04010034 (2) CITY OF CUPERTINO ` `+' x r"... .. ' ' I
BUILDING DIVISION PERMIT LzCONTRACTOR`INP'OI2MATI0N '
4s
BUH.DINGADDRESS: "JOE DONOVAN CONSTRUCTION I t!MITN004010034
10221 T4TT,TX7RR.�T Rn
ifERSNAME: PERMITLSSUEDATE
STEVE SMITH
PHONE: SANITARY NO. CONTROL NO.
(408) 997-8140
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION Job Description
w p I hereby affirm that I am licensed under provisions of Chapter 9(commencing 1]
Zw wet Anion 70(IU)cf Division 3 ofdte Busincaa+np)Profeuium Code.and my liccve is
e_"y in ten erceet. a�YJ REVISION— (WALLS & BEAM) IN HOUSE USE ONLY
Licenu Lie.
�—o te ltoo r rll-Ne NEW PERMIT ISSUED/ORIG. #03090012
p�p'y ARCHITECTS DECD ON _ -
�oe lander a Jm laflfs a�R'b uud uMl Acord
JaU
T u
Licensed Pmfcs, s
sOj JOWNER ER DECLARATION
aY 1 hereby tom Nm 1 em exempt from she G.Aaaea.fs License Law for the
pO following re, .(Scotian 703 L.5,Business and PrnfAe ions Cud Any city ser county
5 m
which require Permit m cnnstrvn,alar.improve.Jcmolish,or repair any structure
PA.to its its cc.also rwi.,he applicant for such permit ro file A signed statement
a Inas he is lic d pursuant the provisions of the C.Alraelols Licenu Law(Chapter 9 Sq. Ft. Floor Area Valuation$34
ye$ (commcnci g
it
Section 7(M)of Division3 or the Business and Professions Csmc)or
33 Net he u gas therefrom and the basis far the alleged exemption.Any violation of
Sccsinn] .5 by any applicantforA conitSubjectstheapplicanttoacivilpunatlyof APN Number Occupancy Type
not more an fire hundmd doll..(55(10).
Q 1.as Owner or the property,or my Amphoras with wages as their nom com,wution, 32616009 . 00
will do the work,end ase swnum is not intended or offend for sale(Sec.7064,Business
and Professions dc:CoThu Contractor's License Law boxes not apply 0 an owner of Required Inspections
property who builds or improves thereon.and who dace such work himaelf or thmugh his
own employees.provided that such improvements arc not intended or uttered forsale.If.
however,the building or improvement is sold within one year of completion,the momr.
builder will have be burden of proving that W did not Wild or improve for purpose of
sale.).
Q L rs aver of the propert,am exclusively crefcom g with:)Th.d convvmora m
Li-
more
La do project(Sec.Tubb,Business rope Professions Code:)The C.ntrazror's nd y.
cane law does not apply je ts owner or inapc.y who Wilds or ant to the
daemon.and. \
who use La ufor such projects with scomnnor(q licensed pursuant to the Conmeuh \ lV\
Licenu Law. \\
'I Am ncmpt under See ,B&PC for this rtazon
Par Data
WORKER'S COMPENSATION DECLARATION
I thereby union under penalty of perjury one of she following declarations
Q 1 have and will maintain a Certificate of Conant to selFinsure for Workei s Compen-
sation,az provided for by Section 37W of the Labor Cndc,for the IcKormme,of the
work rot which this permit is issued.
Q 1 have and will maintain Wake es Compensation Insurance,as required by&coca
37M of the tabor Code,for the performance of Are work for which this Permit is issued.
h mMnsHio
My Worke9sunnce canner and Policy number art:
Ca ' Policy No..�.
CERTIFICATE OF EX MON Fftok ChKERS'
01 COMPENSATION INSURANCE
(17nfs ucGm raced notal �mplcted if comm"isrn.nColadrtddollampli l)
,A loss.)
I certify that in the perform c of c w r for whit Ni nwiA is issued.I shall nut
employ any pe.o oy. Ara. o 'iso Oe Workc,ACompewdon
Laws or Calif. T6au
Applicant
NOTICE APPLIC ,alter making this Cendle.le of Exemption.You should
income, on to tic o cri Compensation provisions or dte LaWr Code,you most
.J Z forthwith comply wi h provisiom or this Permit shall W deemed revoked.
zO ONSTRUCTION LENDING AGENCY
(�. IMrthy it doodra ".c.nssmctinn knding agency Lr Nc per(ormance of
C Nc work for w0 h is peomis u iuucd(Sox.7097,Civ.C.7
a, O Lender's Name,
a Lender's Add ...
U O 1 mnify that 1 hale road this application and suis that IM above information H
Y. F" correct.l agree to comply with all city and county ordinances and suelaws relating to
0 building convection,and hereby authorim representatives of this city to enter upon lM
r I57 above-mentinncd properly for impuuon purpoxa
t„�y (We)Agra to save,inOemm%and keep harmless tM City of Cupertino against
p] liabilities,judgmcnu,costs and expenses which may in any way&arae against mid City
U z in conwArm of Ne granting of this permit. G
r-t APPL A UNDERS AND WILL COMPLY WITH ALL N POINT Issued by: Date
SOU E EGU N :
Re-roofs
Vof ApPln HAZARDOUS MATERIAL$DISCLO RE 1e, Type of Roof
if Ne,applies.,to future Wilding oaupmssto.or handle haard.us material
dcISd by theCupcnino Municipal Code,Chapter 9.12.and IM Health and Safety
tin.zss3z(.)7 All roofs shall be inspected prior to any roofing material being installed.
ll the applicant or ruwre building acupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
colt hanrdous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
Q Yes
I have read Ne,husard usmaterials requiremcnu under Cheri 56.95ofthACalifnr-
air Hcal safety Cade,Sado ,25533 and 25534.1 undersand that if Ac Wilding
drcu c ndy ha n L Nat is my responibilisY a mtily IM xup or the
myvi cn whic ussW clprior uuar¢coraccAurmaeorou pm Signature of Applicant Date
` L All roof coverings to be Class"B" or better
Owner. authomcd egem Da