06030152 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOWINFORMATIO
BUILDING ADDRESS: PERMIT NU-06030152
19900 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
SCANDINAVIAN DESIGN 04/10/2006
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
to, LICENSED CONTRACTOR'S DECLARATION IObDCSCTI IIOn
;-0l
.I Mo ,affirm Net I am licensed under provisions of Chapter 9(commencing p
Uwith section 7000)af Division 3 of the,Business and Profcsstoor Code,and my license Is
in full force and cffecu-
z Leg , li e�/'/ BATHROOM UPGADE
j E2i Licctuc Chis
t;oDam camrazar a,E' CONTRACTOR: PACIFIC CREST CONST PD FOR BL 3/27
ca ARCHITECTS DECLARATION
m I undostand my plans shall M used as public necords
yyV
e G y Lkenud Professional
7 5
OWNER-BUILDER DECLARATION
2 i F I hereby.17vm that I am exempt fromm the contractor'sLicense Law far We
a O following m,.^n.(Section 711313.Business and Pmfcnslum Codc:Any city m County
5: which requires a permit to construct.alter,improve,demolish.or repair any someone
one
prior wits issuance,also require,the applicant for such permit o file aligned statement p
< Nat he is licensed pursuant to the provisions of the Contractor's license Law(Chaper 9 Sq.Ft. Floor Area Valusibs 000
gF2 (commencing with Seaton 7")of Division 3 of the Business and Professions Once,
or
y that he u emmpt therefrom and W e basis for the alleged eumptim Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant m a Civil penalty of3 AI3N NjI fler 0 0 Occupancy Type
not mom than fns hundred dollars($500). �j 9D rj U.5 8
L asmwrari fthe Wesrrty,or Is airomov withwaguee their tele compensation,
and pr Newark and We he C..ture u me.Lkdcd oroRe do d;fic.1 a(Sec.I Ole,Business
and Profession Cade:The Comrxmr'a and
law does oro apply m an nough as Required Inspections
property,who Wilds or ed Waves therm.,and wM ares such work himself al Nrosgh has
own
ever.W Wilding
Net melt improvementsItmidwithin
not mar ofdmpictin.far sale.If.
however.We buildingb r improvement u sold within oro Weld of completion,the ower- /
builder will have the When of proving Nat he did rat build w improve for purpose of
ole.). J /
❑1,as owner of We property.am=elusively contracting with licensed contractors to Y
w=est Wed project(Sec.tit in weer of andprofessionsCalle:)prmWenon.U.
cove Taw dors not apply je an owner of proprny who dtiW or improves Wurmn,and. �
who contracts for such projects with a contracmgs7licenua pursuant to the Canuutor's
License Law.
n
1 am ezempt undo Sec .B&P C for Nis reason
It Dau
WORKERS COMPENSATION DECLARATION
I hereby union under penalty of perjury ane of the following decimations:
1 have and will maintain section
37M of Conlan r self-inure fm Woorma Camp m- h1!
wore f r provided for mi Section 7]00 of the Labor Code.far Wse peAormance Of The
work far which this permit is issued. a E
0 1 have and will maintain Worker's Compensation Insurance,v required by Succum v A
3700 ofthc Labor Code,for We performs....1m.work for which Nin permit is issued.
My Warker'a lCo_mpIcw� lion Ltsuramx arriesand Policy number art:
Cartier. SACC/ � policy No.:
� 'Cr'
CERTI MON'FROM WO ERs'
COMPENSATION INSURANCE
(Dussedion need not he completed if Its,permit is furan hundred dollar(SIM) W
or leu)
1 ceNfy that m to performance of We work for which this permit is issued.l"l not
employ any permn in my mamnerm as to become subject to the Workers Compersatim
Laws of califumia-Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you Would
become subject or We Worker's Compewaon provisions of the labor Cade,you an"
,,- O forthwith comply with such provisions or Nis permit shall he dccmed molted.
z CONSTRUCTION LENDING AGENCY
[-v 4 Ikmby affirm Nat Were,Is a construction lending agency,for the performance of
C 9 the work for which this permit is Leased(Sec.3097,Civ,C.)
GA Lender's Name
.7 z Lender's Address
U C) I certify Net 1 have mad this application and state Nat the above information is
!L Correct 1 agree to comply with all city and County on i.ances and state laws misting to
�U Wilding emuwnion,arta hembyauthofim rprsc.mi.of this city to enter upmo We
H 0. above mentioned property for inspection purposes.
(We)as.t.save,inacmnify and keep lu mtieu Out City of Cupcnirm against
fn liabilities,judgmcnu.cvts and expenses which may in my way ascan agaiccamid City
UZ ineonuquenccofWegssntingofthis permit. C/_/6—v G
APPLICANT UNDERSTANDS AND WILLCE R y;OMPLY WITH ALL NON-POINT Issued by:MDate
SOURU /
Re-roofs —�
Sigwurc of Appli..nWCrntracmr /Dau
HAZARDOUS TER DISCLOSURE Type of Roof
Will tic applicant or rums building occupmt score or handle hzvardov material
as defied by The Cupertino Municipal Code.Chapter 9.12,and the Health and safety
.Section 255324)+ All roofs shall be inspected nor to an roofing material being installed.�
If a roof is installed without first obtainingan inspection,I ree to remove
Will the applkant or future Wilding occupant tau equipment or devices which agree
emit hasardov air contaminants as defined by the Bay Area Air Quality Management
D smC17 all new materials for inspection.
❑Yes 2N. .
I have real We hvardwsmaurials requiremems under Ch iner6.95oftheCalifor-
niaHvlNBSafdyCadc.Sectims25505.25533and25534.Imacrund Naz Rue building
dose not currently haste a Mount,that it is my respmeihility,to notify We,occupmt of the
reyuimmcnts which Le mtt pdarwi f mtifi..te of Occupmq.
Signature of Applicant Dale
Owner oratrNarbedagent m All roof coverings to be Class"B"or better