08050134 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '�6GOI�ITRAC QRINTQI.tMAT+ION,-;
BUIIDI D KESS: PERMIT NO.
1( SCENIC BLVD C & D FREITAS CONSTRUCTION 08050134
OWNER'S NAME: PERMIT ISSUE DATE
TIM & EMILY MASLYN 23620 MORREL CUT—OFF RD 05/30/2008
ONE: SANITARY NO. CONTROL NO.
(408) 356-5790
ARCHIECTtENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u o o LICENSED CONTRACTOR'S DECLARATION Job Description
iI 1 beroby affirm NlicenseesCrl
at 1 am
d under provisions of Chapter 9(commencing P
with section 7000)of Division 3 ofthe Business and Professions Code.and my liccuse is REVISION: REVISED HARDY PANEL—NEW
in full force and elect
'2245 Lies.Class tde.• STRUCTURALCALCS,
Date ARCHITECT'SDECLARATION FOUNDATION CHANGE TO PORCH, BACKFILL SEPTIC
Dov lunamrwndmypla.smmheuwd,anublcrteow TANK—ORIG PERMIT #07100058 NO NEW PERMIT.
k C G Licensed Professional
Sha OWNER-BUILDER mDECLARATION
.E E I hereby affirm that 1 1, exempt from to sC s :Any c Lew for the
p o following reasaa.permit
t ]on 1.5,Business and Professions Code:Any city ar rummy
E a which rsu, it re co.bttel alter.W
rcqui Pum prove.dcmolLsh,.r repair any itronurt
3i< thNrmitsiensedpaiwmgo tiro pro inion o for suchpermit mfilo.signedsutemmm
F thatneis.h.gwiit pursoam loth)pmasiom of the Conummes u¢law(LCopter9 Sq.Ft. Floor Area Valuation
y9 (commencing ,Atherfromandshon 70W) barb.n3 nfaleged catemp ProfeuACode)or $0
— Nn h u exempt therefrom applicant
and de bur for the alleged the exemption.Any l pennon of
Schon]031.5 five
anyrydred dat0 for a permit subjttu the applicant N+civil penalty of Number Occupancy Type
not more Nan fiw hundred dollva(5500). 35704035 .'� P Y YP
0 1,u Owner of the property,Or my cmployses with wages as their able compensation,
will do the work and Neawcmm is not intended or offered fanale(Sec.7W.Business
and Professians Cade The Comuctors License Law does Out appy as an omor Of Required Inspections
property who builds orimproves thereon,and whodoes suchwarkhimself or Waugh his
ownernph,mcs.Provided that such improvements art on,inteMW moffuW(wale.If.
however.she building or improvement is mid within one year of completion,the ow er-
builder will Nve the burden of paving that an did Out build er improve for Purpose of
sale.).
jg 1,as ower of the propmy,.m exclusively comracting with Iiaensul rnnuano s to
cawnsct ute project(Sec.7014,Business and Professions Cade:)The Contracmr's u.
come law dam Out apply to an ownes of property who builds or Wis. .s Merton.and
who contracts for such projects with a canusom(s)licensed pumumn to the Canoattots -
License law.
❑I am exempt under See ,B$PC far is reason .,
caner �� Date�Z— OB
lhxc�yORKER'S COMPENSATION DECLARATION
1 hue y affirm under penalty of perjury one of Ih fallowing declaaatiortg
0 I hsve and will mainYin a Cenifinte of Covent wself-Insure forWouteY.Campen-
sedan.as provid til for by Section 3700 of the Labor Code,far the Performance of Ne
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the lather Code.for the performance of the were for which this permit is Issued. '
My Watters Compensation Insurance error and Policy number art:
Csobe, Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus serum need Out be completed if the permit is for one hundred debars($IM)
or less)
I certify,Net in the iamformarme of the work for which thin permit is issued.)anal am
employ any person in any moon as m becomambjcct to we Warken'Campensati.n
Laws of California.Date o D
Applicun
NOTICE TO APPLICANT If.after making this Certificate of Exemption,you should
become subjttt o the Worker's C.OrKma uan proviso..of to,labor Cade,you mum
.J v7.' forthwith comply with such provisions or Nu permit.hall be deemed rooked.
Z'O CONsrRucnON LENDING AGENCY
[—t I hereby affirm Nat them is.conrtroctinn lending agency for the porfuecome.1'
the work for which Nis pvmit B issued(Sec.3097,CO.C.)
GA unites Name
a z Lender's Address
U O 1 certify that 1 boom read this application and sure that tk abase information is
[]. ^ mrttt m 1 agree In tyl
comply with all city and county Ordinances and se laws relating N
.O SV' building construction,aM hereby auNoriae rtprexnuums of this city m enter upon Nc
ahbie-mcnuoned property for inspection which ms
F C (We)agree to cave,inc emsufy and keep harmless the City of Cupertino against
IA incomesuWgme.s,comandexpenaswhich may in any way eccroe against said City
V z m cotseq NIT of Ne granting Of Nu permIs
F-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicsaDataor D,
KAZAR
xAznRDous building Au o1scl,osuRE Type of Roof
Will the a Cupertino
o future Wilding e.Chaptmore 2.handle h eallous mamdai
as defined by ute Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Cade,section2s53zf,>? All roofs shall be inspected prior to any roofing material being installed.
or'.40 �r0
Will the applicant or futurn building Occupant use equipment or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
emit hw,,a dons air conumi.nu as dc(ined by the Bay Arca Air Quality Management all new materials for inspection.
District? P
0Y. Win -
I have mol tk harardousmamrials requirements under Cbap cr6.95 of the Califor-
nialicalNh Safety Cade,Sceuo.255(15.25533 and 25534.1 undcrsmnd thatlfthe building
dose,rot cunemly have a mount.than it is my m-spansimlity be malty the oecuptal of the
mquirtments which must be met print.to issuance of a centient,of Occupamy. Signature Of Applicant Date
3a og
Owner or ren. <dagcm Date All roof coverings to be Class';{"or better