06010085 CITY OF CUPERTINO
BUILDING DIVISION PERMITO 'TRA `.CC';<RTI 'b 'I�. •TU^ ;;
BUILDING ADDRESS: , AHUVA & NILL GELBLUM PERMRNO.06010085
10405 WUNDERLTC!H DR
&'s
NAME: PERMIT ISSUB DATE
�AHUVA & NILL GELBLUM 10405 WUNDERLICH DR 06/08/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHITEL VENGINEER: BUILDING PERMIT INFO
BO EO PLO MEOCH
pop LICENSED CONTE
ACIOBS DECLARATION Job Description
i 0yF 1 hereby air,.Nu l am licensed under provisions of Claim,9(,ammencing
S with Section7O10)ofDivision3ofNeBusinessandPrefasaionsColo.andmylicenseIs
P�zN infull ram AMeffam ADD 497 ' -BEDROOM/FAMILY/2 BATHROOMS
't;6 Lkeea°0i Lk'" GARAGE-407 ' -SANITARY IS SUNNYVALES
D,m c,nDECL
As shall
ARCHITECTS DECLARATION
IundenWnd my plans shall used upublic recarN
tyU
Licenced Professional
h3 OWNER-BUI(DER DECLARATION
<� I hereby af0rm that 1 am comp,from the Conaemars License Law for the
.p O following mown.(Scotian 70315.Business and Prolesaions Cade:My city ter county
$ which requires a per old m construct.Who.Mpmw.demolish,Or repair any suuetum -
-iy prior N its issuance.also requires the applicant forsuch permit to file assigned 0amment
< thmineulkensodpersonnel todee provision,of NecomenaraumnaaLaw(Chapter 9 Sq. Ft. Floor Area Val$diaA000
f�9 (commencing with Section 70M)of Division 3 at ft Business and Rofeuforu Code)or
- — dem he is exempt tkmfrom and the hula for the alleged asemptioe.My viol an of
Sermon 7031.5 by say applicant far a permit subjects the applicant tu a civil penalty of APN Number Occupancy Type
am mom Nan Rum hundred dollars(5500). 37516030 . 00
❑1,uawmcafthapropry,ormyemploym with wgmuNeu sok cempewdoo,
will do theamIL and the s u taOut intended paffend kraak(Sm.7044,BusinessRe aired Inspections
and Prolusions Cade:The Commandoes License law d=an,apply toan owes of 9 P
property who buildsorimpmes dom nn,and who doessuch worthinw5f or through hu
am play=,provided dud such improvements are not intended chartered freesia.If.
however.the building m Imp cavemen,Is sold within ons year of compktim,the awm-
Wilder ,will Me the burden of proving that k did un build Or improve for purpose Of
wk.).
❑1,as..of the property son exclusively con taming with licensed contractors to
mnsmmt de projeu(Sec.7064.Business and Profmskm Cade:)The Conu¢mts U.
cense Law dm oat apply to an owner or property whe bards or immowa Ibereon,and,
who conlmcta fm such pojeN wIN a conuxmrta)licensed p ctuant a Ne ComracdM1
License Lw.
❑lamamong,under Sen B&P C for this mason
4/bm 0 Data ed_,8/06
WORKERS MPENSATION DECLARATION
1 hamby affirm under pemlty,of perjury oro of the following declensions:
7011'havc and will maintain aCertifiate ofeonsem d selfdnsum fmwarlueseampen-
•u provided far by Settle.3700 of Ne labor Cole.for due performance of Wfor which Nis Permit is iuued.
ave and will maintain Worker.Compensation Insurance,u required by Section
of Ne Labor Cade,far the pRorreanee of the wort for which NU Permit a issued.
orker's Compensation Insurance artier and Poliry number am:
r. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sectlan need not becompked lithe pend,is forma,hundeaddoBam(SIM) ,
or less.)
1 comfy that In the performance of the wart for which this perm tis arced.I shall that
employ any person in any manmrw an he become subject to the JlpgjCeyq)Imnmaw
taws of Csiif D, ._ �.i�_
NOTICE,
NOTICE TO NT:IL aMr matin kCemnsof of Later,
Cod you should
become subject u the Worker,Compnw an provisions a(the labor Cede,you most
Qforthwithfowith comply with wen provisions or Nemrevoked.
is panni,shall be deed
,'Z,r tiCONSTRUCTION LENDING AGENCY
t—i Ihereby M.Net Nen is a concoction leading agmry fm Ne prformence of
C>
the wart for which dela Permit is Wood(Sec.sum.Civ,Q
WG Lenders Name
D' sanders Addrens
U I coolly that I have Head this applkatian and sue that,Ne above Infarmatiun Is
I3+ correct.I agree to comply with all city no county ordinances and mu sew,relating to
QU building convection,and hereby aulhorin mpremmauves of this city to enter upon the
W .hove-mcnuuned Property for inspection purposes.
(•^6. (We)agree to save,indemnify and kacp harmlm the City of Cupertino against
ren liebilidm•judgments.cure and mpnm which may in any way scene agaiml said City
U Z in consequence of the granting of this Permit. Date
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REC TIONS.
iL/,N161 at ' �O Re-roofs
Signatureof Applian omncur IF u
HAzARDous MA RIALS DISCLOSURE Type of Roof
Will the applicant ar fuuua Wilding acevpan,wxe or handle havName maw"
de0md by true Cupertino Municipal Codc,Chapter 9.13-and de Health and Safety
.Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑YesNo
Will the applicant or future building occupant use equipment m devicca which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmnlom air commum us u deRmd by the Bay Ma Air Quality Management all new materials for inspection.
Diurict?
❑Yes )eNu
I have mad due henAwu auMau roquhcmceuunderChap¢rS95afdeGllfw-
nuHealth&Safety Code.Sredimn 25105.75533 and 25334.1 omkreurd ded lfde building
dm not curendy have a term.Wt 1,Is my responsibility d nodfy de omupant of the
saw whkhmustbemet . ends,vwco(aCaruflueof Signature of Applicant Date
Owner arwNorisrA ageDatu All roof coverings to be Class„Bn or better
nt