07100058 CITY OF CUPERTINO
BUILDING DIVISION PERMIT z�CONTRACTOitI 'Oi,RM! I •~
BUILDING ADDRESS: PERMIT NO.
10481 SCENIC BLVD TBD — TO BE DETERMINED 07100058
ER'S NAME: PP3N4T MUE DATE
TIM & EMILY MASLYN 03/27/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHMCTIENGINEER: BUILDING PERMIT INFO
BLDGO O PLUMB
MECHO
30p LICENSED CONTRACTOR'S DECLARATION Job DOSCi1pUOn
MVF I hereby"m Nn 1 am licensed under Provisions of Chapter 9(commencing
n?j`. with Section70f10)ofolvidon3mfdmBuunm=dProrcadon.Cnde,awmylkenmu ADD-1, 002 'MASTERSUITE,LIVING,DINING,CLOSET, ADD
Oin mfullfor¢andclTem. 28G5f7
'Az Lice cl . La.is GARAGE 242 ' —REMODEL ENTIRE HOUSE 1, 452 '
ARCHRECI'SDECLARATION 3/17/08 PERMIT APPLICATION EXTENDED TILL 5/30/08 .
I undorsand my pWu still W used u public rxoNa
y1
Qt; Licensed Professional
m Oe,I..exempt I DECLARATION
E 1 lueby affirm a nt I am exempt from tiro[worts o LiA n c LAW for Ne
O O fallowing moon.Permit
]031.5.Business and Hvreuions Cade:Any my stcounty
$ which am Issuance,
a n permit re cnnsNm4 aiter,improve,do emelt t or repair any Inunum
pdormits censedinalso requires thevisimam for such Contrator'tofile ics.gn.J sutemem
FFFOthat the I.(commencingwdpurmammNepmviviouofthan ofineBrumsredPiselawtCrun)orharter 9 Sq.Ft. Floor Area Valuation
Sg that heWdngwthSemlon701ndth basison3nftheegedeanndon.AnynnsCnde)or $374730
LS 3
that he Is 31.5 b 0mmfmm and the Esau for the subjects
the exemption.m Any l Pention of
.ISectionrID3L3 live
any applicant for a pemtlt subjceu Ne applkanl o a civil penalty of N Number Occupancy Type
�t more thIn raw mmnarea dollars ts5om. 3 5 7 0 4 0 3 5 .e�
1,uo ofthepmpwy,ormywPloyceswithwgeau Noirsokcampewdon,
willdo Newark,andtheslramme knninmMeaoronered fmsak(Sec.iW6,Butinua
.m '
and Professions Ceara The Courtesies LimLaw does sot apply m an owner of Required Inspections
Property who WlWa orimproves Nraeon,and who doessuch work hMsclforthrough his
own employees,pmvded Nn Inch improvements K not intended oroQeted for sale.It,
however,the building or impmvemmt is sold within arc year of cerephame.the owner-
huilaer .NB Tuve the bmdcn of proving that M did net build or improve for purpose of
sale.).
❑1,as caner of Ne Property,am exelumvelr contacting with Ilanud caace cors to
commuct NC project($CC.7(110.Business and Professions Cede:)The Cearaemr'a U-
conse Law does not apply m an owner of progeny who builds or improves lumen•and,
who contracts for such pe jecu with a eanracmr(U licensed pursuant he the Continuous
License Law.
❑Lem esempt under See .B R P C for this reason
or Dam
WORKER'S COMPENSATION DECLARATION
1 hereby of Irm under penally of perjury one of the following declaration:
Q 1 have and will mainWn a GeniGtlm of[onsenl in selr-Insum fm WmkeeaL'ompen-
udon,u provided rte by Secdon 370D of dm labor Code.for the performance of the
work fm whkA Nis permit u iuueE.
❑1 horn and will maintain Workers Compensation luuranes.Is roqufrnd by Suction
3700 of the labra Cade.for the pedatmutee order work for which this permit Is issued. '
My Worker.Compensation Ince.artier and Polity numb,e�r�am•�g
Carder: STAT[ CGIHP GINS. Policy No,: / P r 63
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ehksemien need natlecomplemd if IW permit is format hundrtddollan($100)
or lees.)
1 certify Not In me Performance of to work rot which this perch Is tsInma,l(hall not
employ any person in any mannerIn as m Wmmc subJat to the Workers'Compemadon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject the Ne Worker's Compensation provisions of Ne labor Code,you most
.J O forthwith Comply with such provisions N Nis WMIL Mall be decreed revoked. - ..
y 51 CONSTRUCTION LENDING AGENCY
.�..F
I thereby afrm that inert is a mutuctnn Lending a
.ter for the Performance or
C> the cam's for which this Permit ts antes(sar.3097.em.e)
CL,
a l.cnders Nano
J z Lenders AM=
U 0 I ratify Nat 1 have read this application and sum mg,the above inramtamm is
D. F come e.I asrce m comply with all city and county ordinances and sum laws missing in -
pU buildingconstruction,and hereby•uNodxe representatives of Nis city to enter upon the
W ahnve-mcntiorrcd popeny roar iupecron purposes
a (We)agree m save.indemnify and keep harmless the City of Cupertino against
yr VA liabilities,Judgments.costs and expenses which may In any wyacnm against red City
U V In consequence of the Standing of this Permit.
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
M�c�gypnorys. ��� FSE � 32'21 Re-roofs
Signature ofApphian onuactor Da
OUS MATERIALS DISCLOSURE Type of Roof
WILL the appllanl or future building panic..or handle hasatdous material
de0ned by that Cupertino Monaural Code,Chapter 9.12,Ind the Heaith and Saiety
Section 25532(87 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �Na
Wilt Ne applicant or future Wilding aceurynt use equipment or dcdm which If a roof is installed without first obtaining an inspection,I agree to remove
emit hu Immus air conuminsm ss deB,¢d by the Bay Arta Air O.Ally M.vgcment all new materials for inspection.
Guarico
❑Yes yOPo
I have read the huamnumaterials requirements under Chapterd.95 orthe Califor-
nia Health h SafetyCan,Secdans 25505,25533 ad25534.1 umlcrsund thatifthe Wilding
duce t eunen0 Innen.Nat it r my responsibility as notify the occupant of the
rey ' cues hos a Ipriormissuancc ac amarOccupan Signature of Applicant Date
C3 ��r 3 z 710Y
o eronuthamcdgcnlDate All roof coverings to be Class'W'or better