06040107 CITY OF CUPERTINO Pq '""q!T� RVt OzMTIO`N
BUILDING DIVISION PERMITO ,°t''• -
JBUILDINGADORESS: CH G XING CONSTRUCTION I MITNo06040107
945 TILSON AVE
R'S NAME: PERMIT LSSUEDATE
NAM OH 1837 HOLLYVIEW DR 07/11 /2006
PHONE: SANITARY NO. CONTROL NO.
(925) 736-8889
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION ,lob Description
IC 1 hereby of ion that 1 am licensed modo'Pmvisiau of Chapter 9(commencing
to with Section 7000)of Division 3 of the Identical and Professions Code,and my license is
'oy infull to..andeffect. DEMO FOR NEW HOUSE CONSTRUCTION
j,va? License Class _Lic.N
t F p Dow Contrumr
ARCHITECTS DECLARATION
I¢ I understand my plans shall be used as public recorm
pyU
G Licensed Professional
g 5 OWNER-BUILDER DECORATION
2'a I 1 htmhy affirm that I am exempt form the Contrumes License Law far Ibo
a O following moon.(Section 703 1.5.Business and Profeaiom Code:Any city or county
$ which requires a permit to consumer,alter.improve,demolish.Or mmi,any immune
u $8000
umi prior to its issuance.alae reforms the applicant for such Permit to file a signed sentiment
< that be is decried pursuant o the provision of the Contractor's hectic law(Chapmr 9 Sq.FC Floor Area Valuation
r'1- (commencing with Section 700(7 M Division 3 of the eusiwss and Profession Conde)or
i $ that k is exempt mertlmm and the:base for he allcgccl exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of er u u Occupancy Type
not mart than five hundred dallus(5500).
❑I.uownw of Um proprrty,wmy wploycu with waguuhev seleeompenutian,
will do the wart.and tate svumum is notinmMcd oroffered forsam(Sm.70aa,Busixsa Required Inspections
and Profession Cade:The Committees License Law does not apply in
an owner of q P
Property who bui Ids or improves thereon,and who does such work hinilf or through his
Own cmployces,provided that such improvements are not intended oroffened fowler If,
however.the building or improvement is sold within an year of eempledon,the owner.
builder will have the Wnbin of proving that k did not Wild or improve for pulp.of
sate.).
0 I.as miner of the property,am uelissively,conmiming widt licensed contractors to C
contract the project apply
in an Owner
and Profession Code:)The Cwancwh V
come law does not jean with
a of property who Wildsp or improves thereon,and.
who contracts for such projects;with a contractor(s)licensed pursuant to the Canuactoes Q�
License Law. /
I am exempt undo See .B&PCfw Nis reason
Data
WORKER'S COMPENSATION DECORATION TT
I hereby affirm under Penalty of perjury one of the fallowing dalmatian: V�
0 I him and will maintain a Certificate of Corium to self-insure for Worker's Compen-
sation,a provided for by Sation 3700 of the Labor Code,for the pwformana of the
work for which this permit is issued.
0 1 have and will maintain Worker's Competition Inwmism.as rtyumcd by Section
3700 of the labor Cade,for the performance of the worir for which mu permit is issued. '
My Worker's Com don Imuran cortico and Policy number are:
Carrier. Polity No.:
CERTIFCATE OF XEMPRON FROM WORKERS'
COMPENSATION INSURANCE
(ITU uc0on Otto ambecomplemd Blow permit is(wane hundred dollars($100)
or less.)
1 conify met in the perfurmance of the woh for which this permit is issatd,I shall Out
employ any person in any manrcrso u in become subject to the Workers'Compenssdmn
Laws of c lifomia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ctniftcam of Exemption,you should
become subject in the Worker's Compcnsetion provision of the labor Code,you mail
.,Z faMwide comply with such provision or this permit shall k clamed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-. I hereby affirm that here is a construction binding agency,for the Performance or
a the woh for which this Permit is issued(Sec.X97,Co.C)
CQ Iandcrs Name
] Z Lenders Address
V Q 1 ttairy mat I have read this application and state that me above information is
f'^ torted.1 agree to comply with all city and county ordinances and sum laws relating in
�O building construction,and hereby authorize mpmsentatimster this city in enter upon tk
[t7 above mentioned property for inspection Purposes.
gy (We)agree h save,indtmni fy and keep harmless the City or Cupertino against
o-F-t rA li ilities,Judgmenta.cosu and upwnwhich may in any way accrue against said City'
V Z i m ooluxurs of the granting of mu permit
L UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
0 REGULATI S. .-
C)4— Re-roofs
ngnarurt of App' H uactaUS MATERIALS DISCLOSURE Dam Type of Roof
will the applicant or forum building aauputsmrc w handle harardoos material
cfiined by Ya me Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
.Sermon 25532(a)" All roofs shall be inspected prior to any roofing material being installed.
� �'o
Will thea applicant orfutur building occtr ant use, If a roof is installed without first obtainingan inspection,I agree to remove
pp g P equipmentor Maria which P g
tour hazardous sus oir contaminants u defined by Ile Bay Arca Air Quality Management all new materials for inspection.
District?
oYa
I eve mad the hznmon materials mquirtmcns umbo Chapter 6.95ofthcCalifor-
iaHc &SoletyCOde.Sections 25N)5.25533 and 2553.l understand than dux,Wilding
does .,01aly have•tenant that it u my responsibility ser nudity du occupant of the
myui swhich moo mel priorm issuance ata Ccnificim of Ottupartry.
eb Signature of Applicant Date
o amarfzed as a Dam All roof coverings to be Class "B"or better