06050080 CITY OF CUPERTINO
BUILDING DIVISION PERMITU,N�'.CRA.�'T(?RZ1VF't'�,, A'PI(1,N
BUILDING ADDRESS: 1 JOSHUA & FAIZA, FREDERICKS PERMIT"0'06050080
10395 PERMIT ISSUE DATE
OWNER'S NAME:
JOSHUA & FAIZA FREDERICKS
INME: SANITARY N0. CONTROL NO,
ARCHrfECT/ENOINEEK: BUILDING PERMIT INFO
HO EO PLUMB MO
app LICENSED CONTRACTOR'S DECLARATION lob Description
!ti I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing
with Section 701X0 ofDWidon 3 offt Business and Prolcasions Cade.and my licence Is
In Implore.aaderr L��/p.� ADDITION-869 ' /GARAGE 426 ' /REMODEL 819 ' /STUDY
�8p�p Date "9 - cnmctor y L �tc/y� r 1 BATH, REMODEL (E) BEDRMS/HALLWAYS/MASTER SUIT
ARCHITECTS DECLARATION SANITARY IS, SUNNYVALES JURISDICTION
i a�77�t 1 understand my pans shall M used as public¢tarda
JyU
yG Licensed Professional
cOatNEBUILDER DECLARATION
114Wby affirm I em.umps from the Contractors
a Law(or my
Coo following (Section
n7and Pm(cmdnCom:
Anyc orre
$9 whichttnue,. esel(acuennow shor,hmprov,demoish,carrepar city
yuuctum
pdartoits aswnme.isuuie,ftafn moTia as atemcn'
8Wlhe6lcenmdpuretantWdipmvisionsOfWCammoil'iucemLaw(C14pter9
Sq.Ft.Floor
Valuation
yh$
(commencing with Section 7000)of Division 3 of the Busoera and Pmfetsinro Cade)o $300000
E5. that he 6 retrain dmrefraa and can basis for We alleged aanpdon.Any violadn of
Saban 7031.5 by arty appllum(m a Permit abjttu Ne appfi=m W a civil Faulty of APN Number Occupancy Type
trot more dun five hundred dollars(5300}
❑1,u owar of W ryvpmY.m my wplaYen with wage u thew sole mmpcnssdon,
will do the work and the aweman 6 not amnded m offered to,sWe(Sec.7014,Badrma3 Required Inspections
and Professors Cadem
e:The Cmumeme's Lite law does ani apply m an caner of q p
properly who build.Or improvestheran,and who domsuch work himmefm Waugh his
own employees.provided that such Impmtemenu are not intended uroffered farms,If.
however,W building or improvement Is Bold within one year of amaidu on.the nwner-
bullder will have W burden of pmving that W did Amt build or improve for purpose of
sae.)
0 1,a owner of W property,am exclusively contracting with licensed convectors to
construct W pmject(Sec.7064.Business arta pro(aalan Code:)The Contractor's LI-
ccnm law does not apply to an owner of property who builds or improves W lean.and
who contracts for such projects with A conuatar(s)licensed pursuant to W Contractors
Lialm Law.
❑I am exempt under Sec ,B k P C far thismason
aer Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty,a(Pmjury ane of the fallowing declarations:
❑I haw and will mdnuin a CeNTuate of Conmm to self-inure for WokeraCampcn-
aarian.as provided for by Sttdon 3700 of W lobar Cade.fo the pedarmarmce of W
work f which this permit is issued.
bow and will mdaWm Workers Compenudon Insurance,as mal by Section
3700 of du labor Cade,far W performance or W wok for which this permit 6 issued.
My Workers ComperuWan insurance carrier and Policy number tie:
Carder: PoI'Iry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(This sedan need not be completed if W permit is rorone hundred dollars($1001
or less.)
1 certify Not in dm performance of the work far which this Permit is issued,l Well not
employ any person In any manners as W become subject to the Wariness'Compensation
taws of Califo ilia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation previsions of the labor Code.you meet
O forthwith comply with such provision or this Permit 31411 be wanted mvoked.
zy r~�.. CONSTRUCTION LENDING AGENCY
f-. 1 hereby%Mm dw dart is A construction lending agency for W Nrfarmance of
C> W work far which this permit 6 named(Sec.3697.Cis.C)
W Q Lenders Name '
Da Lenders Address
U Q 1 eatery that 1 haw reed this application and sum dm the show Information 6
U, E-' comm.I as=he comply with all city and county ordinance and sum haws Wallis to
QC) building construction,and hereby autharien Wpmacnumems of this city to enter upon the
l
W hove-mentioned property( inspectioninspections
L1. (Wc)agree to sive,indemnify and keep hamlets W City or Cupertino agarol
mHr T/f iabili0es.fudgmcnu,tosu and expenses which may in any way attruv agarol said City
U F77 in conequenee of the granting of this permit.
APPLICANT NDS AND WILL COMPLY WITH ALL NO
Issued by: Date
SOURCE ULATI
762 -" Re-roofs
Signorina of ApplicuubaftContntcmr D.te 'Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future building occupant atorc or handle hazardous material
as darned by the Cupertino Mu id al Cade.Chapter 9.11.and the Health end Safety
am.Seedenv53ua)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will W applicant or slam building aecvpam tic equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
ern hmaNnn srcanuminanu dCRned by W Bay Area Air Quality Management all.new materials for inspection.
District?
C]Yes No
I have mad WhLmdsaummed reryimmenuunder CTapwr6.95 ofWCalifon
nia Hcalthir Safctycade.Secdou25305.25533 wort 7353/.I undersuM dutdde building
does not currently 14m•tenant.that it a my WsponsibilitY m notify do oaupant of W
maul hkh mutt W met priorto issuance arm Certificate of Oceupanry. Date
5ate"t 'tp -t2 Signature of Applicant
All roof coverings to be Class"B"or better
Owar w Wahamcd agent Data