08080063 CITY OF CUPERTINO "N- - : – - — _
BUILDING DIVISION PERNUT CONTRACTOR�INEORMATTON-
„ _
PERMIT N0,
IBU1Lp1iM19FSEDERBR00K LN PETER CONSTRUCTION_ _ 08080063
NEWS
1111 WEYBURN LN STE 52 10/20/2008
PHONE: SANITARY NO CONTROL NO.
(408) 529-6412
ARCNtTER/FNGINEFR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
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.68
LICENSED CONTRACTOR'S DECLARATION
C 1 hby affirm that 1 m lived mticr pnsiumns of CTapmr 9(Commencing lob Description
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t� with Section 7M)of Divimm3 ofthe Business and Professions Code,and my license is ADD 635 SQ FT TO NEW ENTRY PORCH & FOYER, LIVING
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in full for and oBecL
License Clan . r
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°am in :C tbnID ja EW BEDROOM & BATH/REMODEL BATH-SANITARY IS
ARCHTECI-S D
� u I understand my plan sslWlbe npubb � SVLE' S
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44, Licensed Professional -�
ao3 JURISDICTION.
in
awNER- IIDER DECUannon
'� f 1 hereby aRrre Out I am empt from then Contractors Lteemm law far the
p O followmg moron.(Seed an 7031.5.Business and Professions Code:Any city Of county
Egg which requires a intention
m comswcl,after,mprow,demoliah,or mPon any am em.
2 y prior in its issuance.alm mquima the applicant fns such permit in file a signed slatertlml
p < that he is lianmd Potential 1.the pmrisiam of the Commerce-License lgw(Ch-Pw9 Sq.F[. Floor Area Valuation
$80000
(commencing with Sncm 7000)W Divson)of thBusiend Pfuimu ).r
that he u eampl Ihemfem and the bass for the alleged eaonpdm.Any Holadon of
Section 7031.5 by any applicant for a Permit subjects the applicant e a civil penalty of Number Occupancy Type
Cot mom Nan fine hundred dollars(SSW} 369200441 [�
❑1.u awry of the prvpenty,a mY rmployces with wages ss Ness Cole Compensation,
wdl do the cowl.and the mucmm anti,intended oroRered far$at.(SecJOSa,Business Required Inspections
and Pm(esaies Cade The Comemmrs License Law does our apply m an awxr of q P
properlywle builds orimpairs thereon.and ohodoessuchwart mainline Lh msgb his
ownemployces,paWded Nat such impm umenu art aattn¢nded araRemd!area-IL
however,the building or impmwmcut is sold within am year of completion.the owner-
WildV will have de Muds of purring that he did rot build m impmw for pmpme of
am.).
0 1.ss marten of the property,am eu:luaiwly contracting with licensed Contractors as
Constrwd the pains(Sec.70th.Business and Pofemons Cade.)The C"Amem Ys LL .
cense Law dons not apply m an owner of impurity who budds or imprem daemon,used,
who conuacu for such pejecu with s eonvacmr(s)licensed punwnl he the Contractoes
LiaLUY lour.
0 l am exempt under See .B At P C far this mean
Dos
WORKERS COMPENSATION DECLARATION
1 heeby affirm under penalty of pegury one of the following donlarmonsi
0 I hart am will Motown a Cere fiou of Consent W self-insert fm Warless;compm-
smon,ss pruvtdod for by Section 3700 of the Labor Code.fm the performance of the
for which this Permit u issued.
1 turn and will mainuin Waimea ComPanssuafa Insu..as mquimd by Section
3100.17 the Labe Coda,fm the PaRoror an.of the wort forwhlch Ous peen u issued. '
My Waekefs Compaudao Insurance amict and Policy numbs ate:
Cartier. s G Z•��(/ s7 Polity No.0 v
A TE OF @XE MON FROM RK
W ERS'
COMPENSATION INSURANCE
(n ds ma lm need not M completed if the Panel,is formic hundred dollars(5100)
m 4ua)
1 certify Nat to the perfomanca of the wart for which this Permit is Wood,1 shal ml
employ any Poison in any Wormer an as to become subject to the workers Compnsailon
Laws of California.Dr--
Applies-
NOTCH IV APPLICANT.IC after making Nu Cer ificae of Exemption.you should
become subjm in the Workers Compensation Provisions of the labor Cade you mum
0 O forthwith comply with such porisiuns m Nu parfait shall be contend rewked.
CONSUCTION LENDING AGENCY
[•+► TR 1 hereby affirm that them Lt.conmtctim lending agency,far the prfmmance of
CL the work far which tiffs emit a issued(Sec.3097,Cir.C.)
W 0 Lenders Nan•^
az Lenders Aside••
U 0 1 amity Nat I haw read this application vM auto Nat tie above information is
(L Ey Correa I ages an Comply with all city and county ardhwwes and sum laws relating N
0 U Molding co mucdon,and hereby authmrz mpreaeoutives of this city In enter upen the
W alew-menmos d Property for impaction purpmes
Lis (We)agree m saw,indemnify and tap hamless the City of C.Pamma against
Iiabiliues,judgments,cams and espn¢s which may In my way afaue igunstsaid City
U,'Z m cansegmem of the gemming of this Permit.
^-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. _
Signuum of Aplifan✓Con Re-roofs Q
u
US MATERIALS DISCLOSURE Type of Roof
Will the apparent sir future building ommpanlmon,m hatalc hmaNans mamma
�defined by the CupW non Municipal Code.Chapter 9 13,and ate Health and Safety
de.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑ins
Will the applicant or future building occupant am equipment or deriry which If a roof is installed without first obtaining an inspection,I agree to remove
emit hauNOns aircanummanu as defined by the Bay Area Air Quality Masgemenr all new materials for inspection.
Dmnctt �,/
0Yor 7�Na
I haw mat the huatdms mamas rtquirtmeau under Chapter 6.95 of the Cabfor- -
na Health k SafcryCade Such.25505,25533 well 25534.1 m ismand then d the budding
door Cot currently hew,a annual.tint it a my nemonsibilily m family the aatmutl of the
raximmmemis which mum be meteor an aama;of a cmafmam of amPaaay. Signature of Applicant Date
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'�� _ l h�="��u?J All roof coverings to be Class'W'or better
Owner or mtharimd agent date rj
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