08030010 CITY OF CUPERTINO
BUILDING DIVISION PERMIT kCO1VTRAORTN +OI21C'TATON,
RU` 0.
BLVD C & D FREITAS' CONSTRUCTION 08030010
NEWS NAME: ti PERMIT ESUS DAIS
TIM & EMILY MASLYN 23620 MORREL CUT—OFF RD03/27/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 356-5780
ARCHIIECTIEmGINEER: BUILDING PERMIT INFO -
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION IM Description
1 hereby affirm Thai OIP
at I am licensed under provisions of Chapter 9(commencing
;� who Section 700D)of Division 3 of the Business sol Profeesium Codd,and my licca¢is DEMO FOR ADDITION & RMODEL
519 n full fou m"of 'T 2 86 S t 7
License Lk.N
a Dam Contremor
ARCHITECTS DECLARATION
I ml my pude met tat used a public ocoNa
ltwb G� Licensed Professional -
OWNER-BUILDER DKURA71ON
j�E I hereby affirm That 1 am acopt from the Contrecmfs License Law for the,
is O O following mason.(Section 71131.5,Business and Rofusiva Cuda:Any city or county
S$ which mqulrea a permit m construct alter,improve,demolish,m repair my structure
Zs
prior To I%issuance,also¢quires the applicant forsuch permit to Ole a signed snkment
C that he is licensed pursuant to the provisions of the Contactorillmnse Law(Chapter 9 Sq.Ft. Floor Area d� Valuation
$ (commencing withSeNon7000)ofDisvlon3ofNeBusineaaandProfessionsCode)or JZOOOO
Then he ts exempt clamminess,and the buts for the alleged e¢mpdor.Any violation of
Section 7031.3 by any applicant for a permit subjects Ne applmsm m a civil penalty of Number QccU anC e
tat come than Rw hundred dollars(S"" � 35704035 .E Occupancy
❑1,u awoer of the propeory,m my wploycn with wages u Neo seta compemdon,
will do Nawork,and the he Curtknors Lim oroa,does n,apply Tk.s,..ror Required Inspections
Nd property
who
t&or The CanaamM1 and
who Vw rich or apply if an r ugh is q p
pm moployc Wimaorireprowsch Imprncon.ovement
ve whodceasuc tendo muttered forsake.
his
ownswer,me
uipmHded pr sem Impmwmatsatenot intended aidesmd md. .IL
however,Ne building a an Improvement is sold within et year of completion,Ne ow¢s-
"I..)Wilder will have the Eurden of proving Net be did net build or Improve for purpose of
Q I,as owner of the property am exclusively contracting with licensed¢numtaes To '
cunstmm the pmjen(Sec.70ad,Business and Prafesslou Cade:)The Cootracmts Lt.
¢ora Law does net appy,he an d.nmr of To pert,who ands or impm.a thereon,and.
who comencu for such projects with a ednuacmo(s)licensed pmaunt To Ne Contractors
License Law.
❑innesconTamdersec. ,BhPCforthumamn
Oner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aro of Ne following decheatiou:
❑I ham and ids maintain•ed..3cete of Coaent r se Cook,
for for WorkebGeopen-
atlon,u provided(pe mi Ss Non 3700 of the Jaber Code,for Ne per(osman¢of Ne
work for which Nu permit u iasued.
X1 hoe W will maintain Workers Compensation Terminate,as occulted by Section
700ar Ne lsbar Cade,fm Ne pcRorman¢a(1M cork for which Nu permit klasuel '
My WmIare.counp�enuGon
Cemrkr. St at/'z h/emsIeJ.V•¢jlirynumbersse.Vi oml7Na.:-257
76
CERTIFICATE OF EKEMPITON FROM WORKERS
COMPENSATION INSURANCE
rDrs sore.need not be completed if the permit is for ane hundred dellsm(s lin
tor ken) ,
I ce ify that in Ne performance of tbd work for which this permit is Wood,I shall not
employ anyperson in any reentrant as To become abject to f Workerf Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject To The Worker's Compensation provisions of Ne tabor Cddc,you mus
OfaMwith comply with such provisma or Nu permit Nail be doomed mated.
,E.n`n CONSTRUCTION LENDING AGENCY
I Mmb affirm that more k a comuuction kndin a
F r g agency for the pormrm.mwe of
C the A deworks s nor which thisthispermit le issued(Sec.3(177,Civ.C.) 'Lender's Name ,
= z Lmdeh Address
V O 1 certify that 1 have read This appliwion and mm Na the above infotmadoe U
ly f+ ConeCL I agree in empty with JI city and county ordimmam aM aYk laws miming To
Wilding construction,and hereby authorise representatives of this city m come upon tie
Lrl show-mentioned property for Inspection purpsee.
L>r (We)agree to saw,indemnify and keep homeless Ute City of Cupertino against
TA liabilities,judgments.costs and experms which may in any my acme agJnst said City
(J 7 in conaq¢nee of the tooting of this permb.
r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
c=, 3
CATIONS. Z7 0O
Re-roofs
signuete of Appn r o.
HAZARDOUS MATERIALS DISCLOSURE I Type of Roof
WIII Ne a Cupertino
upent nr fMuni Municipal
Cg acuhaptpme sir handle Health a material
dented io the 32(a)?tm Municipal Code.Chapter 9.12.and the Nu1N and Safety
.Section 25532(x)?❑Yu ®��[[No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or rurutum building eceupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
well heaedpns air contaminants as,defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Vu
I hew mad the mammas materiabnotimm.tamic,01hapscrit.95.fthe cadifoo.
ri.Health h sJmyCNe.Sees.25505.25533"25534.I undemakd Ne iftic lwiming .
dc%tatttsessurtly, a enter,wt R u my reapowNOty m entry the occupant or the
fire w le tpripp a dr nytearo pmwy. �SignatureofApplicant Date
C' 3 2 All roof coverings to be Class'V'or better
Owner or mNomed ages te