06030141 (3) CITY OF CUPERTINO , �� tpat��. ° y(�� * `• '��}
BUILDING DIVISION PERMIT 607, %�1�,171l6f,60
BUILDING ADDRESS: PERMIT N0.
10371 MANN DR
R'S NAME: PERMIT ISSUE DATE
ELLIOTT KATHLEEN A 10311 MANN DR. 03/23/2006
PHONE: - SANITARY NO. CONTROL NO.
(408) 930-6786
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR S DECILARATION lob Description
u I hemby affirm that I am Remand under providons of Chapter 9(commencing P
0b Section 70(10).1'Division Sof the Business and pretenders Code,and my license is
in full force and.vem REVISION-ADD OUTLET/SHOWER STALL
Viz License Class Lk.N ORIG PERMIT #06020172-NO NEW PERMIT
=Jp Dau Contractor
a71ARCHITECTS DECLARATION
c i understand my platy shall he used u public records
u G In Licensed Professional
OWNER-BUILDER DECLARATION
3r. I hereby a1Trm that 1 am exempt from the Camractafs License law for(he
o O following rtuon.(Section 703 1.5,Business and Pmfecsions Code:My city or county
5$ which mquba a Permit to m ISINCI,almr.hormone.demolish,lir repair any suacmre
—zy Prior u its issuance,slue requires No applicant for such permit to fileasigmdsuwromm
F Nat he is licensed promotion to the provisions of the contractor's Ucenu Law(Chapter 9 Sq.Ft. Floor Area Valuation
I (commencing with SmU.n7000)of DMA..3 of the Buthandwd Professor.Code)or
.. that he a exempt therefrom and the basis fm the alleged exemp0an.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil porosity ofOccuParc y Type
two ream than live hundred dollars(ssao). .l
❑i,an owner of the property.M my employer with wages as their sick compewti.,
will do the work and the structure a not intended or ofreral far sale(San.7044,Business Required Inspections
and Pmressia.Code:Tom Conuamodes License Law tires ret apply u an owter e ns or q P
properly who builds m improves thereon.and who doessuch work himnef or through his
awn employee.provided that such imp conswenu and,not intended unaltered fmsala IL
however.the Wilding or improvement is sold within om year of campletion,the owner.
builder will have the barters of proving that M did nm Wild or improve fm purport of (�
am.). C
jo 1,an wnec of Ne property,am eadusively c.asmi.S with Reensed canuacton w
co.tmct Ne p.ject(Sec.7044.Business and Profesat.N Cade:)Tim Comuacmr's U.
c.law does am apply in an owner of property who Wilds or improves there..and. 10,�s
whomeLA..far such pu ojeewiNaconracnor(a)Iice. n. to NnM1
licensed Punte Canuao
License taw.
❑I am exempt under
rSec.
.BIII PC far the tesaon
Dam
WORKERS COMPENSA710N OECI.ARATI0 V
1 hereby affirm under penalty of perjury arc of 0m following dmlan0mr: �\
❑1 hsm and will maintain a ceniriam ofeoment m self-alum fmwork escompen- v
author,N provided for by Section 3700 of the Labor Code.for the performance of Ne
work for which this permit is issued.
❑1 Mw and will maintain Wmkafs Compamation Insurance,as required by Section
3700 of Ne liber Code,for the performance of the work fm which this permit is issued.
My Workees Compensation Insurane artier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITC scmi.recd not be completed if the pemd(is foram,hundred dollen(5100)
lir mos)
1 Coolly that in the perform..of the work for which this permit is issued,l Nall am
employ any person to any m.tmao as w become subject to Nc Workers'Compe.Won
Laws of California.Dam
Appliam
NOTICE TO APPLICANT:If.aper making Na Certificate of Exemption,you should
became subject to the W~s Compensation proviso..of Ne labor Code,you mar
.J O forthwith comply with such Provisions or Na permit shall be demur rtwked.
r� CONSTRUCTION LENDING AGENCY
[—t I hereby aRnm that Nen is...=do.lending agency forth.perierroo a of
ai
the work fm which this permit is issued(Sec.3097.Civ.C.)
QIandee.Name ,
i7. z Lemines Adders
U Q 1 certify that I have mad this application and sum that Lou aWw information is
U,F correct.I agree to comply with all city.d county ordinances and state haws mating to
OU building construction,and hereby Cathedra represemaincs of this city to enter upon the
[17 above-mentioned property for inspection purposes.
6. (We)agree to Co.,indemnity.d keep harmless the City of Cupertino agai.1
,..h ItabilWa.judgments,costs ad expenses which may in my way accrue against said City
U 7 ire c.mclue.c of use granting of this permit.
1'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGUL IONS.
l/l i -tQ .3ZIalob Re-roofs
511maure ofApplicsw Conwwwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or(rum Wilding occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.13.ape the Health and Safety
.Semon 153$a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes tRN
Will the applicant or future building occup.t use equipment or devices which If aloof is ins[alled•withoutfirs[obtaining an Inspection,Iagree to.remove
emit hazardous air eonmmin.m as dcflncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yen
I have rad the Weardnoa matedals requirements underChapmr 6.95 of the Califor.
nia Health&Safety Cade,Sections 25505,25533 and 35534.1 understood that if Ne Wilding
dean.t Carmody haw C bound,Nat it is my responsibility re notify the oucupa of the
requlremmm which most be mal prior te issuance or.cenircam offkcup.cy. Signature of Applicant Date
Owner or authmined. art Data All roof coverings to be Class "B"or better