05120003 CITY OF CUPERTINO �* _ MON
-'
BUILDING DIVISION PERMIT rC01''1'.�.Rr�CTOI�' 1 'CS' ' TbN
°. 911 w xr-I e
BUILDING ADDRESS: VISION SCAPES & ASS . INC. PERMIT 110.05120003
jjFR'S NAME: PERMIT ISSUE DATE
MICHAEL & JOAN O'DELL 1780 BUENA VI T 01/12/2006
PHONE: SANITARY NO, CONTROL NO.
(925) 243-9585
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
boa LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions or Chapter 9(commencing
with Section 7")of Division 3 ofthe Businessand Profesd sC .andmylicensais
ni umRfameledarect. 2 BUILD CABANA (W/CEILING FAN)
Dn? Lken us Lk.M
Data Contractor
HIT - '
e ARCECTS DEC-
Y I underuenJ my plans shall be used as public record.
J�
L C Licenced Professional
OWNER-BUILDER DECLARATION
<XI hereby.(Simi that 11. exempt from the ConvanCo e:My c Law for the
p o following mason.(Section co str Business and improve,
dem ro Cade:My city or nutty
$ which acquires;•permit re quires the aloe impmvu,demolish,of repair any.muner $25000
—i5 pdorto itsiamme,Num ED the thovisioc of fortho sucCohpermit miensete a Law(Chaned mem
s< that licensedwithSeetion7 )ofDivioroofthe eBusintolsndPreaelaw(Chapur9 Sq.F[. Floor Area Valuation
�$ that he
(commencingwithSeaion70ndth bandisan3 of Neeged exa and Paofca vi Code)sea
R.. Net he u exempt therefrom ntl Uu butt for ore atkgp4 csemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of r Occupancy Type
not mart than five bundled dollars(ML
❑I,u owner of the property,or my employees with wages As their sole compensation,
will do the Mark and the structure is not intended of offered fm We(Sm.704(,Business Required Inspections
and Profeaioro Cod.The Commensals License to e
r
ce law donot apply an aw s of q P
property,who builds on improver thesmn,and who does such work himself or through his
own employees.provided that such Improvements ate not in tended or offered for ale.IL
however,the building or improvement is said within one year of completion,the owner.
builder will have the burden of proving that he did not build ser improver far purpose of
Asia.).
❑1.As owner of the property,am exclusively contracting with licensed contractor to
construct the project(Sec.7044,Business and Professions Code:)The Comrumla U.
acue law don not apply to an owner of propeny.who builds or improver themon.and,
who contras for such projects with annmacmr(s)licensed pursuant to the conmassah
Lkense Law.
❑1 am exempt under Seo. .B k P C for this rearm
Dau
WORKERS COMPENSA71ON DECLARATION
I hereby affirm under penalty of perjury,Are of tiro following declantione:
❑I ham and will munuin aCW 0nu of Conserv to Alf-imam for WaakelaCompen-
Oman,as provided for by Section 3700 of the labor Code,ror the performance of the
work for which this Permit is Issued.
❑1 have and will maintain Workers Compensation InurOce.u required by Section
37Wof the labor Code,for the perfomnn of the work forwhich this Permit is Wood.
My Worker C prtio once artier And Policy num a`¢
Carrier �yys Policy No.: U `v
CEIMFICKTIE EXEMPTIONFROMWORKERS'
COMPENSATION INSURANCE
CILis toation reed notbecompleted ifthe permit Is foram hundred indarm($IM)
or kat)
I ccm v that in the performance of the walls for which this permit is issued.l shall nut
employ any person in my manner so As to becomesubject to the Workers'Compensation
Law.of California.Dau
Applicant
NOTICE TO APPLICANT.If,After making this CeniOcats of ExemPtian,you should
become subject to the Worker's Compensation provisions of the Labor Code.you most
,JO forthwith comply with each pmrisiom Or thin permit"I be deemW revoked.
rEN
CONSTRUCTION LENDING AGENCY
4
[—t (hereby air.that Nem u•announced.lending agency far the performance of
p:> the wurk for which this permit is issued(Sac.3097.Civ,C.)
QLender'.Name
n1- z Ltmices AddreO
V Q I unify dust l low read thin application and sum that the above information is
w F correct.l agree to comply with all city cad county ordinuuea And sou laws relating to
Q C.) building construction,and hereby auhoire represenuthocs of this city toenter upon tion
W ahove-mentioned property for iropecdon purposes
P. (We)agree to ave,indemnify and Loop humlea the City of Cupenin against
in liabilities,judgments,eoau and expenses whish may in an,way accrue against said City
U Z in consequence of the gambling of this permit. /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2-
d—
5U REGU NS.
Re-roofs �6;zq
Signature,ofApolicanVCOAMW Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(more building occupant nor or handle hvWous material
O defined by the Cupertino Munlei al Cade.Chapter 9.17.athe Health and Safety
M'..2553x( fing material being installed.
❑tin No
Will the applicant o lour building omspant use equipment n dcvi¢s which If a t00f i5 installed without firs[obtaining an inspection.I agree to remove
.it henadnm all Miami Is aydefircA by NC Bay Area Air Quality MOagemem all new materials for inspection.
Distract?
❑ �'f4/
tin u
1 hoc rad the MOadommawlasrequirements under .Chapter6.95ofthe Califon
me Heal"SafctyCode.Soca=25505.25533 un125534.1 onderaud dun ifde Wilding
duet bot cWCMIy haw a W'Ink Wt It Y my anpomibilay in wtiry the 0.emPnt of the
rquiremcpas thm bemetpdouiumrccofaCcnificatea("' n^L7 Signature of Applicant Date
O\/wnelrMor`•suNovcd agent / Ds„e All roof coverings to be Class"B”or better d•