06070036 CITY OF CUPERTINO ."'^'
BUILDING DIVISION PERMIT oNTRt�LCITOwINEOR_MA7?I BUILDING ADDRESS: GREATER BAY CONSTRUCTION PERMTINO06070036
11081 S STELLING RD
R'S NAME: PERMIT ISSUE DATE
PANCAL CATALANO SUITE 200 08/03/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 248-6600
ARCHITECTIENGINEER: BUILDING PERMITPL INFO
BLDG
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I sup6 LICENSED CONntACTORS DECLARATION Job Description
1 hereby affirm dal 1 am licensed under Provisions or Chapter 9(crummuklne
with Section 7M)afDivision 5af the Business and Professions Cade,and my Ecorse is
? w mornro.&w1.rfea REMOVE OLD HOUSE AND CLEAR GROUNDS
,i Z Lkenm Class Lk.Y
-Fq Dow C)ntrac70r
' W ARCHITECTS DECLARATION GREATER BAY RENEWED AND PAID BL 7/7/06
i 77< 1 understand my pines than he wed as public records
tQF Licensed Professional
OWNER-BUILDER DECLARATION
S I herchy o(BomS.c .n 1 am exempt from the Daum.Co,Lkenm Law far do
❑O whichi"dion,apermit in.. s1.00k,Business and ,c1 clots Cade:Any City oroaumy
5$ which requires a permit re cnnmot,ppitc mforsu demolish,rar repair any ied statement priormits issuarcc,alw requires thovisiosof Badewhpscutes Lice=
fileas Law(Caomem Valuation
pp <
(that he commencing
ithSccmnt7000)ofDivioion3of uonaacmraniceueld,oulC(Chapter Sq.Ft.Floor Area
d€O (commis exawiNSation7and of basis far
the
theegedcssad PmfMYvi COQ)or $10000
-59 that he is eaernpt therefrom and tie bub fes the alleged nsmptiom MY violation Of
Section 7071.3 by any applicant for a permit subjects the applicant In a civil PW4ltY of APN Number Occupancy Type
not mom than five hundred dollars(5700). -
❑1,u owner of the property,as my employ=with weges u their sole cum seaddon,
win do de wark.and the structure is not intended or offered for sale(Sec.7014,Business - Required Inspections
and Professions Cade:Tbmm
he Conrs License Law d=rot apply b an owner of q P
property who builds or im proves daemon,and wha dos such wart himelf ear Through his
own employes,provided Uwsuch improvements sae notinxnded oro@rod for sale.If.
however,the building or impmveraM is mid within arc Year of Wmpletim,the awner-
builder will have the bwdan of proving that he did rot build or Improve fes purpose of
sale.).
1,as owner of the property,am andusively contracting with licensed ronaacmm se
onsmum the project(Sec.7044.Business add Professions Cade:)The CWmaemes U.
cove law does not apply to an owner of propeny who builds or improves thereon,and
who contracts for such projects with a eantsamaKs)Beensed pursuant in the Contractors
License Law.
❑I oro esemp0 u ----sum P C r N'"mama
ORKERS OMPENSATIONDECLARATI-N O
I hereby andm under penalty of perjury was of the following Qcluatio�
Ilam and will for bineCeNaeu of Code.
for
performance
of e
ration,kf r which
thin
for mi Section 7700 of tiro labor Cade,fes do performance of the
wank for which Nis permit is issued.
❑I have and will maintain Workch Compensation Insurance,as required by Section ,
7700 of the Labor Code,far the Performance of the work far which this permit is wood.
My Workers Compensation boatmen artier and Policy number m:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tab section wed nothecompicod due Permit Is funds hundmddoom($100)
or lass.)
I comfy that In the performance of the work for which this permit Is Issued,I shall nes
employ any Person in manrcrmssthbocome subject Wa trn'Compensatian
laws of Califamia.D � �� ,
Applicant
NOTICE TO APP :IL atom making this Coni s o Exemption,you uMuW
Occome subject y the W ch prou Compensation permit
low of the labor Code you muss
�O forthwith Comply with tach pmvisons or this permi,MVI be dcemed revoked. ,
„z„r~rA., CONSTRUCTION LENDING AGENCY
1 botchy alrnm Nes them Its construction lending agency for the Performance of
a ,7 the work for which this permit is issued(Sec.7097.Cls.Q
W Q Lender's Names
fY Landers Address
U 0 I certify that I have read this application and sum dot the above infamution IS
Uyt-" ewreca I agree m comply with all city and county Ordinances and sok laws raising m
0 U building construction,and herebywthodm representatives of this city to enter upon One
W above-mentioned property for impaction pugores.
gy (we)agree in save,indemnify and kap harmless,the City or CuPCvmO aPins,
fq liabilidea.judgments.cost sad expensea which may In my way amus against sold CRY �.
U Z in canxgwnce of the granting of this permit. G
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE NS.
I-- 3�0Ib Re-roofs
signature oijispalibanwComrsesor D°oof Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will use,applicant,or futum building orampanta70m or handk hvsNons maovial
deRdsd by the Cupenidm Municipal CoQ.Chapor 9.12 and the Health and Safety
Section 35532(m)? All roofs shall be inspected prior to any roofing material being installed.
IYes VNa
future building Occupant use equipment or dovi=which If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or
emit huadow air contaminants as denied by the Bay Area Air QUABLY Management all new materials for inspection.
District?
Oyu No
I have read the has materials oquhemems urkerCNpor b.95offtOdifw-
nbHcalthkSafmyCaQ,Seen.35505.35537 and 25534.1 undemonA"It he WHOM,
d=Out Currently hew a scot.On,1t is my ospamibilily to wary the=up.,of de
uimmcfh_mus0 mel ormissuana ofaf oar�`aFan Signature of Applicant Dale
II^ em `\ ± 00 Da All roof coverings to be Class "B"or better
Owner r ariatl eCenO Dam"