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CITY OF CUPERTINO
BUILDING DIV is10N PERMIT
BUILDING ADDRESS:
BELLA CASA BUILDERS INC
""MR"'06030041
899 SEPTEMBER DR
1670 SAN PABLO CT
05/05/2006
_
PHONE:
SANITARY NO. CONTROL NO.
(408)206-1540
ARCHITECT/ENGINEER:
BUILDING PERMMINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nal l son Hamed under provision of Chapter 9 (ammncing
wit Section 70(10) of Division 7 of the Business and Profession, Cade. and my license or
mfull fares and effect.
ADDITION 596.61 BEDROOM/DEN/LIVING ROOM
License Class Lie a
Dao: Contractor
ARCHITECTS DECLARATION
1 uMerstand my plans shall be uw•d u public Occurds
Licensed Prof,ssionaI
OWNER -BUILDER DECLARATION
I hereby alum Nm 1 am exempt from hoc Contractor's License Law for do,
following mason. (Section Rn 1.5. Business, and Pwfitle n Cade: My city or county
which requires a permit to continuer, alms, improa, demuluh, Or repair any suumure
$127978
prior to its osumcc, ldm requires to applicant forsuch permit tO file a signed statement
t, Conoacmr's liana Law(Chapmr9
Sq. Ft. Floor Area
Valuation
tail he is licensed pursuant to provision of the
(commencing wits cm 7000) of Division 3 oftc Business and Prof. -ns Calc ar
Nat he is exempt therefrom and to buts for the alleged exemption Any violation of
31rU
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant w a civil Penalty of
not mart Nan five handed dollars (53007.
I,uownv of lite propeny,amY emPloycn wiN wages utc'v sole campemation,
Inspections
will do tho. k sad Nestrecom u ret hounded orortertd formic (Sec. lou. Business
and Profession Code: The Contractors License Law docs not apply to as owner of
%1 quired
property who builds miropmvm Nemun,and.W daessach were himself., through his
own employees, provided Nm such improvements tie not standard aalfemd fOr Side. If,
miswr,Ihe building Or improvement is sold whin one year Ogarepeom. to Owes-
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builder wi0 have the modest of proving Nat he did not hold or improve for purpose Of
❑ 1, as owner Of one reopen, am cadusively convening it licensed antracmrs to
convect the project (Sec. 7044, Bninns and Profession Code) The Convacts's Lt-
ttnu law docs not aPPIY m an weer of pnopeny who builds or imProvn Nemon. and .
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anCanvactofs
licensed puutmte
whesjewiNacnnacgs)liars
u for such prom vm
/r\O
La
ew.
License 4
❑lam ucmpt under See .Bd:PC for Nu retire
,
Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following declaration:
Q 1 haR and WIII malOmla a [cult Wm or [an5enl W .I[If-Insure fW Workers [Ompen-
ra11On. as provided for by Scemn 3700 Of the tabor Code. far Nc perform. Of the
work for whim Nis permit is issued.
❑ 1 have and will maintain Wakn9 Compensation Insurance, u inquired by Section
3700 of the Labor Cade, for to Performance of to wale for which Nu permit is issued.
'
My Warhefs Compensation lnmena canna end Policy mark, am:
Cartier. policy No.:
CERTIFICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Thu snvm need not he completed if llm Permit is fmonc hundred dollars (5100)
v
loss.)
I certify that in the poli m Lir. of the were for which tis permit is issad, 1 shall not
employ any person in try mannerse, at m become subject to the Wohcri Compensation
Laws of CAifomia Dam
Applicant
NOTICE TO APPLICANT: If. after making to Certificate of Exemption. You should
becom subject m the Worker's Compensation prevision of to Labor Cod, you mail
' hart.M comply wit such provision or this permit shall he deemed narcoses.
i CONSTRUCTION
I hereby Jlirm that mere is lending agelay for to performance of
! mocum leading amY
30
to work for which Nis permit u issued (Sec. 3097. Civ. G)
s ed (Sec.
Lender's Name
Lendeh Address
'
1 I anify that T have read this application and sue Nal to above information i5
coma I agree to comply wit all city and county ordinances and sum laws relating to
building construction, and hereby autome replesentalivos or this city to cant upnn m
above-mentioned pmperly for inspection purposes
(We) agree to save, indemnify and kap harmless the City of Cupertino against
j liabilhica,judgmnu.coses and etpases whim may in try wayamucagaiest aid City
in Oof to granting of t
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Siglutua Of ApplieuUCOnDam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will IK applicant or forum building amupant Aon or handle haiardou5 material
fined by hoc Cupeno Municipal Code. Chapter 9.11. and tHeat o Heaand Safety
. Section 15531(a)?rti
❑tan ON.
All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or to,.. Wilding .,.at use tenement or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
call Wart. sir canuminanu u defined by Ne Bay Amo Air Quality Management
all new materials for inspection.
P
Dintrmt7
❑tan ON.
I have read Ne herardaus mverialsmquirem umdcrChmW6.95OfteCalifor-
nuHoslN&Safely Cod, Sectiau 255(15,15533 and 25534.1 understand tazifthe building
docs not curmmty hest a tanank Nil it is my maponsibility to nobly dm occupant of Nc
requirements which mus, he met prior m issuance ofa omrssm of Occupancy.
Signature of Applicant Date
All roof coverings to be Class ••B•• or better
Owner aautarimd11.1 Dam