06060242 (2) CITY OF CUPERTINO r skr .q�
BUILDING DIVISION PERMIT �.�ON TRACTOR INFORMATION
BUILDING ADDRESS: MAIN STREET BUILDERS INC PERMIT NO.06060242
10381 N PORTAL AV
OWNER'S NAME: PERMIT ISSUE DATE
MARDESICH JOHN J AND JOLEN L1906 QUEBEC WAY 06/28/2006
v E: SANITARY NO. CONTROL NO.
(408) 558-7984
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j O o LICENSED CONTRACTOR'S DECLARATION
.�C Ilmreby>from
Nnlamliamcdunde"boynaiauorchapmr9(commcncing Job Description
n with Section 70701)of Division 3 ofdm Business an!Prolessiuu Code,AM my licenseis
± N in lullfameandeffect. SL�� KITCHEN & MASTER BATH REMODEL - NON STRUCTURAL
x$? License Class Lic.N
F p Dam Contrx
ARCHITECTSDEC ATION
I w U 1 understand my plain shall he used as public records RNA
t.
s e.
O G Licensed Professional R H A eii'l,FD
3 OWNER-BUILDER DECLARATION WWW 111777
p 1 hereby affirm that I em exempt from the Contractors License Law for the
p o following mason.(Section 7031.5,Business and Professions Codc:Any city or county C.
<$ which rtyuired a Permit a ennmusL slec improve,demnlush,or repair any suuaum U ,IJ ') Z, / 845000
priorwitsismance.alwrequires lheapplicutforsuchpermitm Elcasignedstammcm
ma Nat he is licensed pursuant the provisions of rhe Colombo's License Law(Chapter 9 Sq. F[. Floor Area f} a[iOn
,t (commencing with Section 7000)of Division 3 of that Business and Professions CWc)or
that he Is exempt timrefrom and th.basis(a N.alleged esemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of XFRr ,I �bOccupaney Type
nmine Nan five hundred dollars(5500).
ot CG „.an
❑1,d eworof the Chemo sure6 ..intimated withwagedu Nev sale 7044. uinum
will do thewona and a,The Cure u nas Licensetimated Law doeseal Act applys(see.in an o uixu Required Inspections
AM property
h mu CMc The.thaterm Liaise law dict int apply lf an owner is q P
propertywhobuildsruimproves Nermrand who dmsnahende confinedthroughhu
owneer.the Wilding.,
impthatrovement
well improvementsi.ans not intended srtfarsale.,-
bu«evv.din Wilding Wreenowmenn is mid wididnot Wild
of mprove for
.,-
builder
' J
builder will have de WN[n of proving Nat k tlitl not Wild or improve far PURae a(
sale.).
❑1,as owner p of project
property,.Business uarty cumarin with:Tossed enntracrors f-
cease a d canon(See.rin werofaMProfession Cattle:)The es thenen. Li 1
come Law coed for
apply je an nater of property who ded p or Improves theman,and.
who contracts for such projects with a conuanor(s)liceued pursuant a de Conuectoh
n Law.
❑ larr I V
am exempt wda See .Bd PCfa Nu reason
Owner Dam �Zql
WORKER'S COMPENSATION DECLARATION f n
1 hereby aRno under penalty of perjury ane of the following declvaziou: `(�/
Q I bcw and will maintain a Certificate of Consent to self-insum for Workda Compon-
sstim,as provided for by Section 3100 of Ne lawn code.for dm Performance of de wort for which NNis permit is issu . Ron 1 have and will maintain Worker's Compensation Iruurance,u required by Section
37M M.label CM..for the performance of the work fa which Nu permit is issued. '
My Wmim"Compeuauon burn.curler and Policy numbs Are:
Carver. r!MfA4 vD Policy No.:
CERTIFl ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
musseaion need not W completed if the permit is forone Wndreddoilm(SIM)
Iced.)
I cenify A<' ce of the far which Nis permit u issued.I shall on,
cmployany person in any manarso m yet the,Warkmn'Compeuauw
Laws of California.Dam
Applic or
NOTICE TO APPI I T.If,after making this Cen ficae of Exemption,you should
become mbjest to the WakcYs Campeuation provisions of the tabor Cade,you muu
.Jaz
forthwith comply with such Provisions a Nu permit shall be deemed revoked.
? O CONSTRUCTION LENDING AGENCY
[-v Ihereby affirm this Nem is a convsuction lending agency for the Performance of
a Nat..,it for which dost permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Tender's Address '
O C) T anify that 1 have read this application and sum that Nat aWw information is
U„ F" correct.1 agree to comply with all city and county ordinances and sure laws relating to
O C) building construction,and hcmby authorize rcprescnmi.v of this city to enter upon the,
r ahovomcnuoned pmperty for inspection purposes
F W (We)agree to save,indemnify and kap harmless the,City of Cupcnino against
p)
liabilities,judgments.costs and expenses which may in any way same against said City 6—
of the
of this permiL
V z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6-2 U
SOURCE REGULATIONS. -
b Re-roofs
�Ifrmttube fAppIi%4wrC.nuAcnor Da <
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant a faun,building aeupant store or handle banardoas material
az dcRad by the Cupertino Municipal Code.Chains,9.12,and the Hcalth and Safety
cam,Section
25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
Yu r.o
•, t/� If a roof is installed without first obtainingan inspection,I agree to remove
Will m.anpfiaam or tion,builJing acupanr usc.yuipmc.i or devices which P g
emir hovardnu air contaminants As dcgncd by the Bay Arta Air Quality Management all new materials for inspection.
Disuictl
❑Yu gNO
1 have mM Oel 2rdwsmamdals mquim=nm under Chapmr6.95 o(Ne Califor-
niaHcalN&Sdcty Cude.Scc a=25505,25533wd25534.1wWc dtheir Nat Wilding
does not currently havea enanl Wt it u my mponsibility m nodly th.occupant Of the
requi ual W missuance of acenlficamafOmucpmmy. Signature Of Applicant Date
r authors enl Da All roof coverings to be Class "B"or better