04070009 7.
CITY OF CUPERTINO .' -" �. ,� �AT ,
BUILDING DIVISION PERMIT Cox x T ;; „.,„„ , „ 11,=,_
BUILDING ADDRESS: GREATER BAY CONSTRUCTION PERMIT”04070009
OWNER'S NAME: PERMITISSUEDAT6
GB ESTATE HOMSE SUITE 2on
E: SANITARY N0. CONTROL NO.
(408) 248-6600
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRAC'TOR'S DECLARATION '
U F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
`f
with SactitQ 701NBof Division 3ofdu BasincaagHtl Pmfessma Codc,end my licenxu
in full foreeNq �ffect. /- REVISION--TRUSS FRAME
5n"z_ ucemuclasa sec."
Cantraclor NO NEW PERMIT ISSUED/ORIG. #03110113
^p Oau
ARCHITECTS D TION
1 understand my plans shall he used as public records
Dn
o Licensed Professional
g
OWNER-BUILDER DECLARATION
+� I hereby affirm that 1 am exempt from the Contractors License Law for the
i p o following mason.(Smdun 7031.5,Business and Proportions Cade:Any city or county
s�$ which requims a permit to smstrucl,alter,improve,demolish.or repair my suucmm
prior m its issuance.also requims the applicant for such permit to file a signed statement
that he is licensed pursanl to the provisions Of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area yvValuatiog 115
,S❑$ (commcncingwiih Seation7000)of Division3ofthe Businessand Pmfhsions Cndc)or
3.. Zt he Or exempt therefrom and the basis for the alleged exemption.Any violallan of
Semon 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty Of APN Number Occupancy Type
not more Na Eve hundred dollars WIND,
I,as owner of them 35922074 . 00 i
❑ t muctre mycmptendedwr.vngesas.1.(Se.70",Business will do Ole a&and sheso Comatntintkens La.dofor ole(See.1.Ad,Baines
and ertywh ons Code:The Contremon,License Law doh not apply lf an owner of Required InSpeCGODS
property who builds Or ed tan to champn,and who doesouchenn a himulr offered
his
own employees,provided Nat such improvements are m year
of
or mpletimA forthe salkowner.however,Ne have
do, or improvement is sold within ou year of completion,the Ownco
builder tela have the burden of proving that he did not build or improve for purpose of
am.).
1,as Owner of the property,am exclusively contracting wish Seemed contractors to
swot the pmjecl(Sec.7006,Business and Professions Code:)The Contractors Li.
can a law does not apply to an ownor of property who builds or improves thereon,and.
who contracts for such projects with a commelor(s)licensed pursuant to she Camra mer
License Law.
❑I am exempt under Se. .B&PCf. shit az
11113 r u ? o
W RKER MPENSATION DEC Al q
1 hereby afore under entry of perjuryone of the following deal II me: ,
ave and will main aCenificamafComenuoolf-insum forWorker'sCompere.as provided for by Section 3700 of the labor Code.for the performance of the
for which thir permit is iuucd.
ive and will maintain Worker's Compensation Insurance,as required by Section
of she tabor Code.far the performance of Ne work for which this permit is issued.
orker's Compensation Imumne artier and Policy number am:
r: Icy No,:
CERTIFICATE OF EXEM FROM WORKERS'
COMPENSATION SURANCE
(This section need not he completed if the Pewit is for one hundred dollars(I IM) '
or less.)
1 certify that in the periarreanee of the work for which this permit u issued.l shall not
employ any person in any mannerso as b become subject o the Warkers'Compenatlan
Laws Of California.Data
Applicant
NOTICE TO APPLICANT:If,aper making this CertiOcam of Exemption,you should
become subject to the Workers Compensation previsions of the tabor Code,you must
Z forthwith comply with such previsions or this Permit shall M deemed revoked.
zO CONSTRUCTION LENDING AGENCY
E1 hereby rebRr
y an Nat there is a construction lending agency for the Performanceof
ILA the work far which this permit Is issued(Sec.3097.Ci,C.)
QLender's Namc
z Lender's Address
U Q I certify that 1 have mad this application and sum that the above information is
D.P cower 1 agree to comply with all city and county eminences and state laws miming to
0 U building construction.and hereby aushonre repmasmulim of this city to cnur upon the
abovo-memianed property far inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
w%
liabilities,judgments.corm and expemca which may to any way see...Beirut said City
V Z in consequence Of the granting of this Permit.
F-t APPLICANT UNDERSTANDS AND WILL COMPLY W AL NON POINT Issued by: Date
SOURCE REGULATIONS. 's O
Re-roofs
Signature ofAp,lic OUCan m Data
HAZA D S MATERIALS D1SCL RE Type of Roof
Will the app'cant uumbuiidbrgoccupanutoma handlchaallousmaterial
az defined by the Cu me Municipal Code.Chapter 9.12,and the Health and Safety
adSection0y.25532(g)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or antra building by the B use equipment or devices which t
havardnus air contaminants az departed by the Bey Area Air Quality Management all new materials TOC inspection. (_
tract? \�
❑Yes
I have mad the haramous materials requi.mem a under Chapter6.95 of the Califor-
O"Hcalsh&SafetyCodc,Scetiam 25505,25533 ad 25530.1 vodcrs.nd thmif dte building
J of currentlyhme a mnm4 Net it is my responsibility m notify the tic upan oria
e
myui¢menmw e.mntpnermianae.araeenifihumOgpy cy. Signature of Applicant Date
owner art anthe 6 am All roof coverings to be Class "B"or better