07120025 PermitCITY OF CUPERTINOBUILDING
DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
10773 STEVENS CANYON RD
MARINKO BALDE
07120025
W NET'S NAME:
PERMIT ISSUE DATE
MARINKO BALDE
10773 STEVENS CANYON RD
01/28/2008
PHONE: -
SANITARY NO, CONTROL NO.
ARCHTTECr ENGINEER:
.,
BUILDING PERMIT INFO
-BLDG ELECTPLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hi cby affirm thus I am leensed under provisions of Chapter 9 (commencing
with Section 7010D) of Division 3 of the Business add Professions Code, and my license is
REVISION—EXTEND (E) BEDROOM, FIRST FLR.ORIG
in full farce and cillm
Lima. Class Lic.if
#05010117 NO NEW PERMIT.
Dam Condamr
ARCHITECTS DECLARATION
1 understand my plana shall he used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 harehy alarm Net 1 am exempt from the Contrattors License Law far the
following resson. (Section 7031.5, Business and Profesxio s Code: Any city or county
which mqulms a permit to conduct. slur. improve. demolish, or repair any structure
prior m its issuance. aim requires Ne applicant for such permit to file a signed summent
Mid he is licensed pummtto the provisions of the Connector's Liccese law(Chapar 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 0
that he la red
exempt thcaro and the basis for the alleged exemption. Any violation of
Satire 7031.5 by any applicant far a permit subjects the applicant in a civil penalty ofNumber
,V(I
Occupancy ane
O Tope
trot mom than five hundred dollars (SM.
3 4 217101
y
❑ I, as owner order property, army employees with wages u their into composition,
will da the want, and mesrmnum is notimmnded orrRemd foraam (Sec.7044, BW toss
and PmfcsmWs Cade: The Contractors Lt.= Law docs trot apply in an own. of
Required Inspections
property who builtla or i m proves thereon, and who does such work himself or through his
own employees, provided thatsuch impmvemenu art notmunded aroQcred for We. If,
however, Ne building or improvement is mid within orc year ofmmpletion, the manes.
Wilder will haw du burden of proving that he did not build or improve for Pon = of
sale.
1. u owner of the property, am exclusively conducting with licensed contructars re
a.. the project (Sec. 7044, Business and Profasima Code:) The Canrruur's U.
.
cove law does not apply in an owent of property who builds at improve themwn, rod.
who contracts for such projects with a comdattor(s) licensed personal m the Contrscmh
Lie.. Law.
❑ 1 are exempt under See. . B & P C far this maven
,at •..�,-ApIi✓: —DothaVLOY
f CHEF BNB&TSBM DECLARATION
I hereby crime under penalty of perjury, am of the fallowing declamations:
❑ 1 have and will maintain a Carditcam ofConunt in self -insure far Warkers Compton-
vtion, u provided for by Section 37M of the labor Code. for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Wanamr, as required by Smuan
3700 of the Labor Code, far the performance of the wont for which this permit is Word
'
My Wonters Compensation lvunme carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
Thlaucdv men mm he eomPleuU if the permit is forone hundred dolls (SIM)
K loss)
1 mmfY that in the performance of the wark for which this permit is issued. l shall nut
employ any person in any mannans tab beCe subKctto the Warkcrs Ca"'Ven
Lain of California. Data / /1 • v a
APPlinat—f
NOTICE TO APPLICANT: IL aMr making this Ccr iricaa of Exemption, you should
become subject m the Worker's Compensation provisions of Me labor Code, you mart
forthwith Comply with such Provisions an this Permit shall be accrued revalcod.
CONSTRUCTION LENDING AGENCY
I hereby affirm than dem is a examination lending agency forthe performance of
t a wont for which his permit Is Word (Sm. 3097, Civ. C.)
Lenders Name
Len&ex Address
1 certify that I have road this Vdicadon and sure Nat the show information Is
correct. I agree In comply with all city and county ordinances and auto laws relating to
building construction, and hereby authosiu represenudves of this city to enter upon Ne
above-mentioned property far inspection purP=L
(We) agree to use. indemnify and kap harmless the City of Calamine against
liabilities, judgment, costs no expenses which may in any way seems agalvt sold City
in eansegvnce of the Starting of this permit.
APPLICANT UNDE]ISTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date —y
SOURjREGUUA/IONS.
Re -roofs
Type of Roof
Signature of ApPlicanUCanData
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or (mus building ecmpmtuore ar handle haesrdaus material
as defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
de, I_]y.on 2553g(a)?
All roofs shall be inspected to being installed.
No
11
prior any roofing material
If a roof is installed without first obtaining an inspection,agree to remove
Will to applicant or fuldm building occupant use equipment or devices which
emit hmsrdnv air conuminanu a dcrad by the Bay Area Air Quality Mavgemem
.I
all new materials for inspection.
District? �/
❑Yea air
1 haw coed the haardoru mamdaismquimmcnu under Chaper6.95 of the Califor-
niaHcaiO&SafciyCoM,S=U=BMS.25533mdM534.1 undctsund dhnifdc building
does oat cutrenOY haw a ant. tits t is my maposcohnity, a notify Me compact of dte
reyulremc hent met mi an ohCenificeur(Occupancy. C
8
Signature of Applicant Date
ZD,a
All roof coverings to be Class "B" or better
ow
oreudhomedagctn