06030016 CITY OF CUPERTII�tO � MAUI .
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:MROBERTA SKANDALI S 0 6 0 3 0 016
10177 YER PL '
PERMIT LSSUE DATE
OWNER'S NAME:
ROBERTA SKANDALIS 02/23/2007
— SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGMER: BLDG ELECT PLUMB MECH
p C LICENSED CONTRACTOR'S DECLARATION Job Description
UJ
): 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
:z� withScction7000)ofDivision3ofdteBusincss
and Professions Code,and mylicense is KITCHEN REMODEL—MODIFY WINDOWS/WEST WALL
M in full force and effect.
j ? License Class Lia If
t- Dam Contractor
ARCHITECTS DECLARATION
j a< I understand my plans shall be used as public records
)yU
u.l- Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7(Y31.5,Business and Professions Code:Any city or county
m which requires a permit to constructalter,improve,demolish,or repair any structure
prior to its issuance.also requires the applicant for such permit to file a signed statement �q Ft.Floor Area Valuation
-Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $80000
2 l- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3162305'
Number
not more than five hundred dollars(5500). 316 2 3 O 5-- . V V
❑L as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's Lice Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of
s—ale.).
aa`as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cerise Law docs not app an owner of property who builds or improves thereon,and,
who. rs Cor such cos with a contractors)licensed pursuant to the Contractor's
License - B&P C far thi
er s 7ason
;I - e pt und
Owner �� 1
WORKER'S COMPENSATION bECI ARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain.a Certificate of Consent to self-insurc for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which.this.permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance f wor or hich this.Vo
eo�tt is issued,1 shall not
employ any persorrinapY manner s d�Workcrs Compensation
Laws of Califom' .Da I
Applicant
NOTTCE'TO A PA
ftc ertificatc of Exemption,you should
become subject tocr's C tion visions of the Labor Code,you must
Z forthwith complyuch prov hors or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
E.. �. I hereby affirm that there is a construction lending agency for the performance of
p; r7 the work for which this permit is issued(Set:.3097,Civ.C.)
W A Lender's Name
Lender's Address
I certify that I have ad this application and state that the above information is
LTLT.O recorrect.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against
„�, rA liabilities,judgments,costs d expenses which may in any way accrue against said City
U Z in con sequencl�of the g tini of this rmit. Date !� _
APPLICANT UNDER DS A WILL COMPLY WITH ALL NON-POINT Issued b":
SOURCE TIO
Re-roofs
Signatu ofApplican on for Dam T e of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future build' g occupant store or handle hazardous material
as defined by the Cupertino Munici Codc,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof, shall be inspected prior to any roofing material being installed.
❑Yes o
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future buildi
s dcfing cupant use equipment or devices which
emit hazardous air contaminants an y the Bay Area Air Quality Management all new I naterials for inspection.
District?
❑Yes N
I have'read the hazbrdous materials requircmcnts under Chapter 6.95 of the Califor-
nia licalth&Safety Code, c)jbns 25 5,25533 and 25534.1 understand that if the building
doca n6[ erre ly have a nt that is my responsibility m notify the occupant of the Date
require h'hmust tp rto ceoCaCcrti;icIproccupagcy./ 11 Signator°ofApplicant
ryC /O�J/h �!//Iy/ All roof coverings to be Class 'B or better
Owner o authorized agent Date