08030097 (2) CTfY OF CUPERTINO
BUILDING DIVISION PERMIT CONdCRACTQR Tl�tk'>4RMA` Z9!
BUILgIbr��,SIS"hESTON DR BART & IRIS GACH PERMIT08030097
OWNERS
NAME: C PERMIT SEUE DATE
BART & IRIS GACH 10332 CRESTON DR 03/18/2008
NE: SANITARY NO. CONTROL NO.
ARC HITECT/LMNGINEER: BUILDING PERMIT INFO
-BLDO ELECT PLUMB MECH
30a LICENSED CONTRACTOR'S DECLARATION
jdj L hereby Nims that 1 am liconend under pmvisiau of Chapter 9(commencing Job Description
with Section 7")of Division 3 of the Buuncss and Pmfamiau Code.and my lkenanJe CHG 2 PRNG SKTS TO 3PRNG & GRND REPLC
n in full forte and effect.
g LkcomClm Us.g SWTCHS, LIKE4
t Dam
ARCHITECT'S DECLARATION LIKE WNDW RPLCMNT
eS Iunderstand my plea"ma ted as public meemb
y7Licensed Professional
8
OWNER-BUILDER DECLARATION
i<9 1 hereby atTirm the,I em exempt from 0u Conuum/s Licenm Law far the
C O O fallowing Mason.(Section 71131.5,Bum.and Pmfesskm Code:Any city or county
126! which maims•permit to nom arum.alar,impose,demolW,or coped,any sammum
Prier so its i3eWnce,also requires lm applicant for such Permit to file,signed Wmmenl
<
that he is licensed puramant to ft provisman of the Contractor's Licaram Law Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of lm Business and Professions Code)or $5 0 0 0
that he Je,sump,therefrom and the basis for the alleged eanmptiet.Any A.Intfan of
Section 7031.5 by any applicant for•peMmlt subjects the applicant to a civil penalty of Ap}af Number Occupancy Type
eat more than Ose Wanted dollars(SUM 326370421 V Cs'
0 I.u owner of Ilia property,a my aoplaycec wRh wages u main ole mmpemadm,
will do the work and the stnm5um Is not Intended"offered forsale(Sm.7061,Students
and Profeselam Cade:The Communities License Law dm am apply to an owner of Required Inspections
property who build,or improves absence,and who doesmach wort himael f ertimugh his
awe employees,provided that such Improvements am not installed aroffem!ferule IL
however.the building"improvement listed within one year .of completion.the owner-
Wilder will haw the burden of proving met he did not build or Impose for photons:of
ala).
0 1,as owner of the property.am exclusively connecting with licensed conlncmss in
com tact the project(Sec.70414,Business and Pmfeatlam Cade:)The Cmtrmmr's U.
ceue Law dem am apply in an owner of property who Wit&or Improves ft..and,
who contrmu for such projects with.canumur(s)ficcowd perms.,in me Cmumufs
L Taw.
(2'l un tem/fundeer ST BI PClear th/is muco
Owau��/I�t�-/! Due 10
"��ER'S COMPENSATION DECLARATION
I hereby aff0m under peesiry of peMjury ane of the faluwing dnelantimic
haw:and Provided
of Co manor mI-Wum performance
of on,r PraHtled for mi Section 3]00 of Inde labor Code,for the perfomaMtca of the
work for which this permit is derated
0 1 have and will maktam Wormfs Compenullon huursnce.as inquired by Section
3M of the Ladner Cade.for tin pertarmance of the work for whim this permit M mused
My Wmiste.Compelwdon Inman¢carrier and Policy number am: ,
Cartier: Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThJeccotim reed cot mcernpuwA it ft pem0lr loronehundmdda0ars(5100)
of Issas)
1 certify WI in Ne Perlmaanca of the work for which this Permit is issued,I shall not
employ any person in any mmnerm m��ST�m mbjmttatim Wartupenu
s'Oomtion
Iowa of Callfomia D! *S�X,V" 1
Applicam SN-ALM• �-
NOTICE TO APPLICANT.If,afludmaking this Cer ificam of Exemption,you should
become subject in the Workers Compensation provisions of the Leiser Cade,you must
.J O foMmPrm
with comply with ot Provision m this permit shell m deeed revoked.
N CONSTRUCnON LENDING AGENCY
)—M I homby affirm that Nem Is construction lending agency for the perfarmuam of
Qi ti the work for which this permit is dsteu(Sec 3097,Civ.C.)
1 0 Undoes Name
]Z Lenders Addmm
V Q I certify that 1 have mad this application and sum Phu the show inknnadoe is
I,.U cortin 1 agree in comply with N city and county suddenness and stain Jews running to
O Wilding conurocdon.and meeby.uthadm rePrmentatives of this city to now upon the
W a1mvemendoned Property far inspection purpoma
gy (We)agme to taw,indemnify and hair hamlet the Cil,of CuperOno!gunt
y liabilitienjudgmanu.cmu ande.pmses nrakhmayln anywaymrnm.gaiealuld City
t)'Z In consequence of the Seedling of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUlfE REGUfATi S. e
y Ai2`t . 3/1 rkC Re-roofs
Srijnate a of cans Comrmmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tiro applicant or future building occupant uorc urhandle heamdousmamrisl
as deSnnd by tiro Cupenim Municipal Code.Chapter 9.12 and dirt Health and Safety
Code. zss32(,)7
0y. [3110 All roofs shall be inspected prior to any roofing material being installed.
❑Yea
Will tic applicant or future Wilding aceupant use equipment or devlm which If a roof is installed without first obtaining an inspection,I agree to remove
II hareNnw wm air co meraiu defined by the Bay Arta Air Oualky Management all new materials for inspection.
0 ct7
0Yea IM
I haw rod the hanuMmamuedeb mqulmmmuundcrCMpmr6.95 of the Califor.
me Health&Sak yCode,Sectiau 25505,25533 uW23536.1 understand thetif the building
does not carund,have a umem.than it is my responsibility an readily tiro cceupmt of tlm
requirewhkhm moat armi ,nesaACertifmamarOccmency. Signature of Applicant Date
Owner or au Nom ro Dam'
All roof coverings to be Class'%¢"or better