06050031 CITY OF CUPERTINO A.
� � � AT
BUILDING DIVISION PERMIT
BUILDING ADDRESS: REED ARTHUR M AND JEANNE I P T o-0 6 0 5 0 0 31
10990 MARIA ROSA WY
PERMIT ISSUE DATE
11-"JER*S NAME: 05/03/2006
REED ARTHUR M AND JEANNE K TRU
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
a o 0 0
i p LICENSED CONTRACTOR'S DECLARATION Job Description
vI hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section 7000)of Division 3 of the Business and Professions Code,and my license is
Z<MR. ALL EXISTING WINDOWS AND PATIO DOORS.
y in full force and effect
)2Z License Class Lic.S
t-p Date Contractor
ARCHITECTS DECLARATION
Z a< I understand my plans shall be used as public records
�qV
a Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
Coo following reason.(Section 703 1.5,Business and Professions Code:Any city or county $5000
m 9 which requires a permit to construct,alter,improve,demolish,or repair any structure
prior u)its issuance,also requires the applicant for such permit to file a signed statement Valuation
-Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq Ft.Floor Area
2 F a7 (commencing with Section 7000)of Division 3 of We Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
not more than five hundred dollars(5500).
❑I,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 License Law does not apply to an owner of
property who builds or improves thereon,and who does such wort 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 comPleton.the owner-
builder will have the burden of proving that he did not build or im or purpose of
sale.).
I,as owner of the property,am exclusively contracting with licensed conuWa
construct the project(Sec.7044.Business and Professions Cade:)The Contractor's Ct- �
cense taw does not apply to an owner of property who builds or improves thereon,and. L'
who contracts for such projects with a cora actors)licensed pursuant to the Contractor's �(
License La
❑[am e t B lk P C or tho reason
,r Dare 3
WORKER'S CO SATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers 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 Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for ane hundred dollars($100)
or less)
I certify that in the perform of the w for w' this permit is issued,t shall not
employ any person in any m b'ct to the Workers Compensation
Laws of California
Applicant
NOTICE lb APPLICA :If,after making this Certificate of em tion•you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
fYw> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
Z
Lenders Address
U 0 1 certify that I have read this application and state that the above information is
(>~ cormL I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
tH„y liabilities,judgments,costs and expenses which may in any way assns against said City
V Z in consequence of the grantin f this pe it Date
►-r APPLlC N LL COMPLY WITH ALL NON-POINT Issued by:
SOURC At
RE NS.
Re-roofs
Signature of Applicant/Contractor Dare T Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 4`o
/" If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes r Flo
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Saf y otic Scctioru�5505,25533 25534.1 understand that if the building
does not cu ntly ha ate t. ' u is res risibility to notify the occupant of the
reyuire ts w me to'" f a Certificate of Occ er Signature of Applicant Date
J� All roof coverings to be Class"B"or better
Owner or authorized agent are