07080257 CITY OF CUPERTINO .• .s:m¢ sSf "' y lien •� snaa a °"x`� '" ° .
BUILDING DIVISION PERMIT C01�1,TRA-G'TQIi IN ,U�tMATI ;,
PERMIT N0,
BuaDllrOrD 94ESTMINESTER CT TBD — TO BE DETERMINED 07080257
NER'S NAME: PERMrr WUEDATE
w
HELTON GLENN S AND EDMONDS— 01/31/2008
PHO SANITARY NO. CONTROL NO.
ARCHIT ECUENGINEER: BUILDING PERMIT INFO
O EO PLUMBO 0
30p LICENSED CONRACTOR'S DECLARATION lob Description
ices C 1 bemby arrirm that I are licensed under provisions or Clu ner 9(commencing
with section 701)(1)of Division 3Ofdb Budlieu ad Proraaabm Coic.and my lien¢is LIVING SPACE 50 PORCH 38 COVERED
in fun fore.and effect.
I _ eeve Claes LIe.a PROCH
u
f
Dow.Contractor
ARCHITECTS DECLARATION OVER NEW ENTRY ON SIDE OF HOUSE/ENLARGEMENT OF
3t IundewndmyplanshailWusedupuhlier.eaNs BRFAST NOCK BAY WINDOW REPLACE FLAT WINDOW ON
g Licensed professional
Sgor OWNER-BUILDER DECLARATION
i E I Wmhy offer that 1 am"empt from the Contractors License Law for we
OC fnllnwon.on.(SxOm 711513,Burn.and ProRuian Code:Any city or county
II E! which meas.a permit to conmrsel.after,improve,demn0sh,nor¢pair any aroctuou .
Zi prior b its iawnce.aim requires we applicant forauch permit to rile a signed aabmem
—o the W u licensed ltmnsum to the yroviamm lir me Contncbrt License Law(Ch.ptm 9 Sq.Ft. Floor Area Valuation
•�� (commencing with section 703())of Division 5 of the Business and Prefesdons Code)or 40000
f;- that he IN exempt therefrom and the beta for the alleged contraption.Any violation of
Sedco 705 1 5 by any applicant for i permit subjects the applicant to a civil penalty ofNumber O
nal mere man it.hundred dollars(Ms 3 4 212111 AR Occupancy p y Type
1,u m=of die pmpmy,or my employees wW ng"a lair mle c mpenadm,
will do du work,and 0uswcture is not Imendedar offered fanal.(See 7044,Bum. Required Inspections
and ProfeVlan Cade:The Contractor's License Law does not apply b e an Owner of q P
property who builds or Improves thereon,and who does such work him¢If or through his
ownemployme,Provided that Such improvements are not intended oroffen d forule.If.
however,the building or lmprowmant is Sold within one year of completion.the owner-
builder will haw the burden of proving that W did Out Wild or improve for purpose of
ale.).
u Owner of the property,am"elusively contracting with licensed contractors to
u.,wt the project(Sec.7044,Business and Profession Code:)The ConmcmrS LI-
ceuse taw J.out apply ban.,of property who Wilda or improv Merton,and
who cmlracts for such pmjecm with a contractor(s)licensed pursuant to the Contractors
License law.
01 am"empt antler Sec B&P C gar this reyp
lies ()•Y. /��-.. Dab ( -3t7'f�
WORKERS COMPENSATION DECLARATION
I hereby affirm under oferjurOm of the followin
under penalty perjury g declarations:
rl I have and will maintain a CeniGwte of Consent an self-Ilium far Wartrrs Compen-
sation,No provided for by Section 5700 of the Labor Code,for the perfomaance of the
work for which this permit is issued.
❑1 hew and will maintain Worker's Compensation Insulin,a required by Section
1700 of me labor Cade,for the performance of me work for which this permit is[Sound.
My Warkers Compeusadon Insurance esmior and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORXERS'
COMPENSATION INSURANCE
OWN Moslem need not W complewd ifthe Permit is rare=hundreddollus(SIW) -
orlesa)
1 certify slut in doe perfomarce of the wort for which this Formal,If issued,I"I set -
employanypersoninmymaim So5 b ecomp iccltedaworken'Compewdm
Lan of Califs t Dau V
Applicant w
NOTICE TO LIe Wor ,atom making Soh CiNOesb of Farm Cod you should ,
become Subject b tier Wohers ,arthis
Compensation provisions of the labor Code you most
.,O roMwithcomply with such providnus or this permitalWlWdomed¢coned.
Z CONSTRUCTION LENDING AGENCY
1 hereby&Mm Wt them is a constmewso lending agency for the performance:of
u: > use work for which this permit is issued(Sec.5097,Civ,C)
GQ lenders Name
D fendAddresss Add
V O I mtily ma I haw and this application ad vita thus the&haw information is
gy^ conttt I agree to comply with all city and county aNinua"and orb Ian mladng to
.0 Wilding Wilding cowrvction,Soul b.mbyauthodarepre¢nudwtsofthis city tombrupon n
Liz shove-mentioned property for Inspection purposes.
G (We)agree m naw,indemnify and trey homelands the City of Cupertino against
cn liabilities.judgments.costs and upcues which may in my nay acntte against said City
V Z in contegwnce of the granting of this permit.
.. APPLICANT UNDERSTANDS APO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUI�A770N5. - I — '-3O f
('Yta^�� (� O Re-roofs N.
Signature of App UConmeler Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllnant ar future Wilding acupam stare or handle hazardous material
No defined by the Cupertino Municipal Cade,Chapter 9.12.and thus Health and Safety
da,section 25552(a)7 `�� All roofs shall be inspected prior to any roofing material being installed.
❑Yes A.
Will the applicant or future Wilding Occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit husrdnus tar contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DUL1117
❑Y" CIN.
I have and the hazardous mauriab requiromenta under Chapter 6.95 or the Califor- -
nb Health&SafetyCde,Seders 25505.25557 and 35554.1 undcnud dos ifdb Wilding
does not currently haw a bnant,that It b my msponmllity In notify me oceuPant of
requih Ito"' m most elnrbieseanca lir.caNnaalra�pKay Signature of Applicant Date
ownere¢nrmhonredagent Dam' All roof coverings to be Class"B"or better