06030178CITY OF CUPERTINO
��'BUILDING
DIVISION PERMIT.C,ONTRt1T4RTNFORNIA',I.O,w.'
.:
BUILDING ADDRESS:
PERMIT NO.0 6 0 3 017 8
1342 S STELLING RD
I R'
08/16/2006
PHONE:
SANITARY NO. CONTROL NO.
ARCH"ELT/ENGINEER:
BUILDING PERM" IN
BLDG ELECT PLUMB MECH
r__11� E! to
LICENSED CONTRACTOR'S DECLARATION
' Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) afDivialon 3afthe Bm inex end Profeuium Code, sed my Iicame ts
in full fame Z04 affect.
ADDITION 1106' /REMODEL 7211 -ALL BEDRMS/BATHRMS
Claw Lic. #
FAMILY RM/ (E) KITCHEN/LIVING RM/ADD GARAGE 484'
Cont
Do, Container
Dam
ARCHITECTS DECLARATION
MAJOR ADDITION/REMODEL NEEDS DEMO PERMIT
I untlersund my plane shall be used as public rteaNs
Licensed Poi estimed
OWNER -BUILDER DECLARATION
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I hereby affirm that 1 am exempt from the Conumto's License Lew for the
fallowing mason. (Session 7031.5. Business and Prefeuiom Cam: Any City or county
which requires a permit to construct, alum, improve, demolish, or repair any moctum
prior to its issuance, also requires the applicant rat such permit to Tile a signed Ntermon
Cmbmtor's License law(Chapect 9
Sq. Ft. Floor Area
Valuation
bat he is licemcd pursuant he ten provisions of the
Section 7000) Division 3 of the Business and Pm(C.uians Cade) or
$337022
(commencing with of
bet W Is exempt therefrmn and the basis for the alleged exemption. Any violation of
Sexton 7031.5 by any applicant for a pmmit subjects the applicant to a civil penalty, of
APN Number Occupancy Type
not mart dun five handled dollars (35(101.
p 1, M owner of the Property. m my emplayec with wage entheh mkeompensaton,
wi0 da be wark. andtheswcturttsrotineMedora@red rar,.la (5n.70w, Busircss
Required Inspections
q P
as Law dot apply in an owner of
and Professions Cade: The Cont ecmrs Limes Am
property who bu Ilds or improves thereon. and who does tach wark himself or Brough his
awnemployeed, provided that such improvements am Imtinuntletl oroRenal fmsele IL
however. the building or improvement la mid within ane year of compiauon, to mon-
builder will have be burden of proving bat M did rot build or improve for purpose of
sem.).
❑ 1, as on. of the prurient, am emluavely contracting with licensed ommmters in
condoner the project (Sec. 704, Business and Professions Cale:) The COnrrselOr's V -
to. Law dots out apply in an owner of property who WiWs or improves lemon. it.
who comment for such projects when acontrmmr(s) hummed par stent m the Cmuacter's
Ucmtm law.
❑lam aempt ti;Se B& C f/or this
�res�mn
�P
Dam,
l:7
r_
DECLARATION
I hereby aR3rm un er penalty of perjury am•, of the fallowing unwho tans:
❑ I have ono will eaNn O7ca70te a
worn, provided for by Sectionofdic Lab"Cods, filltheperformance of the
work for which this permit Is Issued.
❑ 1 law and will maintain Won sh Compensation Wurmm. w required by Section
3700 of the Latter Code, for the Mrfam omof the work for which this permit is !aimed.
My Worker's Compmaddion btsuwno curim and Policy number art:
Cartier. Paliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mttssecton mend rot he completed If dm permit Is form= hundred do0an ($100)
or ins)
1 certify bat in the performance of the work fm which this permit is issued. l shall not
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employ any person In any mannCrm as in beCamC mbjecl in to WOW=
Laws of
Applicant
NOTICE TO APPL C If. after making this Conili of Exemption. you should
become Subject I the N(o rsCompenudon pmvisiws of the UMr Coda you mum
forthwith comply with sui provisions or this permit shall be domed mwkcd.
CONSTRUCTION LENDING AGENCY
I hereby thi that them Is construction agency for tIC pCffI1r11mMC or
s 30 7. Civg
' theLe work far which thty permit ts issued (Sec. 709'1. Civ. C.1
which
Lender's Nene
'
Lendeh Addmas
1 cenify that I haw read this application W sum due the above Informeuun is
• comet, I agree in comply with all city no county ordinancn and sum laws misting in
building construction, and hereby authmix, mpremmmlws or this city to enter upon the
for inspection
abovomentioned pmpcny Purpows.
(Wee) aglee to save. indemnify and keep hermless the City Of Cupcl ino against
Ifabllitca.judgments, cord and expenses which may in my way mems agatmtsaid City
r in consequence of the granting of this permit.
APPLICANT UN FRSTANDS AND WILL COMPLY WITH ALL NON -POINT
_
Issued by: Date ✓t os -.G
SO CE REG FINwor/
e'VRe-roofs
Type Roof
signatule orA UConuacmr DaeOf
US MATERIALS DISCLOSURE
Will the applicant orfuture building Occupant stere of handle hawrdoes material
e Cupertino Municipal Cade. temper 9.13. and to Health and Safety
dCRrmd by bin
Secdan 33533(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yat McNu
If a roof is installed without first obtaining an inspection, I agree to remove
I Will the applicant or future building Occupant um equipment or devices which
emit hamous air contaminants w defined by the Bay Area Air Quality Management
all new materials for inspection.
Diatrict7
❑Yat am.
I haw mad be heard. mamrialsmquimmewundu Chapter G950fthe Cobra.
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niaHalthkSafctyCode.Sa-U m75505.35577md75534.lundermmulthmifthe building
does not currently hew a unm6 that It is my mspoodwity in notify ted Occupant of the
muimmentswh u faaemneaearoccupancy,
Signature of Applicant Date
1
06 06h
17 owneraramt
All roof coverings to be Class "B" or better
y gen Dam