08080107 (2) CITY OF CUPERTINO
BUUAING DIVISION PERK UT CONTItACTb*1NF4RMATI 1�
BUILDING ADDRESS: PERMIT NO.
10285 DEMPSTER AVE BAYCAL CONSTRUCTION 08080107
NER'S NAME: PERMIT ISSUE DATE
SWEE:NFY DENNIS JAND ELLEN S 1236 OLIVE BRANCH LN 08/14/2008
NE: SANITARY NO. CONTROL NO.
(408) 426-0805
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
woo LICENSED CONTRACTOR'S DECLARATION Ib Description
a 1 bunchy affirm to 1 am licensed under provisions of Chpmr 9(commencing OOSCr1 p
U wit Sixdon 7(0))olDivisdon 3ofte Business ad protectionist cod",And MY license is RMDL KTCHN(110SQ-NON STRCTRL) & 3 BTHS (37 . 9SQ)
in full farce and cifect
�� License clean
conacmr HALLBTH,UPSTRBTH (46 .3SQ) &MSTRBTH (64 .4SQ)
3F' ARCHITECrS DECLARATION
us 1 understand my plans shall be used as Public records
U
n
g Licensed Professional
H3 OWNER-BUILDER DECLARATION
1 hereby affirm than I am exempt from tc Comactes License law for to
i O O following masa..(Sued..7113 1.5,Business and Prof ..Code:Any city or county
3$E! which requires A permit t,eo or 1.sher.improve,dermlit.nr repair any suunum
_.4prior u,its issuance.aLw nCoufrea the applicant for such pemi,to file a signed statement
< wt he is licensed pursuant to to movisions of oh,Connector',U..Law(Chap=9 Sq.Ft.Floor Area Valuation
XE�G (commencing wit Section 7")of Division 3 of to B unloosen And Professions Codes) $85000
S Nu he u escmpt tuefrem And the bud fa to alleged exempthon MY violation.of
Section 7031.5 by Any applicant for a permit subjecu tc applicant In a avil Penalty ofN Number Occupancy Type
nm mane than five hundred dollars(SM. 32647083 . W
1,uawnerofthpmpuy,amymploymwitwagpute wlccampenudon,
will dotewart Cede:
Tactorslstine,License
Lawit for s.a(Sec.ill Am Buunesa
Add Professions Cade:The ves uumh Ld who 4w urea wt apply m rt owner is Required Inspections
pmpcnywlw Wiprovid mpmvex shimpr and who daessmh wank himvlfor trwgh his
owv<mplaym,providedtatarmsimproold wi in one
intendedmoRaet fmsale If.
builder.We Wildingmidemoprovinu sold withinarc ild.1cmove foron.to Owner.
of
Wilda will Nw to burden of proving tat h did not Wild a improve Ire purpose of
i�o'
see704Buiu : ThoCmns (Sec.]OCC,Buinm aM Pmf«siou Code:)TW Conuacmr's U-venapply m an owner of property who builds or improves thereon,and
hoch projects wit a conmem r(s)licensed Famous,a to Comuamofs
a;eccer .B&PCfor to don
Dae
WORKER''COM ATION DECLARATION
1 hmby,Bi rd under Penalty of perjury ane of to following declaruians:
�Ihaw and ids maintainaction 37M of to Labor Code.for forWarkdaCmpen-
word,,uproh this for by Ss issued.3]OD Of are labor Cade,for to peAowance of to
wort far ankh Nu permit u issued.
❑1 have ab will maintain Wortefs Compensation Insurance,As inquired by Sccuw
3700 of to Labor Code.for this performance of to work furwhich tis permit u issued '
My WorkeYs Compensadon Insunmc Carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This atuw need not he Completed if to permit Is fm ane hundred doo,ra(S l OD)
Or kw)
I comfy tat in to perfors-re of to work for which ti,permit is fsstad,l"I not
crnphly any Perm.in any mso,pf,A�u m becdWaubjec,m lte Warkcra'Compewaw
law,offeM1011B�,D.0 47j;4]g
APPII naG --
NOnCE ng thta ConiEexu of empuon,you should
become subject a to Wohrls Compensation provisions a bur Code,you must
O raMm
wit comply wit such Provisions or tis permit shall W deemed a eked.
CONSTRUCTION LENDING AGENCY
F= Ihcmby arDm,that them is•cnnstmcuw lendingfor form Ana of
a.) p r
ai to wstrk for whim Nls Fermi,is issued(Seta 309'1,Civ.C.)
W�Q Lander'.Nine
Z f<ndeh Addrw
U Q 1 certify that 1 have mad WA application sed Aisle to to Above Warrenton is
Lp,E correct 1 agree m comply with all city and County ordinances and sou laws re sung m
O Wilding wmuvuniw,tab Wmby cataria repremouth,«of to city a aur upon to
LTi� alcove-mcnudproperty for inspection pugmas" CL (Wes)agree to save,indemnify and keep harmleu to City of Cupertino against
CA Ii,biliaex.jedgmgmenCoNaMc,pensu which may in any w'+Yamue,iaiulsaid City
U Z cdmrquerce of to granting of this permit.
^� APPLI UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date c'(-"
S ER ULATION'. p-
Sigl.�mLa7',�pplli `uron r6Ar— - —���5�DAw Re-roofs
ss6
HAZARDOUS MATERIA IscLasuRE Type of Roof
Will the applicant or( uni Wading aaupaptvom m WMk hamdou maudai
As,deBwd by the Cupertino Municipal Cale,Chapter 9.12.and to HcaiN And Safety
dc.Section 25532(a)7
[:]Y. All roofs shall be inspected prior to any roofing material being installed.
Will the,Applicant or future building amu.ret use component If a roof is installed without first obtainingan inspection,I agree to remove
Ire C p q pmcm m dMan. which p
ems hA'rard.uA air c.numinanu u defined by IM Bay Area Air Quality Management all new materials for inspection.
D wicty
❑Y« eNlti'
I haw red this n»aNmu materials requiremcnu axkrChapter 6.95 of the Califer.
nu Halt h Safc,YCede,Seeums 25505,25533 aed 25534.1 ouseMend do,iftc building
da«not ay hawaanon thWftu m mAPuMbililYmwdfYda OccuP,ntofthis
menowM muse mi ear,cenifaase.fampanry. Signature of Applicant Date .
Rh a
Owner oreuta snaages au All roof coverings to be Class jQ"or better