08040142 CITY OF CUPERTINOxa ,c. ..t' w
BUILDING DIVISION PERMIT CO1TRt1GTORiNFPPPPPRMATTIO, N'T�"
BUILDING ADDRESS: PERMIT NO.
1.0481 SCENIC BLVD C & D FREITAS CONSTRUCTION 08040142
OWNER'S NAME: PERMITMUEDATE
TIM & EMILY MASLYN 23620 MORREL CUT—OFF RD 05/30/2008
NE: SANITARY NO. CONTROL NO.
(408) 356-5780
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG EI.ECr PLUMB MECH
u00 LICENSED CONTRA unJ proviConstal10N lob Description
�C 1 hr by affirm Nal I am IianaM muter provisions of CMpicr 9(commem�ing P
0with Section 700(f)of Division3oftbo Business afM Profession Code.and my license is REVISION,MINOR FOOTING, STRUCTRL REVSNS PER SOILS
in full force and cffecL
,43 Lic,: mClass Lie.» ENG,RELOCATE WINDOW,MINOR CLARIFICATIONS SEE
exp,
Date—Gertrude,
ARCHr1ECTS DECLARATION A3 ,A4 , 1S1, 1S2 , S1 ORG#07100058—NO NEW PERMIT
y 1 underaund my plan,hNl W dead u public records
DaU
p o� Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm Nal I am exempt from the Convxcm"Uccmw Law for tut
00 following mason(Section 71131.5.Business and Rofession Code:Any city of county
i$ which requires a permit to c..L alear.hnpnw,dcomHad.or mean any structure
oi< prior In its issuance.Ms.requires the applicant forsuch permit to file,signed su¢mcnt
that W u licensed pursuant In do provision of Ne Convector's License Law(Chapor9 Sq.FC Floor Area Valuation
t�s (commencing with Section 7000)of Division 3 of Nc Business and Professions Codc)Or ��
,at Im is exempt thcrtfrom and the baso for use alleged exemption.Any violation of
Section 70315 by arty apykust for a pemnit subjects the applicant to a civil penalty ofNumber T
nomore Nut five hundred dollar, 35704035 .E Occupancy P Y YPe
0 I.as owner of Ne ryopvsy.ormy omployces wit wages ss Ne'vmk cmnpewtian,
will dote weft and but,down.Is net Mounted of Offered fe,sale(Sm.7046,Business
and Profetioes Code TW Contractors License,Lw don rot apply to an ownu of Required Inspections
property who builds orimproves tberan,and whodoessuch work himselfm notto his
Man employees,provided that such improvements art not intended uroQered for We.If,
however,the building or improvement is sold within one You of completion,Ne Momm,
builder will have On boom.0f proving Nat he did rot build 0r improve for purpose of
L14).
®1.u owner of the property,am exclusively convening with licensed contractors m
mmtmn the project(See.70M,Business and Poo(m mn Code)The Coaoxmrs Li-
Law does not apply m an owner of property who Wilds or imposes themon,and,
who contracts for such projects with a contractor(s)licensed pumunt to the Contractors
License law.
0Iam axe(/(�ay��o�`wn,de�r�/See ���AJ ,BB PC for Nis won
Owner tel///YV/f//y I Dau r 3D 0&
WO ER'S COMrNSAnON DECLARATION
1 Wmby a i m under pertly of perjury ooe of de fellewing dmla oma
❑1 have and will maintain a Cenificm of Consent be self-inure fa Workers Compere
cation,u provided for by Section 3700 of the labor Code,for the Perform.of the
work for which this permit is Luded.
1 have and will maimain W.rkers Compensation Insurance,as sequined by Sectio.
37W of the labor Cade,far the performance of me work for which this Permit is issued.
My Workers Compensation Wuanee carrier and Policy number art:
Carrier, Policy No.:
CERTIFICATE OF EXEM PITON FROM WORKERS'
COMPENSATION INSURANCE
Mus section recd not W completed if the permit is foreoe hundred dollars(SIM)
tor less.)
1 certify dun.in the performance of Ne work for which this permit is issued.I shall trot
employ,any person in any manoer an u m become object to the or:en'C m ensntian
fovea of Califomia..➢ar� c
Applicant �/.Me�! (Fl
NOTICE TO APPUKNP.IC atom making thi Cesioiute of Exempd ori you should
become auomp y it Workch Compensation this provisions,of the Labor Cade,you most
.J O forthwith comply with such yovidon or Nu permit shall W domed rented.
'Z'y CONSTRUCTION LENDING AGENCY
FI hereby arine Nat there is a contructino lending agency for the perfmmamc of
a 5 to woh for which this permit is issued(Sec.3097,Civ.C.)
lender's Namc
z Landers w
Add
U O 1 cenifY Nat I Tuve read this applicants.W sou thea tut above Wromoutho u
(L ^.
correct.1 agree m comply with all aly and county.n it uuea cad sum laws mhoo,m
Wilding cansuucuoq and hembyoNOrine mproenudses or Nuciy to entmupM Ne
Fabou
ve-mtiomd property for inspection purposes y (We)agree to save,indemnify and kcal,hamdess Ne City of Cupertino agunt
ti Z inconseque consequence
of th,casts end expenseswhichmryin any way accrue against said City
UZ A APPLICANT
of the UNDERSTANDS
of tope WILL
Ss�a C�
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGIJ3>ATIONS. '
Re-roofs
-'gnuum er AppllcanUCto r IF Dam
HAZARDOUS MATF!IALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding emupant stem or handle lowardon material
as defined by Ne Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
Cale,Section 25532(,)7
40 Ores (0N. All roofs shall be inspected prior to any roofing material being installed.
Will the. licantordnre Wildin ocou m d,e If a roof is installed without first obtaining an inspection,I agree to remove
PP g W equipmenter Mara which g
c�i4h>iardnn air conuminnu u dc0mo by the Bay Area Air Quality Management all new materials for inspection. ,
C]Yes ®No
I have mai the hasadous makrials requirements u der Chapter 6.95ofNe Calirea.
nix Healdt&Safety Cade,Section 25505,25533 and 25534.1 understood thea if Nc Wilding
does not currently hoc•enan4 Nat it is my maponibility m notify the mcul,ant or the
roquim sines ch must W met poor m issuance of•Cendicam.f Ocapancy
m s16e�p /1�ov� / S/3o/y 1' Signature ofApplican[ Date
Owner or udWnwd.gc t D,a All roof coverings to be Class'R'or better