08020096 CTTY OF
CUP
ERTINO " x - *
BUILDING DIVISION PERMIT i�QN_TRt1�Q( INFORMA.'�'.T�7J!
I
BUIL PERMIT NO.
� � DRESS:S STELLING RD FRANKOVICH ROBERT J 08020096 ,
W NER'S NAME: PERMIT
ISSUE DATE
FRANKOVICH ROBERT J 1392 S STELLING RD 02/14/2008
TIHONE: SANTIARY NO. CONTROL NO.
ARCHTIECn GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
foo LICENSED CONTRACTOR'S DECLARATION Job Description F 1 hereby affirm Nat 1 am limnsc l under provisions of Chapin,9(mmcn
mcing
with Section 70M)of Division 3.f dee Business and Profcaiues Code.and my license is KTCHN RMDL,MSTR BTH,HL BTH,WNDW REPLCMNTS,WNDW
o in full from and effect
i=? LI..ma Class Lie.g &SKYLGHT& VNT FIREPLACE ADDTN
et- Desk Contractor
eS ARCHITECTS DECLARATION
y I understand my plans shall be used a public rttorda
JyV
g 0 Licensed Pmfcstianal
7 OWNER-BUILDER DECLARATION
Canuact
4l4 I hemhy.(Yarm on 1 em exempt from the Genions Co :Anse Law for to
p O following masa. emit t 7113 LS Business and Improve.
demolish,
Cade:Any city s county
at$Ev
which
requires a permit m c.nswe4 alar.Improve,demalixh,m repair any awcturo
°zry^ prism im iavance.ala.mquira theappliam fommh permit t.file a signedantamem
p 0 that heislicensed pursuant mtheprovisions ofthe Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
3�a (commencing with Mcdon 7000)of Division 3 of the Busincasand Prolmdons Code)or 85100
Q that he Is exempt thcmfmm and dee Wats for dm alleged eampuon.Any violation of
SmOm 7031.5 by any applicant for a permit subjmts the appa m.to a civil penalty orNumber Occupancy Type
not roam moa Ore hundred d.li m(M). 3 6 61710 3 .
❑Las owner of me pmpeny,o my employees with wagm as a bsole compensedon,
willdo thewoka.dtheswmm,brmtintendedoraffared locale(Sm.7044,Businea ns Required Inspections
and Pmfealons Code:The Contractors Limas Law does not apply m an none,of 9 P
propeny who build.or i mpmves them..,end who dm.such work himalf o Rwrgh hu
awn employees,provided tiaauch improwments.re nutinsendW araRered far sale.If.
however,the building or improvement is mid within m¢year dfcompletion.the owner-
builder will have the burden of proving that M did not build or Improve for purpose of
ale.).
J,u1, ,owner of the property.am elusively commeting with licensed contractors a
awn .dee prokm(Sec.70x4.Business and Profestiaa Cade:)The Cmuacmes U.
came Law does not apply to an owner of property who builds or Improves theme,and
who contacts for arch projects with a mntramora)Ikeesed purswnt to the Comrmmts
L'menw Law.
❑1 oro aempt uncle en ,B&P C f r thi reason
otic Dare 4
\ ORKPR'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury rn of we following decimations:
❑I ham and ids!for by Section
37M of a.Labor
a Code,
far Waarrow.amPen-
workf r provided ler mi Ss intn TI00 of tie Labor Code,for the performance of dm
work far which Nis permit is ivutl.
❑1 have and will maintain Worker's Compensation Warrants,n retained by Section
3700 of dee Labor Code,for tie performrom of We work forwhich ties permit is laud
My Wmkefs Compensation Whor mce artier and Policy number ase:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CThtsmmian need aminecomplamd If an permit Is foam hundred dollars($100)
or less)
1 MmfY Not in the performance of the work for which this permit is Wood,1 shall not
employ any person in my manorsp eg WCa9ma subject to the Workers'Compensation
Laws of Caltfamig(jlate 1 L^R 41✓X
Applkan1 I y t
NOTICE TO APPUCANr:If,after making this Certificate of Exemption.you should
become subject to the Worker's Compensation previsions of the Labor Code.you most
.J O forthwith comply with such provisions or tris permit.hall he deemed rewkid. "
z., CONSTRUCTION LENDING AGENCY
^
[-r I Woubyalriime that there is a construction lending agency for dee performance of -
CG > the work for which this permit is Wand(Sm.3097,Civ,C.)
UJ QLamer's Name
Z)
z Lender's Address
V 0 I certify that I haw read this application and saw dead the show information is
4L correct.I agree to comply with all city and county uNlnsnco end slim laws misting on
_0 building construction,and Mreby authotla representatives of this city a carr upon den
1.17 above-mentioned propeny for inspection purposes
G (We)agree m an.indemnify and keep hadmlen the City of Cupertino against
y liabilities,judgments.casts ad opera which may in my way merue again,said City
in V r77 MiL
APPLICA consequence
UND RSTANDS AND this
WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date 2,t
SOURCER q ILA�IONS.
1 IVW — Z�la�d Re-roofs
Signature Of Applian✓Conrmmr Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicator funro building occupm,mom or handle hazardous maseritl
as defined by the Cupenim Municipal Code,Chapter 9.11,and the Health and Safety
40
Code.Section 25532(.)?0 y All roofs shall be inspected prior to any roofing material being installed.
�No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove
emit hammnus air comamiunts a defined by the Be,Area Air Quality Management all new materials for inspection.
District?
❑Yes dT No
I haw mad the handoamatarials requirements under Chapen6.95 of the Collier-
me Health&SafmyCedc,Smu be 75505.25533 and 25534.I undersand ukifthe building
dos mm m nay h a aan4 tar It u my mwmibili,y m nou'y dw emupmt of tie
requourem 'ch uadbeme,pdorluiauaoc.faCceifmamof0mpm . Signature Applicant Date
11 0 g
Owner or amhoriaa agpm , - All roof coverings to be Class°B°or better