03110079 (2) ctTY OF CUPERTINO CONTRACTOR INFORMATION .
BUILDING DIVISION PERMIT
BUIL DING ADDRESS: vFRED BOITANO PERMITNO.0 3 110 0 7 9
11457 LINDY PL
NERS NAME: PERMIT LSSUE DATE
ED BOITANO 11/14/2003
NE:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
=
1 O o LICENSED CONTRACTOR'S DECLARATION Job Description
u 1 hereby afhrm that
1 am licensed under provisions of Chapter 9(commencing p
W with Section]LYIU)nfDivision3ofthe6usinessanJProfessinnsCndc.endmyliccnscis ALE®
+ „ mmnmreaanderfect CLOSED ATRIUM & ENLARGED
Lic ��
j cnsc Clow Lic.N
,ha Dam Contractor
ARCH7CTS DECLARATION
za 1 understand my plans shall be used as public records
s o Licensed Pmfessinnel
NOV h5- 2004
v :5 OWNER-BUILDER DECLARATION
Mq 1 hereby affirm that I am exempt from the Contractor's Liccnsc Law for the
❑O following mason.(Section 7031.5,Business and Profcxsinns Carl Any city 01 county
<� which requires a permit to construct,alter,improve,demolish,or repair any structure 1.CC+ 0 0
4—r prior to its issuance,also requims the applicant for such permit to rile a signed statement
za thatpursuant he is licensedpursuanotheprovisionsoftheContractor'sLiecuse,Law(Chapter9 Sq.Ft.Floor Area a a
2p
2h (cat he
(commencing with Section and of but&on3 ofthe
egeBusiness xempt Professions Code)of
O R R Net he is exempt therefrom and the bazia for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 0 0 Occupancy Type
not more than five hundred dollars(2500).
❑ I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Profession&Code:The Conuaetor's License Law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for rale.If.
however,Ne building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving Nat he did not build or improve for purpose of
sale.).
L u owner of the property,am exclusively contracting with licensed contractors to
rintout the pmject(Sec.7044,Business and Professions Cade:)The Convector's Li.
Case law docs not apply to an owner of property who builds or improves thereon,and,
4w,hoontracts far such projects with a contractor(s)II nYd pu numnitoNeContractors
se Law.m exam der5� ,B&PCfort am n
DaW RKER'S OMPEN ATION DECLAR TION
I hereby afOrm under penalty of perjury one of the foil oaph decimations:
ave and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of on.
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u acquired by Section
3700 of the labor Code,for the performance of the work fnrwhich this permit is Issued.
My Worker'Compensation Insurance carrier and Policy number am:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not M cumpined if the permit is form.hundred dollars($1(())
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
,.play any person many manner sn as to Mcomc subject m the Workers'Compensation
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Excerption,you should
become subject to the Worker's Compensation provisions of the tabor Code,you must ,
�O forthwith comply with such previsions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby&hirer Nat there iso commroctinn lending agency for the performance of
Y, r� the work far which this permit is issued(Sec.3097,Cl,C.)
Uj
Q fenders Name
z Lcnders Address
U Q I certify Net 1 have read this application and some that the above information is
k. (~ correct.1 agree to comply with all city and county ordinances and state laws relating to
Q(.j building construction,and hereby authorise representatives of this city to enter upon the
(jl
.1hove-mantioned
agree
property for impaction purposes
(We)
(Wcagree to sesta indemnify and keep hartnleas the City of Cupertino against
raj)
liabilities.judgments,fthecoarsing ex this per.
i:.0 mays ray way ecerec against said City
V(� in consequence of the Starting of this permim. ,
^' APPLICAN NO STA AND WILL MPLY WITH ALL N NPO T Issued by:S44 Date
SOU UL ONS
U" �� �y d Re-roofs
Sign t fApplicanl,Conlracmr etc
HAZARDOUSMATERIALSDISCLOS� Type Of Roof
ill the applicant or future building occupant stare or handle haratduus material
u cfincd by the Cupenine Municipal Code.Chapter 9.12,and the Health and Safety
ode,Section25532(a)? a All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will me applicant or 14 building=open(o equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Distrin7
❑Yes kNu
I have mad the hmardous materials requirements under Chapter 6.95 of the Caiifno-
in He. tlt Safay Cndc,Sccuons 255(15.25533 and 5534.1 unJcrsmand dust dine building
Dees not Cu aptly haw a tenant that it is my r pon&ihilimy to nobly rah rccupant of the
req ' �hic aim ptiortoiss eeoracrnihtof &pay Signature ofApplicant ' Date
Q ner mhorizeJ agent All roof coverings to be Class "B" or better