08080097 (2) CITY OF CUPERTINO )>�xP.sxv 'r3,izx
BUILDING DIVISION PERMIT �CONTRACITORINFORMA.TZON
BUILpING ADDRESS: * PERMIT NO.
10973 NORTHSKY SQ OMEGA CONSTRUCTION 08080097
'R•S NAME: PERMIT ISSUE DATE
YOUNG CHRISTINE 451 FENLEY AVE 09/19/2008
PHONE: SANITARY NO. CONTROL N0.
(408) 243-0404
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoa LICENSED CONTRACTOR'S DECLARATION -
a h
1 reby affirm Natm lia
1 ant under provisions Description
Poof chapter 9(commencing�L'� withsm,mu, n)ofoividon3OremRucnessandProfeadonsCode,atdmylzenseis REVISE TRUSS FOR STAIRS & CONVERT ATTIC SPACE—
in full forte and em.
jn? License Clue Lte.Is ORIG
"6£- Dam ARCHITECTSDDEECoLARATION PERMIT #08060056 NO NEW PERMIT.
C<7W< 1 uMenmml my planashall he used u public records
>yU
t C I7 Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby am.the 1 em exempt from the Convanafs Uneme law for Ih
OO O following reason.(section IIDIA Bond.and Profession,Cade:Any city ar County
$ which mquirn a caused to enormous.alma improve,demolish,or repair any structure
_iy pnarbits issranee.also mquirts the,pplicent for tach permitm tilt,signed iwement
ss< thatW isl;ecn,W pursuant to the provisions of the ConvacmrY Llecae law(chapom9 Sq.Ft.Floor Area CValuation
xF$ (commencing with Section 7000)of Division 3 or the Business and O Professions Code) J
_ Nat W is exempt darefrasto end the bub for the alleged eumphan.Any violatfm of
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of �p�Number Occupancy
not mom dun live hundred doll.IV=. 31640044 .`VV' P Y Type
0 1,a owner of the Pmopmty,or my eroployces with wags as Neo®k eompeaation,
will do the wak and the structure is not intended or offered for sale(Sec.70/4,Business
atd Pmfmsdon,Code:The Cantracmr,Li.law dem wt appy m an owner of Required Inspections
property wW Wad,or Imposes thmeon,and who daessuchwork hb sdfm throMis his
own cmpinyma,provided that such imp onve.enIs aro not intended oro0eod forsale IC
however,the Wilding or improvement b sold within arc yearecompledan,Ne owner-
Wilder will have the Wrden of moving slut h did not Wild or impure for Purpose of
sale./)
� u owner of project
pop 134 ane exclusivelyand
convening with licensed CoConernmes m
come, a don,ees not (sec.7014.wmerof endrtywho n,Code:) pr mthemon. lid
who Clawduranotdi pr can ownerofproper(who Wilds of improves dmmoa.and.
who Contracts for such projects with aconvanor(s)licensed pursnntm the Convacwr's
Liccns taw.
Sec .BAPCfor this mason
M.
911 0'e
R COMPENSATION?EC RATION
I hereby affirm under Ponalty of perjury one of the following declarations:
❑Ihwand will maintains Cerdficateor C...twscIf Worefor W0r .Compen-
sation,a provided for by Section 37M of the Labor Code.for the per rano.of the
wok for which this Permit in issued.
0 1 hale and will maintain Workel's Compluation In,ur,nca,a saluired by Sccbon
3700 ofthe laEor Code.Fier do performance ofdw were forwhiclt this pemsit is i,sued. '
My Worker's Compemadon Insurance canner and Policy number art:
Carrier. Policy No.:
CEXnFICATE OF FXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ITB section need not be cum plemd Ifft permit or fur ane hued della;($100)
lir less.)
I«slify that I.the perform n.of die work fee which Nis permh is issued,I shall not
mt,fl, ray perm.in any manner o robe me mbj wd,e WarkeK Compewtion
laws of Ca]ifasofa,pam
Appll n✓H Y.i i.... /.vim.
NC CE''ID APPLICANT:lfs}wr m,Y,aig s Ipso of Eacmpdon,you should
Immune.subject w the Wareeb Compctdah m p cions of Ne labor Conic,you most
.,O forthwith Comply with area povbwu or this Permit shall W dermam
d alted. -
zr h CONSTRUCTION LENDING AGENCY
(--i I Wreby amen that Vert b acoaauctinn lendingagnry for the Performance of
(La the wok for which dun,permit b Wood(Sri.3091,Civ.C.)
0 Undoes Name
z I<nder's Address
U O I eenify motor luno read Nis applieuian and state on,the a mw iNormatiun b
t2. cmmcL 1+tree w comply with all City and county ordinances and state laws relating m
.� Wilding convection.and Woby,uhronse mprommhvcs of Nb city m mm,upon the
t27 abwe-mcntioned pmpny(cel inspection which may
4 (We)Mom 10 saw.indemnify and ltecp harmless he City of Cup,me,Mairm
Z in Consequence
Of oncpuand capueserit. they in enY'vay,nine agaleslsaid City
C.1x in coaegvanp of the granting,(this prtniL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date y �//'6✓
SOUR REGUTAcanUC N
I 1
i'stuoofA Dam Re-roofs
IS ALS DISCLOSURE Type of Roof
Will dm applicant or fuluoW dingaccupantvomorhandlebv usmawnal
dcecfred by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Stio Z5532(.)?
❑Yes 1F1,11C All roofs shall be inspected prior to any roofing material being installed.
Will the. lipnt or mere ewldi. Occupant am If a roof is installed without first obtaining an inspection,I agree to remove
pp t p Area
Air cot or Mara which g
emh iel? sir conumin,nts a fined by dm Bay Areca Air Quality Mmegcmcm all new materials for inspection.
D vrin7 P
❑Yes No
1 have mad the hasardom materials req.irtmems under C!umWr6.95ofdm Califor.
nix Ree"SeetyCeM,Seedam 25505.25533 am125534.1 understand thatifthc Wilding
don not cumrtndy have a moan,that it b my responsibility w notify Ih oceupml of the
reyuim n;which mocut be met calor to issuance of a ccNBpm of Occupancy. Signature of Applicant Dale
owner an oath ndqpdl Dam All roof coverings to be Class'R."or better