03110140 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACOR INFORMATIQN�
BUILDING ADDRESS: NAVICO, INC PERMITNc103110140
10954 STEVENS CANYON RD
R'S NAME: PERMIT ISSUE DATE
NE
BYRON NAVID (LOT 1) 20480 BLAUER DR. #A OrlIS12004
E; SANITARY NO. CONTROL NO.
(408) 741-0555
ARCHriEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
' 0 0 0 0
too LICENSED CONTRACTOR'SDECLARATION JobDescri [ion
mF 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
in3 with Sectors,7 "Division 3.1'ft Busiae.•and Pmfpssion Coda.md my license is
<aimm�mreaandeffea SFDWL-2 STORY (3336 SQ. FT. LIVING SPACE)
$'q_ Dom class Co...,— GARAGE 701 SQ FT. eee��� t� 66 ppp {q�g
€� Dass, ARCHITECTS DECLARATION ry—��/a ys �g
'�z< 1 undcraund my plan¢lull be used as public¢cord (g5g�� ttyppttp`�Vtl9 LHyr'�
�yU
,'�o� Licensed Profesti.nal
5OWNER-BUILDER DECLARATION
<F 1 hcrcny affirm Nut 1 am csempr from the.Contractor's Lianse Law far tW A O[] �,j(t L+
p O (allowing mvmn.(Section 7MI.5.Business and Proagorms Code:Any city of county A t� I)V
q tui which requires a permit to construct.altar,improra,donnish,or repair any stmetare
rzy poor In its issuance.also require the applicant rorsuch permit in file a signed mammal _
< that W ro
is licensed pursuant to in.prisnn of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area ®® V
eFs reF$ (commencing with Secti.a7000)of Division 3 of thc B.grucomd Professions Cods)or y �p
— dust he u exempt therefrom and the basis for the staged exemption.Any violation of 11 ♦♦]] 'l n
Section 7031.5 by any applicant for a permit subjects the mislicanuo a civil pcnaby of APN Number '"' Occupancy Type
ads...Nan fico hundred dollars(M), P Y YP
35601043 . 00
0 1,as owner of the property,or my employers withwages as their sole compensation,
will do fess s andthe he Carmine,
Lt. sow does
m, (Ser.]004,euunw
and profess as Code:The Conluctor's License Lew docs not apply td an owner.f Required Inspections
propenywh.Wild.mimprom thereon,andwhodocsauch work himself.,through his
own employees,provided that such improvements are not intended oraQered forsale,if.
hmverer.Ne building or improvement is sold within ane year of completion,the owner-
Wilder will have she burden of proving that he did not build or improce for purpose of
ulc.I.
IIyyt�tI s owner of IM pro ,•perem enclusucly contracting with licensed contractor to
4dtstruct the project(Sec.7044,Business and Pmfeuiou Code:)The Comoscmri Li.
cense law dos not apply to an owner of property who Wilds or improves thereon,and,
who contracts for such projects with a c.ntrdaons)licensed pursuant to the Contractor's
Licenc taw. ,
0 I.esnmin sad., .B&P C far this mason
vmer Date l2/lam
WORK MP ION DECLARAIYpJCy/
crebY affirm under penalty of perjury arc of the folloLing declanrions:
I nave and will maintain a Ceri fixe¢of Consent self-insure for Wora 's Compen.
union,as provided for by Section 3700 of Ire lama Code,for the performance of the
wok for which this permit"'a
s iuucd.
0 1 Wre and will maintain Wortrr's Compensation luurana,as refined by Section
J7oo o(she lab.,Code.far the performance of Ne work for which this permit is issued. ,
My Workeri Compensation Insuraatt artier and Policy number are:
Cameo Policy No.: v
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Iolasee on,tad norbecompleted ifthepermit is rine hundred dollars(51010
or less.)
1 certify that in the perfnrmanee of the work for which this forril is issued.I shat]not
employ any person in my manner an as to become subject to the Workeri Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making Nu Ccndiialc of Exemption.you should
become mbjax to the Worker's Comimunsonn provisions of in.labor Code,you most
Oz forthwith comply with such provisions or this permit shall be deemed revoked.
z�i CONSTRUCTION LENDING AGENCY
r+ Ihereby affirm Nal Vert is a construction lending agency for the performuce of
C' thc work fur which this permit is[..ad(Ser.3097,Civ.C.)
D.Q landcr'w Nnnc
a z Leader's Addm_ss
L)0 1 canify that 1 have mad this application and same than Inc mm,c information is
U.f-' castle.1 agree in comply with all city and county on inures and suss,laws heating in
0 U building construction.and hereby euthorme mpmsentatim of this city to toter upon But
r W above-menumod!property for iupecuon purposes
F0. (We)agree f0 saran indemnify and keep harmless one City of Cupertino against ( /
' fA liabilities,judgment,cows and mc.which may in any wayaccruc against said City
U z in consequence of the grand Of amnia permit. Issued bY: Da
APPLICANT UNDE TANDS AND WILL OMPLY WITH ALL NON-POI
SOU REGULATI
x
If Re-roofs
gnmum.(ApplicanV ontraclor D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thc applicut of future Wilding occupant arum o haodlc haufdou material
u dcfin.d by tiro Cupenim Municipal Code,Chapter 9.12,and the Health and Safety
ale.Section 25532(¢)? All roofs shall be inspected prior to an roofing material beim
❑Yea tan. P P Y g g installed.
Will the applicant or fumm building..,at use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hametious air comaminant as defined by'he Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ,.
1 haw marl thc hmaNmu mareualsrequiremens under Chapter 195 of thc Califon
ria Health&Safcsy Cade,Section 35N)5.25533 and 25534.1 undcrsund thnifthe Wilding
dors not currently ¢nam,Nal iI is my ponihiiisy to notify thc occupant or he
requirements which mug to tpdrmias a.racertigatc.raapan`. Signature of Applicant Date
Qwnermaaubaoitcdagcm Qa t All roof coverings to be Class "B"or better