04060234 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT COiT1ZA.CTOR INFURMATIUI�, ._ ..._ .._ ..
BUILDING ADDRESS: JAMES GUIDOTTI PERMTTNIb4060234
2264 _. . .
OWNER'S NAME: PERMIT ISSUE DAM
JAMES GUIDOTTI
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lop LICENSED CONTRACTOR'S DECLARATION
Y 1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing Job Description
Sd with Section 7000)of Division Sof NC Business and Professions Code.and my license is
inmBto=and crlbet REVISION--IN HOUSE USE ONLY
re License Class tic.#��� Dale Contractor NO NEW PERMIT ISSUED ORIG. #04030014
qq .shall ..d.amARATION CHANGE SIZE FR: 520 SQ. FT. TO 486 SQ. FT.
$< 1 understand my plena shell ARCHITECTS n,d a DECLARATION
DiU
3 G t; Lic,ned Professional
3 OWNER-BUILDER DECLARATION
I hereby affirmshat I am exempt from On Contractors License Law for the
0 0 fallowing motor.(Section 103 1.5,Business and Professions Cade:Any city or county
K$ which requires a permit to convect,alter,Improve,demolish,or repair any structure
m-e rn prior m its issuance,also requires the applicant forsuch permit to file a signed statement
-
��s Nat he is licensed Pur+uam In the provisions of the Conlnewes License Law(Chapter 9 Sq.Ft. Floor Area Valuation
£ D or the and
,w (cumanisexemng pthherion 70M)romandof basisoM3theOBusinexempton.AnianaCods)or $55733
that he 6 exempt therefrom and the basis for the alleged exemption.Any violafion of
Section 7031.5 by any applicant for a permit subjects the apPlicanuo a civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollar(5500).
I,nownu ofthe prop,ny,umy employe"with wsgesntl¢ir axle compenption,
will do the work and theswctum is not intended or offered fen.alc(Sec.7044,Business
and Profeasiona Cade:The Conuacter'a License Law does nut apply N an owner or Required Inspections
prapenywho buildamimpmves thereon,and who doessuch worlehimselfor through his
awn employ,.,,provided that ouch improvements are not intended c raRered forsale.If,
however,Ne building or improvement is sold within one year of completion,Ne owner.
builder will have and burden of proving Nat he did not build or improve for purpose of
sale
)C]1.I.as owner of the property,am"elusively councilwith licensed contractors to
m
coma the project(See.70 Business and Professions Codei The Codirector,n
coned,
doesnot apply m ann owner of Property who Wilda or e the daemon,end,
who contracts for such projects az
with a canlamr(U licensed pursuant m the Cantnctar's
apse Law.
21 seraph undo See. ,B&PC for Nis moron Yv\
Owl .-6
WORKER'S COMPENSATION DECLARATION
1 rcby aRrtn under penalty of perjury one of the following declarations:
I have and will maintain a CcntOcase or Consent o as]Nasum for Workers ComPe a-
sadon,as provided for by Section 37W of Ne Labor Cade,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as mquired by Section
3700 of Ne labor Code,for Nc pertarmanee or Ne work forwhich this permit is issued. s
My Workers Compensation Insurance carrier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed iRW Permit is for one hundred doll+n(SIM)
or less.)
1 certify Nat in Ne per mmance of Ne work for which this Permit is issued.l shall not
employanypen i yore nor an as m boo .subject to the Workers''Compensadon
Laws off: * rnl9, a1C
Ap li t ^
PLICANT:If,after making Nia Certificate of Exemption,you should
,ce e 'c m Ne Worker's Compensation provisions of N,Labor Code,you must
�7.. IMK YwiLh comply with such previsions or this permi"I all be dccmed revnk,d.
rO CONSTRUCTION LENDING AGENCY
[r 1 hereby affirm Nal Nem is aconswctian lending agency for the Performance of
Ci> N,work for which this permit Is issued(Sec.3097,Civ.C.)
V] Landers Name
z Lender's Address
U O 1 cenify Nat I have read this application and slate that the ahove informadun is
1g F~- correct I agree to comply with all city and county ordinances and state laws relating 1. -
O V building convection.and hereby authorise representatives of this city to enter upon On
W alwvc-mandoned Pmpcny for inspoction PUITMOL
(We)agree to save,indemnify and keep hamtleu the City of Cupertino against
nF•r N
liabilities,judgments.costs and expenses which may in any way ace=&gains,said City
V 7 A LICANTeof the UNDERSTA goS Athis
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
A S EREGULATIONS.
'O Re-roofs
ipmouni.fApplk HAZARDOUS MATERIALS DISCLOSURE ase Type of Roof
Aill the,applicant or future building Occupant store or handle havardous material
d red by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
ccurst 25532(&)? All roofs shall be inspected nor to an roofing material being Installed.
❑Ys, P P Y g g
Will the applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Ycs
[how mad the hanardous maledals requirements under Chapter 6.95 of the Califon
ria H"IN&Saf,tyCo .Secgon25505,25533 aod25534.1undersltodthatiflW building
dors not currently hew a tenant at it is my msponibility Ir Madly the Occupant of Nc
w4 iswhfonmustkno t 41.1... ccs, aCemncateoracaP.n,y. Signature of Applicant Date
Ow a ser ahorized agent - 2 Dat0 All roof coverings to be Class aBa of better