06020113 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT CTORINFURMA ON
v�,:i ". :n¢"�SGSikr 'd.� " Rya4
BUILDING ADDRESS: PERMIT NOO 6 0 2 0113
10357 VISTA KNOLL BLVD
NER'S NAME: PERMIT ISSUE DATE
03/02/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENOINEER: BUILDING PERMIT INFO
OEO PLUMB MEOCH
306 LICENSEDCONTRACTOR'SDECLARATION Job Description
1 bereby affirm Nn provisions am licensed under provons of Chapter 9(commencing
with Section of Division 3 of thC BuaWessand ProhWuv Code.W mY Ilcene u
n�
In full fora and CRect. ADD 78' (KITCHEN/PATIO ENCLOSURE)
jg? Dow clue Lk.♦
Couloseler
211 Dam TSDECL
ARCHITECTS DECLARATION
1 udenund my plana shall he used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby.(firm that I ammexempt from the Cashman o :my c Law o for the
10 0 following mama(Section 7031.5,construct,ainess and ore.Prefassimm Cade:My city or county
3 r which its Wa o permit re resftaloe improve,demolish,or repair any suuclum $30000
Z pow mib isssedtur also requires me applicant for Co permit mecrenrile eLaw(atatemenl
SFFO (commesliro ng withSemanunlhapmviviouafOne ofMeB sines ndProfssionCodler9 Sq.Ft.Floor Area Valuation
5a that he iseempttSecfromon 00)and
basis for
of thee einexempton.Any
Code)of
3
that he b reenter therefrom and me bub far the alleged exemption.Any vioh0on of
Section 7031.5 by any applicant fora permit objects the applicant m a Civil penalty of er U Occupancy Type
not mom Nan five hundred dollar($500).
Q 1,u mvnu of the property,or my umploycu with wages u Weir sole rompenssdan,
will do We we&and theavunum isrte intended or offend far sale(See.701/,Busineu
and Pmteaaioru Code:The Ca esseac'a Lien.¢Law deo Out apply in an owner of Required Inspections
property w ho builds or improves thereon.and who dare such work himself art through his
own=play=,provided Nn such Improvemanu an noLimendd aro@red foram.If.
however,We building or Improvement is mid within ons year of completion,the.man-
mildew will have de burden of proving Mat he did mol build ar impnm for puryoe of
co 1,u construct ft p of ct pec.704,B uelosivn d erofesdabs CeM p.Too ronumbn l-
genLad project(Sec.70th,ww or and Nems,Wi dsor i The Conhanmr's ad
eve law dao not apply m an awns of pr ctoms)who sed p art improv Corson,ad,
wnorontnne for such projects with a conuetor(s)Ilaossd pursuant m the ConuxYOM1
Lkene Law. i
❑lama t def Sea .B&PC(or W4
/ Dau m
DECLARATION
1 hereby allu m under penalty of perjury arc of the following declarations:
Q 1 haw and Will maintain aCeN(Iate of Covent to self-ivum far WorkcesCompen-
sstion.as provided for by Section 3700 of the labor Code,for de perfarmute of the
work for Which this permit is baud.
Q 1 have and will maintain Worker's Compensation Immuion.an required by Section
3700 of the Labor Code.nor We performance of the Work for which this permit is Issued.
My Workers Compensation In mance carrier and policy number are:
Cartier. Policy No.:
CERTIFICATE OF IDUMI 30N FROM WORKERS'
COMPENSATION INSURANCE
(Tbbmnion rcd trot bemmpleted lime permit Is forom hundrrddnles(SIO0)
or sena)
1 certify Oat in me performance of tho Work for which this permit is issued.l shall not
cmployanypermnlnanyman tbbcamembjecl to the Worker'Campenssmon
Laws of California.U,m� -�'-
Appliant
NOTICE TO AP C Work IL afZrCom mash e C cam of Laboro d you Would
become object y it Worth Provisions
provision of the labor Code,you more
.,O forthwith comply with inch pmvivav art Wu permit NJI be dcemd mmked.
?l;nCONMUCnON LENDING AGENCY
F I hemby affirm that mem is a corruuninn lendingagency for mat performance of
Ci 17 the work for which this permit Is lured(Sea 3097,Civ.C.)
V4 0 Ie ohn s Name -
2 I.O.OnLAddresa
V I certify that I have and this application and sum that the Above information is
CmteCL I agree 0 comply with W city and County ordinance,and stand laws relating m
pU building construction,and hereby mthoflra mpreenudvv of this city to man upon tha
shove-menliond pmpcny for inspection purposes.
(We)since in an,indemnify and lose humlees the City or Cupertino against
y liabilities,judgments,cum and expenses which may in my my acme kimmst said City
U In eonsequncC of the Staining of this permit.
APPLICAgNTT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date — 2--//l
souaC� /� 3/a/o6 Re-roofs �--
Sig
DISCLOSURE Type of Roof
Will she applicant or future building oceupantataro or hadlc husrdous material
as defincd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safely
.section 25532(.)7
❑Ya QNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or rutum building occupant use equipment or O vicaa which If a roof is installed without first obtaining an inspection,I agree to remove
emit Immolm s air connaminanu an defined by tha Bay Area Air Quality Management all new materials for inspection.
Dinrid7
QYv QNo
I have mad the hvsrdnue materials;requirements undcrC7upwr6.93of the Caliror-
nbHalth&Saclycade.Secdov 2550.5.25533 ad255X 1 andcesund th atirthe building
dors nal cunently More a tenan4 Wet' u my resporWhilily m notify the occupant of the
requlm4 , et ' rmissumucafaCertificate ofupumyr� Signature of Applicant Date
owner 0.r amnariYnda em 5$// D/�am All roof coverings to be Class"B"or better