00090006 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURr:55;
rERNIT NO.
L�xTe/Lld2 SaLV71akJ51/Nc
OWNERSNAM1.1,9988 TWIL APPLICA1'ION s +D'l l:
177-/ ie'Tl7 A✓e
'HONE: JUDY HOGAN SANn9RY No.09" ' . ,, • ..
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D�'/. AHCHITECr/F.NGINI!EH:
BUILDING I'ER5111'INFO
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�.35?— /2- 33 �.,,�H MEGA
yy 1.ICENbEDCONTRAOnder p DECLARATION
o5�'-0 (connownwing
JobDescripti It
with Semon a mad of Division none dn.meax and Pmresamns cede,arta my license
ea y.a ix in full force and cffec o
W
6 License Class
Xas Date /n cornraetor # NO CONDITIONS *.
AHC hee r'S DECLA N
C 1 undcrsl:uul my plans sball husul us pu a recareL
O�O ij,-,rd Imre Donal -
a E o OWNER'BUILDER PECLAHATION
❑M 1 hereby alliin that 1 am exempt from the Contractor's License law for the
F a fallowing rea m.(Section 7031.5.Business and Professions Cede:Any city or county
E x p which requires a pemtit Rs consumer,alter,improve,demolish,or repair any structure
a5� prio to Permit us requires the applicein rile such Peit to file a signed.qutement
that he is licensed pursuant o the pmvisines of the Contractors License Low(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Prnfewinrvs Cede)
or that he is exempt Iheretinrn and the hois lite Ibe alleged exemptionAny violation
ill Seedmt 7031.5 ny any appheunt nor n perm(amJC[la the upplicanl m a alvd pnnalry
of lett nnme noon five lmanrcd dollar,t$500). APN Number Occupan I
- ❑l.as nwnernflhc pro,sor)rmy employees with wagesas their sole compmsutinn.
will do the work,and the smamum is not intended or offered her,ale Nev.76W.
Business and Pot Co c:The Comeactor's License law dues nut apply lo an 31631 7R(.q red Inspections
total of property Who Mmilds or improve themon,and who does such work himself
or through his own employees,provided that such improvements am net intended or
offered to,safe.If.owscvvr,In.milding or bnprovement is sold within one year or 305 — FRAME
completion,Ne owncrbuilder,will have the banlen ol'Inoving rho be did not build fir
inn fornmposeofsale,,, 307 — INSULATION
C1.a,(ovner nnhepl,sny.am exclusively coutraeting with licensed cammelm.to 601. — ROOF TEAR OFF lip/
worm i one project(See.7(W4,Lustre.,anio
:led Prafens Cexlc:)9'he Contractor's
License Law Jews not apply to an owner of pmpeny who builds or improves thereon, 602 — ROOF PI_YI400D NAIL 0
and who contracts far such projects with a eontmchm s)licensed pursuant to the
commerce, ac
O
lJme law. 603 — ROOF BATTENS
❑1 am exempt under Scc. .B k P C for this.,on
Qwmr Dare
604 — ROOF IN—PROGRESS
• WORKER COMI'ENSA'1'IUN UIiCLARAr10N
I hereby utf inn under penalty of perjury one or the following dedemtims:
t I have and will maintain a Certificate of Consent to self-ileum Pur Worker's
nnpen,a', r. as provided for by Sermon 3741 of the labor Code. for the
perrntmanec of the wmk fur which 1M1is permit is issued. _
X1 have and will nwintain Worker's Compensation Insurance,as requord by Seetion
3 )ofthe Labor Codc,for the perfonnanee of the work for whlclnlhis permit is
mted My WeMer's t p taallao lnmrance GI ler u d Policy number ti r
n eitfcaN/S�'Pico W77r i`
Garner: C�R'IIFICA 110 r ex PM rr10NpROb1 W( �KE
Ny�T/
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars
($100).1 le".) -
1 coni ly that In the pdnnrmuce of the wurk for whhb this permit Is issm l'1 -
ahll pl ty. p y nn 'I ' rte wn,les w s
y cr
Carp I I W/niC 11 } � 1
nppl e I /l/
N U11CF TO [CAN If. fl 'tong I C n i m of Exentpr a you should
hese one. 1m1hesi ke .0 pcvt p f the Labor Ce de you most
p fnnhwn comply with such pnni.aom or this perm small M deemed rtvnkcJ.
Z y CONSTRUCTION LENDING AGENCY
1 hereby nitimt that there is a comtmetion lending agency for the peril omtance
W of the work It,whim this senna is issued(See.3147,Cie C.)
C. Q Lundeo,Nmnc
7 I,onder's Add,.,
V 0 1 certify that 1 have read this application find state ohm the solve'mfarnmtion is
lis. P cones,1 agree to comply with all city tied emmy ordinarl and state laws relating
C) U m building comtrtmnion,and hereby national,expresntatires of this city m enter upon
the abase-mentioned property far impaction Purposes.
(We)agree,it)save.indemnify and keep harmless the City of C-Isalmo against
V) liabilities,judgments,costs and expenses which may in any way acetal again,said �DO
V y City in cnmpluence'eel the granting of lot panni, `
APPLICANT UNDERSTANDS ANU WILL COMPLY WITH ALL NON-POINT ISllledb -1ZJ Date
SOURCE REGULATIONS. y'
Signature ofnpNicam/Comeactio Will Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will tete aIndication,boom building o eapant slower handle hvandot s material Type of of
us defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?0Yca CNo All Too s shall be inspected prior to any roofing material being installed.
Will Its appleaul or "for,mrddlngvelapmm uw,cyni,mmfolor devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit huumduus an con,aminunrs uv defined by the Bay Area Air Quality Management
inert+ all new materials for inspection. Applicant understands and will comply with
oyes C1No all no -p int source regulatjonS.
t I have read he hmo materials tequiremcrm under Chapter 695 or the
Cal'dorom Health St Safety Cede.Sections 25505.25533 and 25534.1 umkmmnd that _ -
iff, uild' drum..a,,anenI navaa man not Ilam re>p,nsinihtyfonndry the - 9 I
ecupa d e reyuiretnem.w(ice t n _t r ce of a ceof t r
Oce arc
p ' mature of Applicant Dat
,raeanllterri.edasern + `-,„ All roof coverings to be Class"B" or better