06040076 (4) CITY OF CUPERTINO a -�i'tt ✓,a »»ra"s ""- "� �'^ 'H `
BUILDING DIVISION PERMIT �„CON ,RAGTOR INryFORMATION 5_
BUILDING ADDRESS: BILL BECK P�LMIT No06040076
985 PEPPER TREE LA
'S NAME: PERMIT ISSUE DATE
BILL BECK
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
ioij LICENSED CONTRACTOR'S DECLARATION
e C 1 Mmby of irm Nal I am li¢recd under provisions of Chapu 9(Commencing S
�zto with Section 10falp.l Division3ofthe RusinessaW Nafesdou Cock.and my license is
e<a Wmnmceaneertecf WINDOW REPLAC g SLIDERS
i�= Lie..
Outlet
s�W ARCHr1ECTSDEEJFA...... -- MAY J'Lf ZOO6
f as 77� 1 uncicrsund my plans shall M used as public records
pyU
e u Licensed Professional
`'ro3 OWNER-BUILDER DECLARATION BUILD
®�
<y I hereby affirm I am exempt from We Contractor.IJeensc Law for the �'L■
O o fallowing n.(Sect an 703 L5,Bum.and Profesm.Code:Any city or caun,y
5_(< which requires a permit to Construct chm improve.dermieb,as repair VY saunurt $2600
-Z< prior W its issuance.also,requires We applicant for such Permit to rile a signed statement
that rte is neenteu pnrsuantmthc provitians err the canwemr,uaerlse law(enaPer9 Sq.Ft. Floor Area Valuation
Z
ls-� (commencing with Section 7001))of Division 3 of NC Business and Professions Code)or
y _
that he is exempt Water=and We hasis for We alleged euminim.Any violation of
Section 7031.5 by my applicant for a Permit subjects We applicant to a civil penalty of 3AW lqgw&r J Occupancy Type
net marc than Eve hundred dollars(5500).
i,u owma of Nie pmpeny.m my employers with wage u tieh sole c=Kmdon,
will do We work,and the$.more is matin chedoraRered feasale(Sec.]014.Business
and professions Cmc:The Comracmr's License law does act appy to an owner of Required Inspections
property who builds or improvutherma,and whodoessmh workhimself or through his
awn employees,provided thetsuch improvements are notineaded croRcred for We.It.
however,We building or Improvement is sold within om year of completion,the owner-
builder will have the bu dim of proving that les did not build or improve for purpose of
sure.).
0 1,as mvmr of We pmpert,am esclumvdy,Contractile,with Barued contractors W
Consumer the project(Sec.7044.Businm and P efes Coes Core:)The Cmvumra U.
cove Law does act appy to an owner of property who builds or improves thereon,add.
who Co...for such pmjeets with a conuacma0)licensed Pursuant an We Convectors
License Law.
esteWry ptunder S�ee � B&PCfNarm 14A, Date Y a
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perW ty of perjury ore of We following declarations:
❑..as providlaforby Sc Cutiri<ar of ConLaborC Cade,far
f perf. res Co of We
sour,u provided(Pe mi Sertio^31110 of We labor Code,far the peAonnamsx of the
were far which this permit is lured.
❑1 have sed will maintain Workcr's Compensation Insurance,as required by Section
3700 of We Labor Code,for We performance of the work for which this permit is luued.
My Workers Compensation Inhumane carrier and Policy number art:
Caricr. Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS
COMPENSATION INSURANCE
(Thu section vee not be compleuvl if We pcnnim Is(Drone hundred dollars($I00)
car leu)
1 certify that in We Performance of We work for which this Permit u Waco.l shall not
Lawso anypersan in any muncry u W becpy�ipjye�b lM Wahers'ComPc^noon
f Califamia.D'ta agf��LL�J(( LL
APPliant ✓a
Apid o
NOTICE TO APPLICANT:If,after making this CcniOca c of Exemption,you should
heeome subjtts W We Workers Compensation previsions of the labor Cron you most
�O forthwith Comply with such prvimons or WIS permit shall W deemed rewkcd.
Z CONSTRUCTION LENDING AGENCY
[-+ Ihereby affirm that Were is a commmcma lending agency for the Performance of
rel m7 We work fur which Wts permit is issued(Sec.3091,Civ.C.)
and Lender's Name
.7 Z tandems Address
fJ C) I cmtify that I have read this application and sou about We above information is
(y P comm.l agree to comply with all city and county anteroom and sue laws relating to
OU building construction,and hereby auWomc mpmcscmativv of this city to enter upon We
[d1
above mentioned propc costs
for
ande penes purpwhich a
(We)agree to Save,indemnify and keep harmless the City of Cupertino against
fq inconsesjuet,of ts.We lamming of this permit. may in my way accrue against Said City
V z inmLICANT of the UNDERSTANDS
this per mit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REgU�yATION
wit '10/�f Re-roofs
Signature of AppliomUConuanor Data
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will We applicant are future Wilding occupant store or handle husAous material
fined by the Caperton Municipal Code.Chapter 9.13.and We Health and Safe,,
.Scream 25632(a)7 - All roofs shall be inspected nor to an roofing material beim installed.
❑Yes dNn-' P P Y g g
Will We applicant alfuture Wilding..,at use equipment ordcalms which If a roof is installed without first obtaining an inspection,I agree to remove
crit Avamnns air Common..as dcrimd by the Bay Area Air Quality Mamgemem all new materials for inspection.
Dismal �
❑Yes QNu
I have real We hvaNmsmaurials requirements under Chaper6.95 of We Califon
nin Health&SafetyCole Sceuom25505.25533 and 25534.1 understand thatifthe building
docs not curmmly haw a Worm.that it 4 my mapovihility to notify We cupanm of We
requimrymgwnich must met Pinrm vn¢ofacedricachro Signature of Applicant Date
//WA�/thorri, !! All roof coverings to be Class"B"or better
Owner w authorised agcm Dae. .