06020169 (2) CITY OF CUPERTINO r x> „ » •°' Tri "' ' ' 'k '
BUILDING DIVISION PERMIT C®NTRACT®RINFORMA'CION
BUILDING ADDRESS: PERMIT NO-06020169
21646 ST VE
OWNER'S NAME: PERMIT ISSUE DATE
Ak BEST BIRD' S NEST 03/08/2006
E:
SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION ,,,,//�dggsskkO O O O
4 u C 1 hereby affirm Nat I an licensed under pravislans of Chapter 9(commencing ]Ob a
!Zbw with Sceuon7tX10)ofDivision3ofthe Busimas and Profcssiur¢Code.and mylicertseu
d fumeand anent. TI--ADD INT. WALL
n Z in foLicense Class Lt.N
�Fp Da¢ ContractorADD V_ 006
PPry ARCHITECT'S DECLARATION ort\ 2L
C i I understand my plans shall M used n rn
public rerds
Ddu
Ir Liccnced Professional
g OWNER-BUILDER DECLARATION
y 1 hereby elOrm the 1 am exempt from the Contractor's License law for theIBIJILDIIN
igy
HO following mason.Section 7031.5,Business and Profession Code:Any city or County
$i4i which requires a permit Rt emoiducs,alar,improv.dcmoi W,n repair any suucthre $7500
Z y pd.,it,its issuaMm,alas dop ilea the applicant far such peddiLLO Bl...iircd rlaleaom,
<
than Im is licensed pursuant to the prowitirms of dic Common's License U.;(Chapter 9 Sq. Ft. Floor Area Valuation
yO (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
$ that he u exempt therefrom and the thou for The alleged exemption.Any violation of
Section 7031.5 by say appliam for a permit subjects the applicant to a civil penalty of RUWG�r= Occupancy Type
not mom Nan Bw hundred dollen(5500).
❑Lnownerofthepsoperty,mmyeopdoy n.uhwagu an
teir In cance,madot,
will do the work.and theswcsure is not @
intended orored for take(Sec.7814.Business Required Inspections
and Profcnion
Code:The Contractor's Linme law des mune
onot apply in an ,of Q p
property who builds ser improwas Nermn,end who does such work himself or through his
awn employees•provided that such impmwmmu see not intended croRered forsaie.If,
hawew,.the building or improwmenl is sold within one year of completion,the owoer-
Wilder will haw the Worked of proving that he did not Wild or improw for putpe c of
.in):,
❑,I.n own,of The property.am exclusively contracting with licensed mntrazton to
construct the pmjca(sec.7014.Business and Profession Codc:)The Comment's Li.
cone law docs not apply to in owner of propeny.who Wilds or improves themon,and
who contacts for such projects with a contramar(s)licensed pursuant lathe Commormes
License law.
ED 1 am exempt under Sec. j B d P C for this m/oon
Owner � j�l/I 1 2D21! Dale D G
WORKER'S COMPEIIIIATIDN DECLARATION
1 hemby aff res under perWty of pedury mon,of the following declarstionr
R hI hill
am and wmaintain aCmiftnm of Canedt 1.selLinure for Workers Comped-
noon,u providod for by Section 3700 of the tabor Code,for the perform..of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Sectio
3700 of the lathor Code.for the pedormence of the work for which this permit is issued.
My Worker's Compensation Insurance carrier end Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section need not hecompletcd if the Permit is for one hundred dollars($100)
or]Co..)
1 Certify that in the performance of on, or for which this Permit is issued.I shall not
employ any'personinany, nern>s4obccomcsubjenmlhe Workcm'Compenadon
Lawsof C.1ifomia.Q do
Applicant ` -
NOTICE TO APPLICANT:If.after making is ceniacae of Exemption,you should
become subject to the Worker's Compensation provisions of the tabor Cade,you most
.J z foMwith comply with such Provisions or this Permit.sball W domed ro nked.
z� CONSTRUCTION LENDING AGENCY
[-� I herebyafion that then is a Construction lendingapoey,for the ferfwmamcuf
Ci> the work For which this permit is issued(Sec.3097,Civ.C.)
1 A Lender's Name
z Lenders Address
O Q 1 certify has 1 have dad this application and state Net the a Ww informed..is
L.. correct.I agree us comply with all city and county on inane s and state laws misting in
DU Wilding convection.and hemby authorimreproSenutims Of this city Locator upon use
r a ahovcmemioned.ts. . for inspection pturpcwhich a
(We)agree w saw,indemnify and keep hannkaf the City of Cupcnino against
► N in
of the granting
tsind eepenPamit. may in any way aecmc against did City
t)z, A APPLICANT
of UNDERSTANDS
this permit.
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION Issued
3�d�%ob Re-roofs
Signature of ApidicanuCcurcroxim
DBe
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will due...licant or future building ocmpans store orhanllc harardous material
W defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
Code,Smtion 25332(.)?
❑Yes 'ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuLam budding Occupant use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
it ha.ardnus air contaminants as defined by to Bay Area Air Quality Management all new materials for inspection.
District?
0Yes 0N
Ihaw man the hanNousmucrialstcpuimmenuunderChapterG95ofteCalifor-
niaf alNhSafety Code,secduns25505.25533md25534.iundcrstandtheifthe Wilding
does mL curtcntlyy haw a tcO Nat i.ki my nsparuibilby m mdfy the metepa t of LW
rexporeroen 6�ch —he t urlaissuanmoisCmifeaeof c. Signature of Applicant Date
D 6 All roof coverings to be Class"B"or better
Owner or aur omed agent pee coverg