08070140 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAGTORIIV'EORMATION "
BUILDING ADDRESS: PERMIT NO.
20284 VISTA CT TBD - TO BE DETERMINED 08070140
R'S NAME: PERMIT Mn DATE
.;I1131:{S TRINE C 07/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHf1ECDFNGiNEER: 2 BTHRMS RMMDLE NO BLDG ELECT PLUMB MECH
ebeepo o LICENSED CONTRACTOR'S DECLARATION O O O O
'.�u I barely,""mo tan i ren licensed under provisions of Chapter 9(commencing Job Description
with Section 7000)of I)Mm n 3 of the Business roil Pmfeasiuns Code,and my Itccne,is
N in full fare.end eHM.
5 z Livens Clm Lle.0
nF� Dae Couuacter
qg ARCHITECTS alDECLARATION
D W U I UMesvand my parts slWu l x used public recons
6
gQt; Licensed Professional
3OWNER-BUILDER DECLARATION
E I barely eRinn than 1 am exempt from tba Contractor's Ucmae Law for the
p o following reams(Section 7031.5.Busiriss and Professions Code:My city or county
$ which requires a permit m cnnmuaL alter,improve,demWbh,or repair my someone
prior to is issuanee,atm require thempliemt formch Permit m file a signed swement
<
chat kislicensed purmmtteNeprovisions ofNeComsmbr'sLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
5s (commencing with Secuan 70(y)of Division 3 oftk Businessand Prefessions Conde)or
.- that W is cmmpr thrmftem and the bub fee the alleged exemption.My viola'on of
Section 7031-5 by any applicant for a permit subjects;the app lmort m t civil penalty of APN Number Occupancy Type
tat name than Ow bmdred dollus(51016.
❑l,uowoerof Nepmpeny.mmymaploymwvhwagnu Nebmlecmnpe m,
rune Pr ftewma and the heCom s rot intended¢Mend terata(Sec.70th.Business
uM ur ry wh W cede The centmmnra cad W law dm rot apply to st owner of Required Inspections
man cor whobuildsoimposesch impr andwho doessuchwmthimselfer through his
own employer,presided than such impmsemw t ere not iemndM orlon W forsake.&a own If.
however,the building or impmmnanl a old within one year of Improm for the owner-
saw.). w10 haw tite burden of pmHng that k did rot build or Improve(o purpose of
isle.).
S-1,as owner of the property,am exelus,mly eortuanco,wide licensed comrmmrs an
construct the pmjm s(Sec.7010.Businm and Professions Cede:)The Contractor's U.
cenm taw dm act apply to an owner of property who Wilds,r impmws thertan.and,
who condncu for such project with aeoovactraw)licusmd permanent to the Contswmat
I wenm law.
❑luneaamprunderSee .B3PCfothbrtuon
r_A—t H cr zq-
WORKER'S COMPENSATION DECLARATION
1 hereby Mum under penalty of perjury,one of dee following declustiens:
❑I ham and will malnain aCensticamo(Comem be slf-imure for Wokdscempeo-
cation,as provided for by Sadon 3700 of the labor Code,for the yerfemoso¢of dee
work for which Nb Permit is issued.
❑1 law W will emission Wedwes Compensation I.,as required by Sections
3700 or the Later Code,(a an performance oldee wok Im which dila peerth b sawed. .
My Ww1wes Compensation Wuran a carrier and Policy number me; t
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
nba section need not k completed if the permit Is foorc hundred dollars(SIM)
ca msa)
1 cart that in the perfuse.of the work fee which this permit is issued.l dull net
employ any person to mymanrcrm b4mnembject a tba Workers Compmsuian
Laws of California.Dam in i
Applicant Ar Ar�as.a- i.� -s-v�..sv--�
NOTICE TO APPLICANT:If.after making this Contra=of Excerption,you should
became subject so the Worker'.Compensation pmvialons of wo Taber Cede you muss
.J 0 funw-ul comply with inch per o th
mvisiois aresu
mus sball x doomed kid.
z 0 CONSTRUCTION LENDING AGENCY
j-r I bachy which ten then Nem isaconsWc.30 7.Cin8 agency for the PMurman¢uf
6i the dark for which this permit b issued(Sec.3097.Civ.C.)
W�Q lcnde Nurse
zm)z lcndef.Mn...•
U O I cosily that 1 kw mad this appTieadan and sate than the mow u ioroasiom is
U.P cartem.l age¢te comply with all city and county ordinsmv mad sate tan rtating to
OWildin8 conwunion.real berebymmumme tepramadma of this city in enmrupom de
W above-mentioned property for inspectiou purposes
gy (We)agree to caw,indemnify and Feel,krnJm Re City or Cupertino againt
fA
liabilities,judgments,costs and expenses which may in my way Acme,against said City
U z in consequence of the Starting of lois permit. 7 C
�-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGULATIONS.
Re-roofs
Signuum ol'ApplicaraAConlactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the aPPlieam or future Wilding occupant ooc or handle haununs mamrrial
dcllned by the Coltman Municipal Code,Chapter 9.12 and the Health and Salwy
.Sccuout 25532(.)?
❑Yns 'VN. All roofs shall be inspected prior to any roofing material being installed.
Will the,Applicant or future building oro If a roof is installed without first obtaining an inspection,I agree to remove
Ina G Panum .Air Qu or Mara which g p g
a i�i ardour air contaminants u defined by the Bay Arta Air Quality Management all new materials for inspection.
❑Yca NQ
1 km mad the hamnaumamrials rtqu'vcntems uw1m Ckpmr6.95 o(the Califor-
-a Health A SalesyCede,Sectiw21S05,25533 and MM.I mndemenal dhulithe building
dm rot comend me
on�tmanl dant It b ery mapotmbility a tedfy thc ompam of the
regeirtne,naw hertmemet prior miswm of aCendraw ofoccupancy. Signature of Applicant Date
Owner orauthoriacd agent D,m' All roof coverings to be Class't/ga'or better