05050048 CITY OF CUPERTINO
BUILDING DIVISION PERMIT -iCONTRAGTQR INFORMATION s<
BUILDING ADDRESS: JOHN & JULIE DUNNING PERMIT NO.05050048
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY o. OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ION
in
LICENSEDCONTRACTOR'S
underSDECLs of Chap Job Description
1 hereby affirm Nal i em licensed under provisions of Chapter 9(commencing p
zwith Section 7")of Division 3 of the Businessand Prufessioe Code.and my license it
^=C.
„ in fail mmreamd effect
nyj� License Class Lie« ENCLOSE PATIO /REMODEL KITCHE &
0.9 ARCHITECTS DECLData Ca.DECL ARATION REPLACE SLIDING DOOR/REPIPE
ceU 1 understand my plans shall k used u public records
3 C G Licensed Professional
3 OWNER-BUILDER DECLARATION
<� 1 krethy alrrm Nal I am exempt from the Cmum m's License law for the
0O following mason.(Section 7031.5,Business and Professions Code:Any city or county
g�i which requires a Permit to construct,alter.improve.demolish.or mmir any suucwm
prior m its issuance,also requires the applicant for such permit to rile a signed smemcre
FiG Nat he is licensed pursuant to the provisions of the Connector's Uceom law(Chapmr 9 Sq.FL Floor'Area Valu
BlgOf1000
fat-$ (commencing with Section 7000)of Division 3 of the Business and Professions Cadc)or 4 /,
— Nat k Is=mpl dmrefrom and the thou for the alleged exemption.My violation of
Section 7031.5 by anyapplicant far a Permit subjects On applicant to a civil penalty of AFN Number OGGIISDC
not mom than five hurdmd dollars(55007. Occupancy Type
C1 1,a owner of the propery,or my employees with wages u their sok compensation, 32646020 . 00
will do the work,and the structure is not intended oroRemd fmmle(Sec.7044,Business
and Profession Cade:The Cwmcwrs License law doe at apply w an owner of Required Inspections
Property who buildscrimprowa thereon,and who dmsauch work himself or through his
own employees,provided Nat such improvements are nal inanded aro@red for sok.IL
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving Nat he did not build a improve for purpose of
whet.).
0 I,as owner of the property,am elusively contracting with licensed ronuumrs he
convect the pmject(Sec.7(744,Business and Pmfalsions Code:)The Convector's Lt.
Cense Law docs not apply to an owner of property who Wilds or improves themon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's /O
7
0 /
Law.
l-.am camp_ Iundee Sec. Bk PCfor thisa. ta)5 J
WORKER'S COMPENSAMON DECLARATION41
1 hereby affirm under penally of perjury oil of the following declarations:
0 I thaw and will maintain a Cerifica c of Continuo ulf-insum for Wowl'sCompcn-
sation,a provided for by Secdan 37M of the lakr Code,for the perfarmmee of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation leurancc,as required by Section
37W of the Labor Code,for the perfarmaace of the work fm which Nu permit is issued.
My Wokces Compensation Insurance,artier and Policy number are
Carries Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusection need not W complewd if the permit Is for one hundred dollars(1100)
artl ss.)
I certify Nm in the performance of the work for which Nis Permit is issued,I shall not
emPloyany perm.in mym nc take embjeclmtheWorkeri Comlmnsation
Lawsof 'for a,Da _.= �
APPlica
NOTICE APPLICANT:If,afar making CenlOca a of Exemption,you should
become so jot to the Worker's Compensation previsions of the lahmr Code,you mum
0 z fmMwith comply with such Provisions or this permit shall helamed mmked.
Z0
CONS IMUCfION LENDING AGENCY
[—� I kmhy affirm Nal them is a consuuctinn lending agency for the performance of
FL Ne work for which this permit is issued(Sec.3097,Civ.C.)
QLenders Name
z Lender's Address
J Q I certify Nat 1 have mad this application and state Nat the ahow information u
F' cosset I ague he comply with all city and county ordinances and sus laws relating to
0U building construction.and hereby authariu mpctewil vri of Nis city to enter upon the J��rr�[ ,/1fy(/�' //
r W akve-mentionW property for iapetvon purposes
(We)-grace w save,indemnify and keep harmless the City or Cupertino against
H Z incoisequedg of
caning ofpmssewhich may in any way aamc egaiat aid City
(J,'L in consequence of Ne graining of Nis Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCEREGUL OATI NS.
Aj -s_ .LE-w-^ 5-1 af'�o� Re-roofs
St�g.win of ApplicantrConuacmr Data
V HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant mom or handle Woo does material
a defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
code.
Ely. f1�
1ss3Na 1(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yu
Will Ne applicant or future building oceapam ase eq.ipmant or devise which' If a roof is installed without first obtaining an inspection,I agree to remove
emit hanardous airecalmuna.0 a defined by the Bay Am.Air Quality Management all new materials for inspection.
Dimict7
0 Yca IVINu
1 haw read the hansdaus materials mwimmenu under Chapter 6.95 of the Califor-
niaHealth h Safety Cads,&Co.25N75,15533 and 25534.1 understand Na if the building
does not currently have 4lemeat-Nml It Is my Mspernamlly b nadfy Ne O,apart Of Ne,
"uiermasumichumbemetpdorwiaummofa Cenricamoroccupancy. Signature of Applicant Date
ow roraathori.mset, -05- All roof coverings to be Class"B"or better