08020008CITY OF CUPERTINOBUILDING
DIVISION PERMIT
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N 6.fli'J .S. Rte(' S
BIRLq�I�G-r�lgogmkEVENS
PERMIT
CREEK BLVD
BOB RUA
08020008
WNER'S NAME:
PERMIT ISSUE DATE
BOB RUA
1730 KINGLET CT
02/01/2008
HONE:
SANITARY NO. CONTROL NO,
ARCHI'IECTIENGINEER:
BUILDING PERMIT INFO
BLDG EO PLUMB MIECH
O
LICENSEDCONTRAC'(OR'S DECLARATION
Job Description
1 hereby affirm Nn 1 am licensed under provisions of Chapter 9 (commendng
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with Section 70018 of Dividon 3.17 dm Business end Professiau Code, and my liaise is
COMM' L DEMO
in full farce and effect.
License Class Lk.0
Dam Contractor
ARCHITECTS DECLARATION
1 understand my plana shall be used As public records
Licensed Profcsst... I
OWNER -BUILDER DECLARATION
1 hereby nRrm that 1 am exempt from fee CDnmtors License Law for We
fallowing mason. (Section 7113 1.5, Eastman and Professions Coit: Any city or county
which acquires a permit to construct. alter, improve, demolish, m repair any stnmmac
prior m its issuance, also acquires the applicant for such permit to fele a signed summcm
Nal he is licensed pursuant to to provisions of We Conmwtors License Law (Chapter 9
Sq. Ft.Floor Area Valuation
(commencing wife Section 7QX) of Division Sof the B usiness and Profussians Code)
h
S1 00
that he u exempt Werefrom and We basis for We alleged exemption. Any ululation of
section 70.11.5 by any Applicant far a permit subjects the applicant to a civil penalty of
yp�p Number
Occupancy
P Type
not muse Wan five hundred dafiars(SM.
35717039: tlll'
Y
❑ 1. As owner of We prop". or my employees with wages u Week Auk compensation,
will do Newark. and We swctum m not intended reoffered for We (Sm. 7)44, Business
and Profession, Cade: The C.muactora License Law does ant apply in an owner of
Required Inspections
property who builds m improves theater. and who does such work himself m W rough his
awn employes, provided that such improvements are not intended Wormed for We. If.
however, We building or improvement Is sold within au yur of completion. We mvner-
builder. will have We burden of proving that he did not Wild m improve for purpose of
wlc.I.
L As owner, Of tiee property am exclusively connecting with licensed con.actors to
construct fee project (Sec. 7044. Business and Profes,lons Code:) The Contractor, Li-
aise Law docs not apply to an owner of property who Wilds An improves Wesson, and,
who conuuu for such projects with aamrsmeric) licensed pursuant An the Connectors
License Law.
❑ I ons exempt unmade{[*\m C:( ��s✓/� Bk PCfm th action
nu Ct:5),, T'� Data C 0
WORKER'S COMPENSATION DECLARATION
1 hereby aRnn under penalty of perjury one of the following deeluaoor¢
❑ and will of C for W
worn,
Sudan,for by Section 37M e [.be, urs, far performance
provided far by Section 7700 of We 6bor Code, far Na perfomrana of the
of We
r
work for which Wih Permit is issued.
'
❑ I have and will maintain Warker's Compma tiara Insurance. As acquired by Section
37M of WO TAbm Costs, per We peRarmance of We work for which this permit is issued
'
My Workers Compensation Insurance claim and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7itle section reed antescam pleeed if the Permit is far one hundred dollars (S 100)
or less)
I certify Wel in the porfamuna of We work for which this permit is issued. i shall am
employ my Noun in any manner. An to Weoma subject to Ws Wmkcn' Compensation
Laws of California. Dem
Applicant \
nor
NOTICE TO APPLICANT. If, after making Wiseni0cam you should
become subject to the Workers Compensation provisions of We Ichor Cade. you most
10Mwid, comply with such pmvi,ions or this Permit shall W deemed mated.
CONSTRUCTION LENDING AGENCY
I hereby affirm that W.rt is a c.utroctinn lending agency for the performance of
the work for which this permit is issued (Sir. 3097, Civ. C.)
Lendeis Name
'
Lender, Address
I certify Wu 1 have road this application and sum Wu We above information i,
'
eareel. I as= m comply with all city and county aNlDamons and adds laws Risling to
building convection, and hereby wthmiw representatives of this city to enter upon We
shove-menduncd property for inspection purpmes
(We) agree to save, indemnify, and keep harmless the City of Cupertino against
liabilities, judgments. costs and expenses which may In ray my accrues against said City
in consequence of the Amusing of this permit.
APPLICANT U RSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by;9 Date -�-
SOURCE KEGUAIJONS
Re -roofs
Type of Roof
l
signuu lie ons or Dam
HAZARDOUS MATERIALS DISCLOSURE
Will Weapplicant ufuture Wilding Daupantstons or handle hawrd usmamrial
-_/-
u denned by the Cupertino Municipal Code, Chapter 9.12, and We Health sed Safety
edea Section 35537(s)? �.,✓
E2 Y. �°
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
.mit imeard.ns air conuminenu u ed by We Bay Area Air Quality Management
.I
all new materials for inspection.
District?
❑Yes Nu
Ihave ma NnwmmcuimmenuuChapurd.95orWe il
ASafet,C.d,StiuD5,255.1n NuiffeWilding
Wm occupant of Nnu
ulJoess nMcurrently emp,44nen4 that It u my mufamomMty to notify
requimmen vichm metpd.,toiaanata.f.C.Mf..,AMOTpstl .
Signature. A icant - Date
All roof coverings to be Class "B" or better
owre,.r Da -
eat ,gen