06040095 CITY OF CUPERTINO ad 'awn,�
BUILDING DIVISION PERMIT Y ][RACTQR'W,0 MA.TION +;
. —� .N`
BUILDING ADDRESS: ROCKWOOD CONSTRUCTION COR PERMRN0.06040095
10313 TONITA WY
ER'S NAME: PERMIT ISSUE DATE
BALARAN 14583 BIG BASIN
PITONE:
SANITARY NO. CONTROL NO.
(408) 868-9026
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MEC"
o t� M 0
:pp LICENSED CONTRACTOR'S DECLARATION Job Description
w I hereby affirm that I am liceeed under provisions of CWpwr 9(Commencing
:Z with Scction1000)of Divhmm SofdmlhonessaM Aofcuions Code,arW mylkenwu
<a imfullforetandeffm / REVISION-STRUCTURAL .CEILING JOIST AT FAMILY RM
j,Oy? Liceec Class Lie., F��S'6A4
�o Dam o Conrwwr ADD PIER FOUNDATION-ORIG PERMIT #05110109
A Hr IECTSDECLARADON NO NEW PERMIT-IN HOUSE
1 z I understand my plana shall he used as public homes
>yU
G Licensed Pmfcuianel
3 OWNER-BUILDER DECLARATION
aC 1 Wrathy O,aw .(Trete that 1 utmpt from Uro fessioacwh License Law for the
p O fallowing tcasan.Permian 7031.5.Bminus and improve,
Professions,Code:Any city or county ,
3_ which mquirca a Permit w cmnsWCL alwr,improve,demolish,or lepair any swcrule
_Zv, ph.,to its issuahee.owciiuima Ncapplicant riewth perailw file.signed statement
EEC
that he is licensed purwant to the provisions of Nm
e Comcteri ..Law Sq.Ft.Floor Area Valuation
e�0 (commencing with Section 700())of Division 3 of the Business and Profession.Code)or GAO
y Nat hu exempt mpt thrsem and the basis far t e alleged evemptim.Any vio $
lation of
Section 1031.5 by any applicant for a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not mole Nan pros handled dallan(SSW).
❑I,uowher of 0m propmy,mmy emplayeas with wagssu the'v role mmpewdon, 00
will do Newark rodtdesauctumunotinmnded oroRemd forsale(Scc.10f4,Business Raired Ins actions
and professions Cade:The Commences License Law data not apply w e an owner of q P
property who buildsorimpmoss thereon,and wW doessuch wort himadfmthrough his
own empaoyce t.provided Nat web improvements are not intended waf(eted rarsale If.
however,Ne building or improvement is wait within am yea of compkdon,the owner. ,y
builder
N
will bane Wrden of proving that he did mm build or improve froryow puof C' \
sale.). <
D L as a mer of the D i'll,are exclusively concocting with 1lseeed mnvacwrs w
construct Med pmjcn apply
t0 n Boniness and industriousWi code:)The Contractor's Li- \�
come taw tloe not apply w an owner of progeny who seills or improve Norton,and,
who.Lace for such yojeets with a eanawwr(s)licensed pursuant in Ne Cantrruh
Lieslaw.
XI am uempt under etc .B$PC for Nis moon
IN, Data
WORKERS COMPENSATION DECLARATION
1 hemby&firm under pcnslty of perjury rme of the following decleadiom:
sa Ihsm and ids for
3inw of the Labor sette,fortfe pufferfaComf the
union,r provided fpe mi es own 31W of the Labor Code.far the peRarmenm of the
walk for which this permit is iasund.
D I ban and will maintain Warkeh Compensation Insurance,as leyuired by Section
3100of tW tabor Chile far Nepofamance ofthe work for which this permit is issmd. '
My Worker's Compewdon haw carr ion and Policy number we:
Cartier, PLYG.h9/ Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section heed Out becumplemd it do permit tsfearc hundmddoBas($100) a
I certify tMr in Ne perfomtanee of IW work for which this permit is issued.1 shell not
employ any person in any manherw as in became wbienP the Workcri Compensation
Laws of California.Dam C —�/�F'
Applicant �l
NOTICE TO AP CANT:IL aMr disi this CeniGam of Exemption,you should
haeome subjcn m Ne Worker's Compensation provisions of Ne Iatur Cade,you most
.J O foMwith comply with Rich provisions or Nu panni,shall be deemed revoked.
z''-" CONSTRUCTION LENDING AGENCY
y
(—� IWr by which
Nu deemuoconswc.307.Ch, agency for Nc perfermwxof
ai 1 Ne work fur which Nu permit u issued(Sec.Jo91,Civ.C.)
6W. Lender's Name
z Iembas Address
V Q I certify that 1 have mad Ws applkatian and ram Na the oho u iNamnation Is
corm 1 agree in comply with all city and county ordinances and state laws minting to
V building construction.and hemby mohorim rtpresenmives or this city to enter upon the
W above mentioned progeny for inspection purport&
6.
(We)agree to arcs indemnify and keep harmless an,w City w Cupertino against
r Z i.careacquucarifts,glon" expenses Which may in My way acrnwagaimtsaid City
V z m APPLICANT
ofIW jmntin of NupnmiL
^ APPLICANT UNDERST De AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -ZNUC
SOURCE REGULATI
4- 2_X_& Re-roofs
icon Offliancr
S19AMUM of Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc appli wat or forum Wilding occupant ewre or handle ha an dons material
as declined by the C.Ni inn Municipal Code.Charlie,9.11,and the Health and Wety
.Sacdes 25s3z(a)1 All roofs shall be inspected nor to an roofing material beim
r]Yes Q�Na p P Y g g installed.
Will the applicant or future Wildingaccapon Ow equipment ordcvi=which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanalous air contaminants an defined by Ne Bay Area Air Quality Management all new materials for inspection.
Diwicll
DYes WU
I have war'the hicaAous numri thaws immense to de,Chapm,6.95 of Ne Califor-
niaHcalN&SafrtyCo ,Sections15505.15533aW15534.1un&n dthuifdm Wilding
doe tet curtenJy h sic au Nat it u my respawhility w mufy Nc oszupant of Nc
requircm me which no t car� w issuance ofaC - am of Ora anpry• Signature of Applicant Date
Owner or wthoris0 agent' y 6 All roof coverings to be Class "B"or better
perm'