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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
Un
PERMIT NO.
10370 MENHART LN
DWK CONSTRUCTION
08090091
I NERS NAME:
PERMIT ISSUE DATE
18665 LOREE AVE
10/20/2008
"ONE:
SANITARY NO. CONTROL NO.
ARCHITECT(ENGTNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I thereby affirm that I . licensed A&, Provisions of Chapter 9 mcmurmoctal;
inSection 7") of Division 3 of the Business and Proficemaims, Coda, and my license is
DEMO EXISTING HOUSE 800 SQFT
. Nit f d if 32
10 arm An 0 W!t2
License Class
Contractor ons
10 c, 0 Contractor 1)WK L�51r�crlo�
Dow 1& 40
77�"
I ad land my plans men he used As public ramucas
Am
Linnowidi notional
OWNER- W K&ER. DECLARATION
I Isenclay affirm that I Am asompt from the Convactoes License Law for the
following reason. (Section NO 1.5, Business and Professions Code: Any city or county
which requires a pc mit no construct, altar. Improve, demolish, or mpair my oruclum
prior W its issuance. Also restfirall the m3plmod (Carsuch pencil to file asigrund suaternam
us the of the Contraccusea Licanse Law (Ch.pW9
Sq. Ft. Floor Area
Valuation
That he is licensed pursuant provisions
(commencing with Section 7000) of Division 3 of me Business and Primilesoons Code) or
$12000
that he IS MOOPE and use basis for the Alleged examption. Any violation of
Number
Occupancy Type
Section 7031.5 by arty Applicant for a permit VbjcCu the applicant to a civil penalty of
net more than fin hundred dollars (M),
37516012 .,W
0 1, As Owner of the property, or my employeas, with wages, a chair win compensation,
Required Inspections
win de the work. and the structure is not attended coffered for sale (Sm. 704,4. Business
and Professions Code: The Contractor's License Law does Am apply to An answe, of
pmpmy who bonds arimprom memon. and who docassuch work hosselfarthrough his
Own employees, provided that men improvements Am not inmnak4 oroffeand formic. If.
however, the building or improvement is sold within a= you oftemplation. the amnar-
Wilder ill have the bunds. of Paving that the did net Mid or improve far purpose of
.[A.).
E] 1, As mmr of dam property am exclusively contracting with licsouted contractors In
consumer the project (Sec. 7044. Business and Preesoments Cade:) The Conmamuer's Ll -
cocoa Law does not apply to an owner of property who Wilds or improves, tivemon, and,
who contracts for such Imcfecas with a conummor(s) Restated parmant to the Contrammes
License Law.
E] lumaxamptuadiesSm. ..B&PCfarthismancen
net Data
WORKER'S COMPENSATION DECLARATION
I hereby afrim under penalty of perjury One of the following declarations:
❑ flatware! will
salim As provided for by Section 37M of me Laimer Code, for the perfamanex of time
work for which this cratt A issued.
-1 1 have and will maintain Worker's Compensation lasommum, As required by Section
37M of the LaboaCadds, for the iscriormance offt wort: for which this permit is issued.
My Workee& Compensoutiom Inscrance, carrier And Policy number Am:
Carrier. Putney No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This motion road noLlIecompicied time permit is Income hundred dollars ($100)
or to.)
I moi %.11. the performance of flan warts for which thin permit is issued, I net at
employ any person in my mmrF subject to the Worems' Compermadon
"Wc
Lawsat
U f
Cortiltame of Exemption. you should
become subject to the V . ofthal-mucarCask. you am
forthwith comply with such provision or this permit shall x deconeat revoked.
CONSTRUCTION LENDING AGENCY
I hereby .11han that them I.. movoccomi leading i for the perfixam. of
the waste for which into permit As issued (Sec. 3097. Civ. C.)
Undoes Name
Lamice. Add.
I ennify that I have read this application And same that the above information is
correct. I agree At comply with all city and County ordinammus and sum laws miming on
Wilding construction, and Istaby multorim acturesconalim Of ImS City 10 enter Upon Itle
.1vow...mioncd properly far impaction parpost.
(We) Agree to saw, indemnify And lem, Journal. In. City or Cape against
fiabifiutaa.�Iudgmcms, cam And cafamesca which may in my way access, Against Am City
in consequence Of the Starting Of this Fatah.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE
6- Data
Its4iIARCOUS MATERIALS DISCLOSURE
Will d1b, Applicant or future, Wilding acautproulston, m handle hanandours manamed
as clefland by the Cuarfirm Municipal Code, Clat,da, 9.12. And the Health And lately
Sectm. M32(al
-3 Y. �4,Na
All roofs shall be inspected prior to any roofing material being installed.
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
arrit Im.ndatc. Air mmosaimmas As d.fiand by Its, Bay A. Air Otmit, M .... towra
all new materials for inspection.
District?
0y. XN.
I have mal the hammous materials requirements under ChzpuA&95 ofthe Califor,
nice H,.?Lh&S.fctyCade.S.6.25505.25533a 25534.1.&mundWtifthe, Wilding
does an, currently how A mosm, thato it 4 my responsibility as notify the oneopeal of 0e
acquircromas which am to =I Prior An issuance Of a Certificate of Occupancy.
Signature of Applicant Date
-7 0 C- 2.0-
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All roof coverings to be Class'W' or better
Owner Do.
or ..Ilmn.d age., Y