06060033 (2) CITY OF CUPERTINO -� %'
BUILDING DIVISION PERMIT CONTRAi4j'AW NP'AURMA" IU Y
T-MIROSLAU
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BUILDING ADDRESS: DRAGOJEVIC PERMIT NO.
06060033
9955 PEAR TREE LA
R'S NAME: PERMIT ISSUE DATE
MIROSLAU DRAGOJEVIC
PHONE: SANITARY NO. CONTROL NO.
ARCHIIECf/ENGINEER: l BL EIIDINO P):RMRIN
P�M5eFl"RU
:pp LICENSED CONTRACTOR'S DECLARATION Job Description
1 U 1 kmby affirm that 1 am licensed under provisions of Clmper 9(commencing
wile Section 70f10)ooiA,km 3 ofd,Business and Profeduru Code,and my license is
?� a rollforecandenan. ADDITION 2ND STORY 976 ' , 1ST STORY 306 ' REMODEL
License Class Lk.p DINING/BEDROOM/STORAGE/MASTER BEDROOM/BEDROOM
Dam Conitacmr.
56G47W ARCHI EC's DECLARATION
I I undcmm.d my plans&hall W used as public retards
yj
mM Licensed Professional
OWNER-BUILDER DECLARATION
iS 1 Mrtby affirm that 1 am exempt fume the Contactors License Law for the
D O following mason.(Section BIT 1.5,Buslnms and Profmiam Calc:Any city ger county
which require a permit W consuuct,alcor,improve,demolish,or mens any structure
_Z!„n
prior to its issuance,aim requires the applicant for such permit tafilesigned,tatemen, Vat��IdA822
ppS< that heislicamcdpursuant to the provisiouofthe Contractor'sUc¢mciaw(Chapter 9 Sq.Ft.Floor Area
Y v'O (commencing with Su,ionTODD)of Division 3 of do Business and Profeminns Code)or
(t
that he is emmp,therefrom and de buts foe the allcgnd asempsion.Any violation of
Sudan 7031.5 by tory applicant for a Permit&ubjecss the applicant W a rivll penalty Ofr�yp7f��7 Iltuber Occupancy Type
not mole dun fins hundred dollars($500). 3'1 O.J�U 8 4 . 00
❑Luawtteraftht property.ormyaoploym with wagmu Nehmk eompauadmn,
wBldathewvhanddmnmaurebnot Wmnded"affemdforaak(Sa-, .BgeNeu Required Inspections
and Profeviam Code:The C ournamr't Llceme law dm ani apply W an awtu of q P
property who builds or improv,thereon,and who does such work himself ger through his
own employ,,provided that such Improwmanla son not intended oroffernd formic.B.
howewo rim building or Improvement is sold within one year of compkfian.that awner-
bullder will haps the burden of proving that he did not build or Improve for purpose of
mk.).
1,as nano of the property,am uciudvcly contracdng with licensed commc,ers W
c moot,the project(Sec.7W.Business,aged Profestlou Coda)The Cemlaraers Li-
came law dm aro apply W an owner of proper wage build,or improve theee"m,and.
-aha contractsW It Projects;witha Ks)licensed p"wta"m dr Convaaofs
fi
Lkerrm Law.
I am tie p ndu See .B dPCfm this maven
Data 1-1111(06
W ell SATION DECLARATION
I hereby efrumr and r penalty a perjury aro of the following declanfotu:
❑I ham and will maintain aCutiOmta of Comcnt W self-iuurt for WodsYaCompn-
suion,as provided for by Sudan 3700 of rise labor Code.for the performs¢of tis
work for which this Permit is Issued
❑1 have and will maintain WmWs Compensation Warrants.as requited by Sonoma .
3700 of the lab"Cade,for tk performance of the weak for which this permit Is untied.
My Worker,Compensation Insurance carrier and Polity number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section read Out N completed If the Permit Is fan"hundred d0sca(SIM)
or less.)
I u,dfv the,In the fomuanu of Ue tum c f"which thin Perris 4 Woad,l Nell no,
cmployanyperso anymmacr& to bmembjectWdWWorketa'Canpewdon
Laws of Califs W
NO Iau
NOnCETOct UA :e,aftermastdthk Cargill the
E Abor should
become subjectcep y the Workers CooPenmdon permit
of the labor Code,you must
.J O forthwilM1 comply with such provisions a this permit Nall be domed mwtrd.
.zv CONSTRUCTION LENDING AGENCY
F.t Ihereby affirm that ft.Is.construction lending-racy for rim p:rf--=of
a r7 the work for which this permit is issued(sec.3097,CW.C.)
Qlander,Name '
M z Linder,Address
U Q 1 ratify that I have read this application and slaw that the show information is
U, (~" comma I agree W comply with all city and county onliuncm and swo lave misting W
OV building construction.and hereby authonm mpmsenmiwa of this city to ennr upon We
W shove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless Ue City of Cupertino against
Ihbilidu,ju menu,crus mdexpensca which may in any way seems agalnsmid City
to=Z' oafthe granting of thk porn .
APPLI UNDERSTANDS D COMPLY WITH ALL NON-POINT Issued by: Date
APPLI UNDERSTANDSID
SOUR ULATIONS.
qZ12 b Re-roofs
Sig um ofAppl' mrxwr aW
HAZARDou ATERIALS DISCLOSURE Type Of Roof
Will rite applicant Or future building ooeupanlatam arlundle Incurious material
nand by the CupenirW Municipal Cade.Chapter 9.11,and dW Haigh and Safety
secure,15532(4)1. All roofs shall be inspected prior to any roofing material being installed.
❑Yu )(No
Will the applicant or future building occupant use equipmant or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurdou air conternmanla as defend by Use Bay A=Air Quality Management all new materials for inspection.
District?
❑lam KN.
I hawse thehn,Nas maler45h
imtrensstmderomptor6.95 oftk Califor.
ria Huhh YCaM,S"das2550land 75534.IUMentand Uw Ude dbkeng
dm eat dy how a nnanL mspmsibility W norify,do areupmt of OW
require c hkh us,M et 'or 'Oamofoalseq Signature of Applicant Date
own oo-auth
hi
a c -'!- DataAll roof coverings to be Class"B"or better