04060263 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA"CTOR�INF,ORMATION.s '
BUILDINGADDRESS: STEVEN SANESKI PIERMITNG04060263
10421 COLRY AV
OWNER'S NAME: PERMIT ISSUE DATE
STEVEN SANESKI
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 o C= o
�Oo LICENSED CONTRACTOR'S DECLARATION Job Description
Z
y C 1 Msby affirm chat I am licensed under provisions of Chapter 9(commencing P
<U with section]0(kBaf Division Sof NC Businasand Pfofessiuru Code.md my license is
in full forceand rreeL ADD 336 SQ FT- (MS'� _' V /MS BATH/CLOSET)
Clam
p�? License Clazs Lie.N
Dom_C.Ordration,
p ARCHITECTS DECLARATION
W U 1 undersand my pans shell he used as public records
O Licensed Professional Oct
S OWNER-BUILDER DECLARATION
1 hereby affirm Nat I am exempt from the Contractor's License Law far the
z O C following manna.(Satan](IJ 15,Bulinus and Rofcssiuus Code:Any city or county /O 00�
X. requires a permit to consumer,alter,improve,demolish,of repair any euucare J _ _ 320---
which _ -
'f—'^ prior,tons ominee,alsurcquiros the applicant formch pennitot rile asignedsmtement
that he islicensedpursuanuo the provisions of the Conuaaur's License Law(Chapter 9 Sq. Ft.Floor Arg ��� �� Valuation
HCHC
(<ammcncing with Steelton Mad of Division Jof the Business and Profeasinm Code)or f;
i that k is exempt thcmfram and the bazis for the alleges exemption.Any violation of a
Section 7031.3 by any applicant for aPermit subject the applicant oacivil penalty of 3J?6�S'Ql$r�ter00 " 1ty'� Occupancy Type
not mom than five hundred dollars($500).
I.u owner of the pmpesty.a my employees with wags az their sole compensation.
will do the wart and Be sweture is not intended Or offered for sale(Sec.7094,Business
and Profession Code:The Comeamor's Lianse law does aur apply to an owner of Required Inspections
property who builds or improves Ihemor,and who doessuch work himmlf ter through his
own employees,pmvidcd that such improvement arc net intended oroRered for sale.If,
however,the building or improvement is sold within one year of completion.Ne Owner'
builder will have Ne burden of proving Nn he did not Wild or improve for purpo a of
sale.).
i3 1,as owner of Ne pfopert,am exclusively contracting with licensed conuacurs to
construct the pmjem(Sec.7094,Business and Professions Cade:)The Contractor's Li.
cense Law does not apply to an owner of property who Wilds or improves themon,and
who contract for such projects;with a eantracmr(s)licensed pursuant to do Commador's .
Lice.Law.
I un exempt toiler
S--eec----. B&P C far//th/isJmoron
Owve 'W DaOOO' .
fir// WORK eOMPENSATION DECLARATIOONN��`"' ''
I hereby Num under pe ra ty of perjury oa of the following deelaatons:
have and will maintain a Cenificto of Concnt to self-insum for Workcr'sCompcn-
workaz provided far by Section 37M or the tabor Code,for the pato mmance of the
for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,az raquiad by Section
37M of the labor Code.for the performance of the work for which this permit is issued.
My Workers Compensation Insurance nnier and Policy number am:
Carrier: Policy No.: ,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ohitim ion need not W completed ifthe permit is fmane hundred dollars(fIM)
or los.)
1 certify Nat in the per nee or the work for which this permit is issued.I shall not
employ any person in a nor nes become subject u-0;I ';orppcn�don
taws of California. OO 11NI(( TILL
Appli vi
NOTICE (CANT: ser making this Cenificate of Exemption,you should
become s e0 to the Worker's Compensation previsions of the Labor Code,you mus
.,Z foMwi cam ply with such provisions or this permit shall W loaned revoked.
zO CONSTRUCTION LENDING AGENCY
'e+ I hereby affirm that there is a consummion lending agency for the perromiam of
W> the work fur which this Permit is issued(Sec.3097,Co.CJ
l[] Lender's Namc
1 Lcader's Address
D
U 1 certify that I have read Nis application and surto that lie above information is
E' correct 1 agree to comply with all city and county ordinances and state laws relating to
0 U Wilding construction.and hereby audtariM mpmeenttvu or this city to enter upon that
purpo
pl show mentioned propertycosts
for impaction enes which ea
CL (We)agree to save,indemnify and keep harmless Ne City of Cupertino against
U Z liabilities,judgmcovecontand expenses which may in any way accrue against said City
in
of
U? APPL CA nCeUNDERSTANDS Aranding of rs pli-rot.
ND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU0.CE ATI s
G 35 d) Re-roofs
of Applic uacmr Dam
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant
ser future building Occupant store or handle hazardous material
az defined by the Cupertino Municipal Code.Chapter 9.12.and the Ncalth and Safety
Calc.SCNon23332(a)P
❑yes `{Nu All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I ha,endous air contaminant m defined by the Bay Area Air Quality Managamant all new materials for inspection.
suic4
0 Yes (No
sasaassys,,,�,���,..�'''''
1 have maJ the havaWrm/s mamrialsmyuimmenu under Chapmr695 of tW Califon
ni.H lth&Safmy Calc.SaNat25505.25533am125534.1 undcrsarvJ Beddow Wilding
dao not curtendy have a be thv it' my ms,rechility to notify the accordnt of the -
requirementwh h Iba ria asaanae Iscaniramoracupmay. Signature of Applicant Date
6 ' g y All roof coverings to be Class"B" or better
Own ut orircd age E