertino Municipal Code.Clupmr 9.17,and the Health and Safety
e,Seed 75537(1)7 - All roofs shall be inspected prior to any roofing materia/beinginstalled.
Yu
r Will the apPlicam or fuwrc WIIJing occupant use cyuipmem or Jcvica which If a roof is installed without first obtaining an inspection,I agree to remove
it harardnus air C uannum is u defnod by rhe Bay Area Air Quality Management all new materials for inspection.
isulcl7
❑Yea u
C� IhewicaiNtharaldousmsmrialsrequiremcntsunder Chepmrii.95ordwadifor.
nin Health&SafctyCDdc,SeNou M505,75533.dl55M.1undcmandthatifNc Wilding
duo Our currently hew it Comm,that tr is my rmpouibility m notify the occupant of the
ter nuwhichmusIbe I tovavanaeneertintameaapaney Signature of Applicant Date
toner uname see m1 m All roof coverings to be Class"B"or better