08060001 (2) CITY OF CUPERTINO .�HE
BUILDING DIVISION PERMIT CONTRACTOR INFy�Q'Ith4ATION ,
PERMIT NO.
BUILL}IgG f�r>�Es ANYON OAK WAY TBD — TO BE DETERMINED 08060001
OWNER'S NAME: PERMIT ISSUE DAIS
NANCY H WOJTAS & JOHN 07/08/2008
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION Ib Description
Ua C 1 busby affirm that I am li¢tuW under poevisOeSCTIP
mu of Chapter 9(...in{
<m with Section TOM)of Division 3 of the Bon.snd Pmfessi.Code.and my it...is ADD FRNT ENTRY PRCH&OVRHD BLCNY(124SQ) ;NOT INCLD
n<�N in full farce and street.
ypz Lima.a. Lle.0 RF & INCLDS STRUCTRL
rp Dam Comrsecr
W ARCHITECT'S DECLARATION
7 1 undersand my p Wu Nall W thud as public records
SM6
g o Licensed Professional
b 5 OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contraeroes Uccnse Law for tin
o O following moon.(Sidon 70313,Business and Profession Cade:My city or county
Sa ff which requires;s permit m construe,alter,improve.demolish,or repair any swaure
Z iprior an its issuance.aha mquirn Its applicant forsuch permit to rile a signed sutemml
C that W W licensed putmanuo the provision of the Conmcmr'M LJcecense law(CNpm9 Sq.Ft.Floor Area Valuation
(commencing with 5¢tion 7000)mDivisionlof the Busimssxum Prokviom Cadc)or $26000
lt,
5§§ Net he is exempt themfmm and the basis for the alleged exemption.Any violation of
Section,7031.3 by any appllea st for a permit subjects the applicant to a civil pmwy of
roNumber Occas
nm
roam dun five hundred dolls. 34260007 ! Occupancy Type
❑1,as owner of the property,or my employee with wagea as their sole..mpen wu m.
will do the wart.and the structnm is mtWtendcd«offered formic(sec.Train.Busimss
and Prefctaom Code:The or mxmYs Lt.Law dues rot apply to an owner of Required Inspections
pmpertywhobuildamireprovnumrcan,andwho dm.t.h work hionselfe,though his
owe employoca,pmHded that smh improvements tie not intended oraffered fussie.B.
however.ate building or improvemant is sold within arc year of completion,Cone owner-
builder will Nve time burden of proring dual W did one Wild or improve for purynse of
.k.).
0 1.as owner of um property,Me exclusively contracting wish focused contractors m
construct the pmjea(Sec.7044.Business and Profession Code:)The Cona.taes Li-
come Taw dna not apply to an owner of property who builds or improves daemon.and
who contacts for such projects with a contacmm(s)licwed pursuant to the Comw.saes
Lions Law.
I oro exempttuunder9 ' .B$P.CC fair this mm�a�n
owner L Das/�e'io r
W 1. 'S f� •ISATION DECLARATION
1 by affirm under penalty of perjury,arc of the following drelarmiam:
1 hire and will mainuin a Certificate of Camera to self-imam fm Waukee,Compen-
.tion.as provided fm by section 37m of the Labor Code,fm the performance of rhe
work for which Nis permit is issued
0 1 have and will maintain Wor mer Campcmmion Insuran¢,as inquired by Section
3700.(the lobar Code,far the'damnanceufdme work far which thin permit W issued. '
My Waukee,Compensation hmsomme crop.W Policy nunmer am: '
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nisscuon teed nntaecomplewd time permit i forone hundmddailars(SIM)
or less)
1 cerufv dent in tie p rnmea o wmir for which this permit W issued,l Masi tet
emplq anypersunin anym cr ssm omc subjenmthe Workempomau
'Coman
Laws of California.Dau b5F
Applicantb A )d
NOTICE TO APPUCAXT.IL after eking this Certificate of Exemption,you should
become subject m the Workaes Cm penemon pmovi rman of dte Lahr Code,you am
.J z forthwith comply with such provitlan or this permit dull be damsel rcwked.
z y CONSTRUCTION LENDING AGENCY
[—m Iherthy affirm that Vert u a consuramon Lending agency for the perfpmaou of
C' the wink fu which this permit It isued(Sce.3097,Civ.C)
hW Q unseen Nam
z lender's Address
U O 1 ardfy that I have read this application W sum shin the shove Wfmmauun is .
V. ^. cortin 1 agree m comply with all city and Comfy ordinances and sum]amrclaung m
C) rV^ building construction.and hereby Meehan rtpmscnuuvev of shin city m enter upon tie
W above-memound pmKny fm inpemi.pWp.
F gL (We)agora m.ve,indemnify and keep harmless um City of Cup rhan aguut
H liabilities,Judgments,casts and expenses which may In my my seem agstion mid City
U,z' in cam xpoom of the ganung of this permit.
APPLIPA,NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO EGULA ONS.
"� Re-roofs
�bllgppuoft or M61i mractm Dam
HAZARDOUS MATERIALSDISCLOSURELOSURE Type of Roof
Will she apCampion future building e.Chapter
r 9.1 or handle ha.N.m materim
C de.Sec io the Cupenim Municipal Code.Chapter 9.1g,and the Health and safety
Code.Sermon 255324>+
❑Yu 01K. All roofs shall be inspected prior to any roofing material being installed.
Will the. licantorfuture Wildingooca nt u. If a roof is installed without first obtainingan inspection,I agree to remove
t hevardnm circontaminants as dcfmncby meaBay Area AirnQuall y Ma ag mete P
i am 7 all new materials for inspection.
❑Yon Ewd—_
1 have read dm hicaNms materials mquimmenuunder ChmW6.95 ofthe Ca lim-
hisW-10 k SafetyCeds,Savor 25505,25533 and 25534.1 undemand thatifuse Wilding
dean tet c at have•mmant.dot it u my rtsmntiWlity m mdfy rhe accupmt of the
mq.im w hmust etpeafmiaa,meanCenifm, a alp Signature of Applicant Date
Ow r r thari7a gem Dam' All roof coverings to be Class'W'or better