06040137 CITY OF CUPERTINO
BUILDING DIVISIONPEffibIIT > C®1NTRA 7TOw NF�URMATI�6N r
BUILDING ADDRESS: DOUGLAS SMITH PERMIT"°'06040137
10590 S TANTAU AVE
ER's NAME: PERMIT ISSUE DATE
DOUGLAS SMITH 06/14/2006
PHONE: SANITARY NO. CONTROL N0.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EO PLO O
:Go LICENSED CONTRACTOR'S DECLARATION lob Description
Idi bereby alarm that 1 am licensed under Provisions of Chapter 9(commencing
with SSWnld dfnserten.D)viaan So(NO Bushmen tafrmed
b Prours Code,amylkensels
n full rorty and SFDWL-2 STORY 1, 964 ' /GARAGE 441 ' /REMODEL 850 '
e
;qz Uanscclau Om
Dam Contractor SANITARY IS SUNNYVALE ' S JURISDICTION
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DW ARCHITECTS DECLARATION REMODEL850 ' X 100 . 75 = 85 , 637 . 50
if 7t I understand my plans shall he used as public)oaths
JyU
g G� Licensed Professional
OWNER-BUILDER fr m Ce Conu ON
a� 1 herchy.(Sere that 11. exempta the Contractors License Law far dm
i p o whichfollowre reason.permit
(Section 703 1.3,Business,Aef, and vs.4 Prolusions,Cade:Any oily or county
$ which)egoista a psmit re cores t.aha.vnpmve,demdlah,or e a sig any tWment
'^
prior Wisl lensed p,akumgo the dm applicant for Cela permit to Liu,dsmemeor
-?" " (Chaptar9 S Ft. F1oorArea Valuation
x<
that cconsed porstanl to the 00)of Division
of the Business and
Isco q.
yF$ (cammemingwithhmfrom and
bull
of We al Bedcasopt PmfMYvi Cade)of $531523
Nn he o asteroid b lanmrrom and Ne aper far the dk{ed raemant W Any violation of
mutton 7dum five
urn red dent for a permit subjects the appikam o a dull penalty of APN Number Occupancy Type
not mom Nan 8w hundred do1Wa(5308),
0 1,as owner of the property,a my employees with wages as their sok eompenudan,
will do the work,and the summers Y nut intended or offered for sda(Sce.70/a,Business Required Inspections
and Pmfestlans Code The Connector,License Law does Out apply o an owner of 9 P
property who builds orimmove.thercon,and who fin slochwafthimself or though his
Own emplayen,provided Ihatauch improvements am notimended oraRered fa We,If.
however,Ne Wilding or improvemant Is sold within one year of completion.the owner,
builder will have the burden of previny Wt he did out Wim or Improve for purpose of
sale.).
0 1,as ownner of the property,am exclusively commaing with Reensed conuacoo m
cmlstnmt Ne project(Sec.7044.Businm and Pro(ado s Code:)The Commences U•
come Law does am apply an an owns of Property who Wim.or improves thereon.and,
who commis for such pmjccu with a contranor(U licensed punuanl as the Contractors
License Law.
❑lam nem Iunder See B&PCfa this
r �L\�.Dale g0
ant
COMPENSATION DECLARATION
qr I hereby affil under penalty of perjury note of the fallowing declarations:
❑I have and will maintain aCenifiwteor Consentm self-Insure far Workees Compere
sedan,as Provided fat by Section 37W of the Labor Cade.for the perfomase of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance,u required by Section .
3700 of the Labor Cade.for the Performance of the wok for which this Permit is lamd.
My Worker.Compensation Insures,moria and Policy number ars:
Cartier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
clbls seadw need net x completed if see permlt Is(°one boosted defies($100)
or Imo) '
1 wnify Not in the mr.m.nee of due work for which this permit is iuued.I shill not
employ any person in any reanrmrsP �dmR ci mthe Workers'Compensation
Law a of Califamia.Dames
Applicant A1 -
NOTICE
O APPLIC TL after making Nb CcniRom of Exemption,you should
became subject to the Workers Compensation pmvlaiom of the LAW Cade,you muse
0 O forthwith comply with such Providers o Nu Permit shall be deemed revoked.
�'tiCONSTRUCTION LENDING AGENCY
Fr Ihereby&Rrm that them is a construction lending agency fen the performance of
[C,> the work for which this permit Is issued(Sec.3097,CN,C.)
W� Q Lsndeh Name
]z Lenders Add=
C)Q I unify that I have read this application and sun that the above Infomadam Is
D.f" carect.I agree m comply with all city and county ordinances and auto laws mlating o
O V buildingconswction,andherebyauthorimrepresentativesorthiscitytoenterupondu
>0. above-mentioned property for inspection purposes.
(We)agree to save,indemnity and keep harmleu the City of Cupertino against
t�r/1 liabilidas,judgments,calls and expenses which may in any way amuse 811de tsaid City
V z in cosvegnence of due grunting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU TION
� /%/ Re-roofs
7S 1.t;.of plianUCommcmr Date Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future Wilding asupentsmse or handle hazardous aus mat
ad"caned by tine Cupeni MuMcipal Cade.Chapter 9.12.antl the Bashi,and Safetyc,Schon 25333(.)? All roofs shall be inspected prior to any roofing material being installed.
DYn Nu
If a roof is installed without first obtaining an inspection,l agree to remove
Will the applicant or future building occupant use equipment or dcvlces which
emit ha»rdnn dr contaminants an defined by the Bay Ama Air Qudity Management all new materials for inspection.
District?
DYn Sg No
1 have mad the haaNws materials nequimrnenu muter Chapter 6.95 of theCdilm-
at,Health&Safety Code.Sections 253o5,25533 and 25534.1 undersand thatlfthe Wilding
does not currently have a serer,dual It k my Ra sonability o achy drs occupant of the
mgaimppmtswnkyyanbe armiateanecar.cann.mar�mjpan� Signature of Applicant Date
v All roof coverings to be Class "B"or better
°comer or auttlisfind Agent Dao