06040079 (2) CITY OF CUPERTINO �uu
BUILDING DIVISION PERMIT CONT"5TOwRINF,ORMATION,:
BUILDING ADDRESS: \ PERMIT NO.0 6 040079
10381 N PORTAL AVIMAAv. 8�ree� Bcaa�att3 S,,,e .
OWNER'S NAME: W
„ '.;101 IT PERMISSUE DATE
MARDESICH JOHN J AND JOLEN L yl to WA�i
OEe g Z SANITARY NO, CONTROL NO.
S58 - q -1
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iOp LICENSED CONTRACTOR'S DECLARATION rl Ipb Description
w C I bmcby affirm that I am Ikenud under provisions or Chapter 9(commencing p
t� Ovid,Section 7000)°f Division 3 of NC Business and Proressiom Code.and my license is
inlull(ameAnd effect REMODEL HALL BATH, ENTRY & HALLWAY, REPIPE WATE
7�? License lav L'c.M
=moo Dam coca MAIN AND HOUSE (GALVE TO COPPER)
'F
ARCHITECTS O ION WATER HEATER RELOCATION
a< 1 undersand my plans shell he used u puhlic rtcmda
bcU
eve Licensed Pm(cssional
5 OWNER-BUILDER exempt( DECLARATION
C 2 0 hereby Maso .(Sero that 1 1. exempt Wm he ContramYs License c Law for the
O o which ng mason.(Section 71D IA,Business and w.derau Code:Any city or county
S m which,its issuance.
a permit re cores the plmw improve.h pcmii i m repair any suuetum
¢y thatM its tensed e.akuntto ft thecant for MucConerarmr's Lian file asLaw(ned utamem
< (commecing it purction7 )of Divisio of toeue BuiesWcnnulaw(;hapter Cedc)9 Sq.Ft. Floor Area Valuation
[�o
(commencing Is exempth boxfon and the
Division 3 of Ne Alleged
exe and Proresson.Any vi Cade)of $15000
y��
that h<V exempt thcmfmm and the baso for the alleged esempuon.Any violation of
SeNon 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN NumberIF^A eupancy Type
not mom man five hundred dollars(SSW). �n g...I
01.uownerofthepm eny,ormyumploycvwithwagesutheirmlecompenudon,
will do the work.and me structure b not intended w offered for sale(Sec.7044,Business !D,/ry
and Professions Code The Cnneractoh Li..taw docs rot apply to as ons er of ♦�equuf i&rr�ye/p� c IN:
property whin builds Pimp°seadereon,aMwM arca:ucltwarknimulfnr through his 'I'/V3/'*y,�•aTr/SI�� I)J/
own amployces.provided Nu such improvements art not intended oro@md forseds.If,
however.illhawdue ofimpmvemenngthat withinot year of completion,the owner-
builder will haw Um buNen of proving that he did Out buiM Or improve for purpose of /IgVNI p((,�ft
❑1.43 owner of the propeni,am exclusively convecting with licensed contractors to
convect the proles(See.70",Business and professions Cade:)ran Contractor's U.
cense law do.not apply man ownw of pmpcny who builds or improves thereon, it
who contracts for such pmjecm with a convemar(s)licenzd pufmum to rhe Conuacto's
Licence law.
❑1 am exempt under Sce ,B k P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby art.under penalty of perjury ane of me following declamthmse
ham and will maintain aCenifiate of Consent to self-insure for Worker's Compen.
si don,u provided for by Section 37M of the Labor Cade.for the perfarmane of the
work for which this Permit is issued
❑1 have and will maintain Worker's Compensation Imumme,u required by Section
MyW the Labor Code,for Ne pwfor cant a finework for which this permit uissued 1
37 WorkerCorr Cod ,foa Lauren¢artierAnd Policynumberam: F
AR' .
Cartier. Policy No.; r
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
SA
(Thu section need notbccompkud if the permit is fwone hundred dollars($10])
less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employany person in any manner AM to bccwnesublect to de Workers Compensation
laws of Cal' u�ZC1
Appli e
NOTICE o the Workers
,a er making Nu G,NR s at of Exemption,you should
z Obecome h--I m it W,herS Compenr this provisions of the labor Cade.you mus
forthwith rnmp1Y with such proruions or this permit shall be lamed mwtrd.
Z CONSTRUCTION LENDING AGENCY
[•+ I hereby affirm that them is a constx Linn lending agency for the perfurmance of
ai the work for which Nb permit is issued(Sec.3097,Civ.C.)
C Q l<nder's Nam,
7 z Iendefs Address
U Q 1 certify that I have read this application and stem that the above information is
L F correct.l agree to comply with all city and county ordinances and rule laws relating m
DU building construction,and hereby aumonre mpreacneadws or this city to enter upon the
a above-ms.judg d property t for inspection purposes
(We)agree to rave,indemnify and keep harmless de City of Cup,nino against
o-Fw fA incoitictiuch of the Swung
and expenses which may in any wayeccmc againstsaid City
(),z A APPLICANT
of me granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR � ONS.
` Icro` - Re-roofs
c
Si uatufc nfA I'can tractor to
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant er forum building occupantstom or handle baaardous material
AM defined by the Cupertino Municipal Code.Chapter 9.12,And the Health and Safety
Code,S,etion 255324)1
❑Yes KNa`. All roofs shall be inspected prior to any roofing material being installed.
Will me applicant of future building occupant tau equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
it hovaNnus air contaminants as defined by rbc Bay Arca Air Quality Management all new materials for inspection.
District? AN.❑Yes yt N° .
I have mad the laramnus materials requimmcnts under Chapmr5.95 of me Califor-
niaHcalth&Safcty Cade,Sccdwu 25505,25533 and 25534.1 undersand thmifthc building
docs not currently haw a tuna,dot It 4 my responsibility m notify the oaupmt of one
nracwBe=of Occupancy Signature of Applicant Date
/
wn,ror amhari'rnd m Damw All roof coverings to be Class "B"or better