08030115 CITY OF CUPERTINO
BUILDINGDIVISION PERMIT = CONTRA,CRINFORNfATION ' :
BUILDING ADDRESS: PERMIT NO.
6264 SHADYGROVE CT TBD TO BE DETERMINED 08030115
OWNER'S NAME: PERMIT ISSUE DATE
03/20/2008
ONE: SANITARY NO, CONTROL NO.
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
.Op LICENSED CONTRACTOR'S DECLARATION
8 I herearu
by m that I am Rmnacd under prevision of Chapter 9(commencing Job Description
with Section 70M)of Division 3 afd¢Business and Profession Code.and my licmnu is KITCHN REMDL, FIXTRS &CABNT CHNG OUT
in full farts and cQeel.
� ? License Class Lic.p
an
� Dae Conveto
cr
eg ARCHITECTS DECLARATION
e q 1 understand my plan shall be used u public rardas
p
as Licensed Pnlfasaional -
`y OWNER-BUILDER DECLARATION
COO I roanereby alum mol 1 1. exempt from me Canvas o :censeMy
city
o for
0.
EGC whicfollowing oun.. Promo 7M 1.5,Business and Profession Code:Any city sancutry
+d 9 m which requires a permit m uiruwct alter,impreve,M permit
t,fi mash any swmen
_Z�, prior m its issuance.pursuant to the tit applicant far soh pmmiuo file acense Lacd natamcnt
< (comm is licensedSectiontheprevision.!meCanvumhLimnmlaonsCodtr9 Sq.Ft. Floor Area Valuation
99 that a Is ingext with Section7000)n d ole Division 3 ti the alleged
and Proon.Any ns Cd,on of $8000
Nat he ts exempt therefrom and the buts for Ne alkgmd cumptian.Any violation of
Section 70313 by any applicant for a permit auhjecu the applicant to a civil penalty of An�D,7y�,i Number Occupancy Type
actmom Nan fiw hundred dollus(M). 37541032 . V V
❑I,u owerk.and p e someone
is wplayeu wire wage u their sole W.Bu Nan,
will dathcwark Codec h.Cureunr's Licentended se Lt.
loess hot adic
ad an,Business Required Inspections
,and propP.erty
who bas lis or The m therear's Littre Law don not apply if an owner of q p
property who builds i impnvu thereon,and wcs doesauh work oroffeforemugh his
owns ,,On Wilding
mutsuch impnwmani arenot intend edoroRend omala V,
however,me building or den of pment is old within an year ser Improve
for the ower-
builder will Mve tit burden of pressing ren he did wt build w improve far purpose of
[ 1.u ower of the propenY,em combatively conuutitig with licensed emumcnes th-
commet the project(Sec.7004,Business and Normal...Code:)The Convectors U.
«nae Law data can apply to an ower or property who builds or impreves thereon,and
who contracts for such prejecta MN a conuscmr(s)limned pursuant ut the Conuadah
Lkesue Law.
0 l am
+ '[.._ Dale 2/T
WORKER'S cubnw NsxT tau DECLARATION
I hereby atlan under penalty of perjury an of the fallowing declaration:
I ham and will maimeln a Cenifcate ofC..a.,m elf-(num for Worker's Campcn-
lan,u provided for by Section 77M of the Labor Code.for the performance of the
work for which this permit Is issued.
0 1 hot and will maintain Warkcrs Compensation Imuran,as required by Section
370().f 0.Mbar Cade,far me poor.....(the woh Tor which this permit is issued.
My Workm(1 Compensation lasumnn carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectiml need not he completed If dopermit is far on hundred dollen(S 100)
or less.)
1 madly that in the performance of the work for which this permit is issued.I shall not
employ any person in any menn�rsq ss b�e�ome subject to the Workers'Compensation
L4Wsnr California.Dae )l'b(Q-T
Applicant Si..�
NOTICE TO A ANT:If,arta making this Cisions of of Exemption,you ahaust
become hcompy the Worker's Compensation previsions or me Mbar Code,you mus(
.JO forthwith comply with such prevision Cress permit shall he decreed revoked.
CONSTRUCTION LENDING AGENCY
.N.F I hcmh M.mu sem is a conawctinn leading g Cgeuy Tar the perrarmanm or
14 rte. work for which mice permit Is issued(Sec.709'!,Civ.C.) '
tr, Q Le Lenderm
Leader'.Nae
M z Lenders Address
UQ 1 costly that I have mad itis application and stare Nu me above information Is
{I. U comms 1 Igoe b=reply With all city and county eminences and slam lawn misting m '
C) building construction.and hereby authodm repmentativcs or this city to enter upon the
W .bore-mentioned property for inspection pugmaes
fir+ gys (We)agree to on.dndcmmry and keep harmlces the City of Cupertino eg2iM(
my
liabilities,judgments.coni and expenses which may in any way annum sgaint mid City
V z in consequence of the granting of this permm. �Y
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �^ L CI-J G
SOURCE
— �� Re-roofs
Signature ver Applcads convaclor Dee
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building mcupnts(om orhandle haurdou material
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Code.$CNet 25132(a)t
[D Yet All roofs shall be inspected prior to any roofing material being installed.
Will to applicant at future building occupant use equipment or devim which If a roof is installed without first obtaining an inspection,I agree to remove
it Mvammus air contsminnts u&lood by me Bay Arta Air Quality Mansgcm.. all new materials for inspection.
v ct7
❑Yu No
1 haw mad the hu4stsms materials requimments under Chapter 6.95 hide Calif.r.
niaHuim&Safety CCM,Sccd=u M5,25533md25534.1w&M dmoifdt Wilding
does oat ewormly Mve a scum than is is my responsibility m hour,the atupanl of dt
mquimm yhichmnrusllceofaccstficateofOcctpanry.�my. Signature of Applicant Date
�3;'epe All roof coverings to be Class"B"or better
or sulh.rvtd gcnlaaolharbcd Seat a