06040013 (2) CITY OF CUPERTINO =a=a^a^ '`` '"a"
BUILDING DIVISION
PERMIT �,�C®N7CR�C�TOR INFURMA.TIQN
�xa�lwrxr.ta�,a
BUILDING ADDRESS: PERMIT N0.
20723 CELESTE CL
OWNER'S NAME: PERMIT ISSUE DATE
RICHARDSON KATHLEEN M 04/04/2006
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ioo LICENSED CONTRACTOR'S DECLARATION Job DOECCIpUOn
tJ I hereby affirm that I am licensed under provision ar Chapter 9(commencing
with Ecorse and affect
the Buainvsand Professions Code,and my license is REPLACE EXISTING WINDOWS (11) TOWNHOUSE 2ND STO
_�bn in full torte anti effect
p z License Clens Lie.tu
Doc Gaa
L
ARCHITECTS DECLARATION
L 1 uMcraunJ my plans shell be,used as public rtcnrdi
e C G Lensed PnMcssional .
OWNER-BUILDER DECLARATION
zo I I hereby.(tiro on 1 1. exempt from the Contractor's License Lew for the
iOO following use . Mermen 7rydstr Business and Pr.dcopliCode;Anycbyorcaunry $7449
S$ which its requires issuance,permit re construe,aline improve,demolish,or repair ed ,amount
-if•." prieruaitsensedpursuant in
Ow
thovisioeanf forOne
such permit m fileasUw(Chapter
SS5< (commincingwJpuemantmthcprovivinmafoftheB sines, U¢nselsw(C Code)or Sq.Ft..Floor Area Valuation
Y t'$ (commencing with Section 700()a(DivisionJof the Business and Professions Cnde)or
.. Nas he is exempt therefrom and the but,for the alleged exemption.Any violation of
Scctlan 7031.5 by any Applicant to,.permit subjects the Applicant to A civil penalty of Number Occupancy Type
not more Nun five hundred dollars(5500).
❑I.As owner of the property,or my employes with wages as LIMIT cele compewdon,
will do the work and the swvus is not intended m ripened for W.(Sec.7094,Business Re UICed ❑E action$
And Pmfmiom Cade:The Contractors Lt.=Law doer not apply in an owner of q p
property who bui Ids of i mprwes themon.and who dues such wart himxl f or though his
own employers,pmvided thatsuch Improvements arc frumanded mattered for sale.If. _
however,the building or Improvement Is mid within one year of completion,the owner.
builder will have the burden of promg that he did not Wild ar improve for purpose of `Q
0 1,
1,as t the p of project
property,am Mmes,and contracting with licensed onmctors m Y /
construct the project(Esc.7094,Business end Professions Code:)The Contractor's Li. (O
cense Law dors not apply far an owner of pmpeny who W ills or improve Malcolm.end,
who cammets for..
or inch projects with a contractor(s)licensed pursuant to the CanMAularl
Liem Law.
❑lam ere funder ec. .B&P 1oribmam. '
Own. C/_�i/-� 1—f2 C//r—� Date V6
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the following declarations:
I have and will maintain•CeMfscale of Cnnsem to sail-insure for WorkeelCompam-
sW on,o provided for by Section 3700 of the Labor Cade,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,M required by suction
"W of the labor Code,for MM performance of the work for which this permit is issued.
My Worker's Compensation Inaurance carrier and Policy number are:
Carrier. Policy No.: a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE
-
(This Auction need not he completed if be perm,Is foronchundred dollars($1W .
less.)
I cerfi(y that in the perimmance of the work for which this pefmi,is issued,I shall not
employ an
ypermp ipm97nu9ngiTas tuEc c,mbject to the Workers'Compesa
ntion
NOTICE 1DAPrLbdAKT.If,after making this CeniOcaM of Eaemption,you should
become subject to the Workers CompenndDn prevision of me Labor Code,you most
.JO forOwi(h comply with such provision,or this permit shallbe deemed revoked.
r ti CONSTRUCTION LENDING AGENCY
[r (hereby affirm Out Lure is a construction lending agency for the performance or
rL 7 the work for which this permit is issued(Sec.3097.Civ.C.)
QLenders Name,
0.. z Lender's Address
U C) I certify that I have read this application and stag Nat Ne above information is
I[ —1 come,,I agree to comply with all city and county ordinances and state laws minting to
O V building Manamaion,and hereby authorize represenmivei of this city to enter upon the
W above-mentioned Property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
ti faA liabilities,judgments,costs and expenses which may in any way acerae against mid City
in consequence of the granting of this permit.
ti APPLIC N7DERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
EOR RE LAT( E.
I/— Re-roofs
T5tgnoul .1' pplinnVCommcmr DAM
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stare or handle havardous material -
As defined by the Cupertino Municipal Code,Charter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future building Occupant sex equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants As defined by the Day Arta Air Quality Management all new materials for inspection. .
- DiRlrict?
❑Yes ONO
I have mad the hA nodous materials requirements under Chma,r6.95 of the Califor-
nia Health&SafmyCode,Sections 255115,23533 and 255]9.1 undersmnd that little Wilding
docs no( have A Mnam.Nat it is my responsibility to notify the a:eupant of the
M cnisw hmus Imerpnor tissamccofYceninmaMorOceaPaney. Signature of Applicant Date
All roof coverings to be Class "B"or better
awn's OITY OF CUPERTINO
CUPETYO
I�TINO PERMIT APPLICATION FORM
APN# 2n /„ _h - 123 Date:
�/7�— 9 D
Bud�gaAMailing AddesLifferet from building address):
G
SZ)
!
Ow e s N e: Pho e
LP=e A4
Contractor: oc� License#: elq -� �G /
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg 5- Elect ❑ Plumb ❑ Mech ❑
Job Description: 6C-e- w;-n'AO l 11J -7—ficksto��
Residential V Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project,: / J Occupancy Group:
V) t
Type of Construction: Please check this box if the project is a
_
second-story addition: ❑
ro'ect Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax —Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
•
1 of 3
awiOCITY OF CUPERTINO*
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING •
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE . Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLkIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
•
2 of 3
��� � r Ar' r 4-�,,, r C (k y r b<. Y �c t i"'"y„ � �` ✓ S 4 TA � r .'.
"� RESIDENTIAL G. PROJECT COVER S
HEETR h
t
CITY OF
CUPtkiINO �r• �. a, „2.Y•. r �r ;( ��d, ,,.,r, I x .`
Assessor's Parcel Numb /r:
Name of owner. L-e-- �Q ,r 9�J1r J
Project address. �CS� C.� l e 9 f e �1 �! [`e C ua7 e.r t t�yc O
Contact person. kQ I e-o- i C�Q u`r hone. 40(k-4q - 5776
Fax. Ll/J �9L - `Z- 3-7
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done? /n� r�11W
Brief description of work. -a ,n( a e-, z G c S�`Lt 4 CPJ 64 8 u/ -Jxr-r
Code editions:2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y- N)
2001 CPC (Y -N)2001 NEC (Y -N)
Effective 11/1/02
i<,F CFT-\rE.D OFFICE COPYAPR 0 4 2006
Plan Review Process Work Book Page-8-Revised 4/28/04
T
pAh U'S
T
FO `,1, ct h o u s.�
r
.,, Code Corner
Emergency Escape
and Rescue Windows
by Ron Darville,Senior Plans Examiner,EI Segundo,California
I IE-20" Clear---)�
*-341/8" Clear---)�
Minimum Openable m -
sizeewindow m
for 20" Area = V Openable Minimum
1 clear height 5.7 sq. ft. = size window
Area = for 24"
N 5.7 sq. ft• clear height
i
i '
I
Maximum 44 inches
Finished Floor NTS
t
i
• ) Because so many fire-related casualties occur when occupants of residential buildings are asleep at the time of the fire,
Section 310.4 of the 1997 Uniform Building Code'" requires that:
A basements of dwelling units, and
A every bedroom below the fourth story
shall have at least one operable window or door approved for emergency escape and rescue. This exit shall open
directly into a public street, public alley, yard or exit court. The units shall be operable to provide a full clear opening
without the use of separate tools.
i
Extensive testing by the San Diego Building and Fire Departments established the minimum window size requirements
found in Section 310.4:
A The net clear opening are shall be no less than 5.7 square feet (0.53 m'-).
A In addition to the above requirement, the net clear openable height dimension shall be a minimum of 24 inches
(G10 mm). The net clear openable width dimension shall be a minimum of 20 inches (508 mm). Note that using both
minimum figures will not obtain the required area.
A The finished sill height shall be not more than 44 inches (1118 mm) above the floor.
I
Minimum Width/Height Requirements for Emergency Escape and Rescue Windows (inches*)
*1 inch = 25.4 mm
I
i
Width 20 20.5 21.5 21.5 22 22.5 23 23.5 24 24.5 25 25.5 26 26.5 27
Height 41 40 39.1 38.2 .37.3 36.5 35.7 34.9 34.2 33.5 32.8 32.2 31.6 31 30.4
Width 27.5 28 28.5 29 29.5 30 30.5 31 31.5 3232.5 33 33.5 34 34.2
Height 29.8 293 28.8 28.3 27.8 27.4 26.9 26.5 26.1 25.7 25.3 24.9 24.5 24.1 24
i
The views expressed here are those of the authors and do not necessarily reflect the opinion or agreement of the International Conference of Building Officials.
60•buildings.z:ndasds May-June 2000
x • • Community Development
' 10300 Torre Avenue
Cupertino CA 95014
CITY Of Telephone (408)777-3228
U P E�T I NO Fax(408) 777-3333
Building Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for.the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees. .
For more information on construction-related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
htto://www.cu pertino.org/city government/departments and offices/
environmental services _
COMMUNITY NOISE CONTROL r
The basic noise control requirements for construction sites are as foll APR 0 41006
• Typical construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at http://www.amfeoal-.com/cuo ca/
V IJ
• APR 0 4 2006
Greg Casteel � �niBuilding Officialof ICE cop _�_ f �
• De Anza Forge
550 Division Street
Campbell, CA 95008
408-540-5050 Fax 408-371-5130
March 14, 2006
Kathleen M.Richardson
20723 Celeste Circle
Cupertino, CA 95014-0486
REF: Architectural Application
20723 Celeste Circle
Dear Kathleen M. Richardson:
Your application for window replacement of 11 windows was reviewed on
3/13/06 and has been approved with the following conditions:
1. Design and construction must meet the guidelines as specified in your
CC&R's, any applicable state and federal laws, and as described in the
enclosed architectural application.
2. Please obtain design approval from the appropriate local agency if
• necessary.
3. Prior to the start of any work please make sure that all vendor information
has been provided including insurance certificates.
4. Any damage done to the Common Area will be the responsibility of the
unit owner.
5. Also, at completion of the work, please send to my attention, copies of any
final signed agency permit(s). If we do not receive these documents, we
will understand that you have contacted the appropriate local agency and
they have advised you that their approval is not necessary for the work.
Any additions or modifications to the above referenced work will require a new
application. Should you have any questions or comments, do not hesitate to
contact me at 408-540-5026. Thank you for your cooperation.
APR
Randy Near too. 0 ���^7� Q
Property Manager �";` \6
cc: Property File: 00131-3136
Architectural Committee
• Board of Directors OFFICE
APPL2-ArchitecturalApplicationApproved COPY
• De Anza- Forge Homeowners Association
zARCWnCTURAL APPLICATION
NAME OF OWNERS)
ADDRESS OF HOME:
TELEPHONE NUMBERS: (H) U o�—�i�S�(7
Applicant agrees and understands that the application does not falfill all of the conditions and requirements
for an approval. In addition to this completed "Architectural Application" form, the applicant must submit to.the
Architectural Committee drawings and specifications showing the nature, kind shape, height, materials and
locations of the proposed architectural alteration. It is also understood by the applicant that the submission must be
in writing. The Architectural Committee may require additional information, as it deems necessary to make a
decision. Until all information is submitted to the committee, the application will by deemed to be incomplete and
the application will stand disapproved.
GENERAL DESCRIPTION OF PROPOSED WORK
Window replacement o� 1V. windows, Milgard double pain, tan in color.
All windows replaced to be the same size and style as existing,
including grids in the bay windows. Windows will be new construction
which will liclude breaking out the stuccoaround every a
window nd..: .
repair and paint after installation is complete. Color to match
• xisting building color. Work to .be completed end of March/early
April weather permitting.
Applicant further agrees and understands that in the event that the modification is approved by the
Comrrvttee that they may impose "Special Conditions"of construction and maintenance on the approved work. Any
special conditions shall by attached and be a part of the approval. Any deviation from the approved plans,
specifications or special conditions shall cause the permit to terminate and become mull and void.Applicant agrees .,
and understands that failure to conform to these requirements will be automatic authorization by the applicant to
have the work brought into conformance with approved plans, specifications and special conditions. Applicant
further agrees and understands that all costs incurred by the Association as a result of bringing said work in to
compliance shalt be a charge against the owner's lot. Such costs shall include costs of construction,reconstruction,
administration, fees, attorney fees and reasonable court costs, if incurred. It is also agreed that no work will by
initiated which will: 1) be a violation of any of the provisions of the association's Declaration of Covenants,
Conditions and Restrictions or any applicable building code, 2) be an annoyance to the residents or 3) increase the
cost of insurance.
It is further agreed that,in the event the application is approved,all maintenance repair or replacement of the
approved item will be the sole responsibility of the unit owner and further that any expense incurred be the
'
"-association that is the direct or indirect result of the approved change shall also by the sole responsibility of the unit
owner.All work should by initiated with consideration of the grounds,esthetics,time and noise factors.
550 Division Street Compbell, CA 95008 a (408)540-5026•Fax(408)371-5130
ZO 'd 00 : 1l 900Z Cl Jew
De Anza- Forge Homeowners Association
ARCHITECTURAL APPLICATION(Contd.) Page 2 of 2
Applicant understands that all necessary permits and approvals from municipalities or other jurisdictions are
the sole responsibility,of applicant and that Committee approval of this application is subject to the applicant
receiving all such necessary permits and approval.
,..... ,: .,,, ERSIGNED AGREES TO T1TE ABOVE CONDITIONS
DATE: i` l3 200 /—
OWNER'S SIGNATURES
vwvwwwwwxwxxw++++++++w+++wxww+w++++++w++w++++++w+wwwwwxwwwwwwwvwrxwxxzxxxxxxxxxx+x+xxx+++++ '
FOR COMMITTEE USE ONLY
Approved Denied on ��y1&6 (date)
i
ct"t l � (signed)
�• •w'w w'w/w'w Ywwwwwwwwwwwwwwwwwww
wwwwrxwww a...w'wwwwwww wwwwwwwwwww wwww wwwwwwww ww a wwwwr' ... ...._........__..
ARCMUCTURAL APPLICATION INSTRUCTIONS
1. Complete all information required on the Architectural Application form.
2. Briefly describe the architectural modification for which you are applying.
• 3. Submit drawings of architectural plans,which should include:
a' Applicant's name and signature.
b. Association Name,Tract Number and Lot Number.
c. Address of property and Address of Owner if different than property.
d. Atcliitecd6nginee:es name and registration number,if any.
e. Date ofpiepararion of plans and specifications.
f Scale and legend.
g. Use standard sheet&size of: $.5"x 11"or 17"x 22"or 25.5"x 22"or 34"x 22".
h. Provide a Plan View(if applicable).
L Provide an Elevation View(if applicable).
j. Attach materials specifications,including Size,Color and Tenure,
"NOTE: Some of the above conditions may be waived upon request and approval. Said requests must be m writing.
4. Send or deliver all application items to:Massingham&Associates,(see address below).
5. Applicants will be notified within 30 days after receipt of all required information and completed applications.
550 Division Street,Cbmpbefl,CA 95008 . (408)540-5026•Fax(408)371-5130
£0 'd 00 : U 9002 £L Jew
[20723
ITY OF CUPERTINOah°
BUILDING DIVISION PERMIT �1CO,NTRAGaTOR=INF'UATIQr,
ILDING ADDRESS: PERMIT NO.
CELESTECL
NER'S NAME: PERMITISSUE DATE
RICHARDSON KATHLEEN M 04/04/2006
NE: SANITARY NO. CONTROL NO.
Rip
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j0o
LICENSED CONTRACTOR'S DECLARATION JbDescri tion
1 hereby siman Nal 1 Am licensed under provision of Chafer 9(commencing op
with Section 7M)of Division 3 ofd,Business and Profession,Code.and my license is
9� imm�fameAnd effect. REPLACE EXISTING WINDOWS (11) TOWNHOUSE 2ND STO
z License CIM tic.
Dau Contractor
As mail W use DECLARATION 'N wD
gig 6 I undersand my Plana shall W used M public record
Susi ti Licensed Professional
HSOWNER-BUILDER DECLARATION JUN (�
F 1 hereby oGinn that 1 am exempt Turn the Contractors License Low for the � ZOOM
E O O following reason.(Section 7131.5,Business and PmfcssinM Code:My city or county $7449
5$ which requires a permit to conswe4 alter.hap rve,demolUh,.r repair my structure
_ZS^ prim to its issuance.also requires the applicant for such permit to file a signed statement
< That he is llomod puruenita the provisionsof the Contraue.!.leen.Law(Chapter 9 Sq.Ft..Floor Ar Valuation
a (commencing with Section 7000)of Division 3 of the Business ant Profeuioa Cause)or
.. that las la exempt therefrom and the basis for the alleged exemption.Any statedon of
Section 7031.5 by Any applicant for A permit subjects the applicant to a civil penalty ofum ei• - ccupancy Type
trot more than to.hundred dollars($500I AIN
❑I,as Owner of the property,or my employees with wages As their sole compensation,
willdothewmk,andtheawet.isnoti.w.dedo,ofemdfwsxle(Sm.7044.BMinw Required Inspections
and Pmfadoes Code:The Commute,Lkrna Law does ant apply u an owner of q p
property,who but ldo or improves thereon,and who,does such work himself or through his
awn employees,provided Nal each Improvements are notinunded orortered(ot if.
however,Ne Wilding or Improvement is old within one Year of completion.the Owner.
Wilder will have the burden of proving that W did not Wild or improve for purpose of -
ule.).
❑1.as Owner of the property,am exclusively correcting with licensed cantraure in
construct the pmject(Sec.7014,Business and Profession Cade:)The Conuuur's Li.
aero taw does not apply a an owner of property who WIId at improv therein,and
who mnuacu for such pmjecu with A conuactor(0 licensed pursuant to the Contrs ett's
License taw.
❑lam tie tun eO .B&P far thla reuan
own w -_ �T Dam
WORKER'S COMPENSATION DECLARATION
1 hereby afarm under penalty of perjury ane of Ne following declensions:
41 1 haw and will nu nuin•CWfcam.fCo..tuselhiaumfurWorkeesCompen-
sedon,u provided fm by Section 37M of Me Labor Cade.for,the performance of the
work for which this permit Is issued.
❑1 have and will maintain Workers Compensation Inurance.as required by Sermon
37M of the Labor Code.for me performance of the m&for which this permit is issued.
My Workers Compensation Inaunr c carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Mi.aced..need nor W compleud if the permit 1,17orone hundreddolloa($100)
or tea)
1 certify that in the performance or the work for which this Permit Is Issued.I shall not
am toy any Peuo L TM OI an bjectume Warken'compensadon
laws.(Cal' 4
Applicant �e
NDITCH to APPLICANT If,after making this Ceoificam of Exemption,you should
become subject u the Worker',Compensation provisions of the Labor Code.you most
OO forthwith comply with such provision or this permits hell bo deemed revoked.
'Z" CONSTRUCTION LENDING AGENCY
[–,N I hereby alarm that there its comwclinn lending agency lot the perumance of
lYithe work for which this permit Is issued(Sec.3097,Civ.C.)
14 Q Landers Name
0.z Lender'sAdd.
UO 1«Nban ho
fy that I ve Nis Application and sum t the show information Is
V.PCorton.I Agree to comply with all city and county ordinances and state laws slating to
OU building consbaction,and hereby authorive representatives of this city to enter upon The
W -lave-m-d-ed property for inspection purposes
Ff+a (We)agree to sew,indemnify and keep humkn the City or Cupenim agaimt
arty Ilabilities,judgmcnts,costs and expenses which may In any way accrue againstuid City
U I.APPLICwuenee Of Ma ERRSrrANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO R RE ATI S.
V-4!-64 Re-roofs
Signmuh,of ppllcaData
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future Wilding eccupantnore minMlc haudoua material
As dented the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
code.Section 25532(a)7
❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant at future building=upset use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
h haurd.os air contaminants a defined by tie Bay Asa Air Quality Management all new materials for inspection.
strict?
❑Yus Ohio
I have mad the hurardnos materials requirements under Chapter 6.95 of the Califon
nia Health&SA1OIYCOde,Scctiau35505,25533and25534.lun&mwAmuifdu Wilding
dao not haw a tenant,thn h la my soponsihility u notify the aceupant of Ne
m I enuw' hmns mer9nor riaenaneeaI.cenill. -(Occupancy. Signature of Applicant Date
'Owner lar mthurimd,gent Dmc All roof coverings to be Class"B"or better