08110017 CITY OF CUPERTINO r•px'Fatwif� %�' �=
BUILDING DIVISION PERMIT C L,"%QRANk�f} 0M�;
BUILDING ADDRESS: PERMIT NO.
7995 FOLKESTONE DR LANDMARK LANDS P
Will's NAME: PERMIT ISSUE DATE
PHONE: A CONTROL NO.
(408) 691-8636
ARCHITECfrENCINEER: BUILDING PERMIT INFO
BLDG EISCT PLUMB MECH
0 0 0 0
u o p LICENSED CONTRACTOR'S DECLARATION
U 1 Mrtby affirm Nal I am licenced under provisions or Chapter 9(commencing Job Description
with Section 70110)of Division 3 o(Ne Business and Prafrssiur Code.and my license u
� „ infull force and effe 7 ' SIDE FENCE
r n Z Limns C1au L7 I.ic.t J
v;:
p Date 1/ �x-��w Conlrxwr
= ARCHITECTS DECLARATION
6
U 1 undersand my plans shall be had u public recoNs
P G t; Licensed Professional
5 OWNER-BUILDER DECLARATION
i f 1 hereby aRrm that 1 am exempt from the Coninerm's License law for the
no following Hawn.(Section 7031.5.Business and Professions Code:Any city Or county
e a E' when requires a Permit in construct,slur.Impom.demolish.Or repair my smcture
Aly prior an is issuance,also requites the applicant forsuch Permit rile a signed sutemem
Oppmm< IMtMkliconud puncantaNe provisions of Ne Conuuars Linentt law(Chapm9 Sq.Ft.Floor Area Valuation
n (cmmencingwiNScuon700o)of Divuion3ofthe Busi«s dProfessions Code)or
y
that he u OOr
euntpt thomn and the basis f« m
the alleged cM.Fd .Any violation of 83000
Section 7031.5 by any applicant for a permit subjects du applicant a a civil penalty of APN Number Occupancy T
not mom than five hundred dollars($50y, 36207001 . 00 P y yPe
❑1,u owner of tAe property,«ter wplorw suite wages u dte'v wee compcnudon,
will do the work.and the structure IsmainundMma l.d forsde(Sec.7041,Business
Md Professor Cade:The Conmcmrs Liceme Law dors not apply a an Owner of Required Inspections
pmpenywMbuilds«improvesthertm,andwMd«ssuchworkhimttlrmI ughhu
awvemploym,PmWdW Wtsneh impmvervmu am tat intended«oIW W f«sale If.
however.Ne have
the«lees a proving
ovine mid within r,year or mm Improve
for du awe of
builder MB haw da bum.of pvving the K did rot build«improve f«purpose of
sale.).
0 1.as owner of dte property.w eatlumvely contracting with licensed contruron b
corm mtt the project(Sec.7014.Business uM Professions Code:)The Conm«ors U.
cove,law does not apply to an owner of property who Milds or improws thereon.and
who concocts for such pmjecu with a coumetar(s)licensed pursuant a the Contractors
Leers law.
I oro exempt under See .B&P C for Kia Mason
s Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under purely of perjury one of the following declarations
0 I Mw and will maintain a Certificate acumen,to self-insure for Workers Compcn-
nation,as Provided for by Section 37M of use Inbar code.for the Performance Of Ne
wart for which this permit is issued
0 1 have and will maintain Workers Compevation Insurance,as required by Section
37waf tho labuf Code.for IM perfarmwceaflk vont for which this permit I.hooted '
My Workers Compensation Insurance carrim are Polity number tie: -
carrier. IVA&M.av— —L`ti Policy No.:6ZR 2ICi RL RTS,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dtu section need ambo completed if Int Permit is intone hundrtddollus(5100)
or less)
1 cnifv that in the performance of Ne work for which Nis Permit is issued.I snail not
employ any potion in my.anne,an as on become subject to the WOrkan'Compensauan
Laws of Caliform&Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in tM Worter's Compensation provisions of the labor Code you mus
.J 0Mn
fawith comply with such Provisio «this Permit shall be dce. at
ed med.
?h C'ONSTRUCIION LENDING AGENCY
[—� I hereby alarm the Nero sea mruuctom kndingagency far the perferrommar
C>
the won f«which dds permit u iss«A(Sec.3077,Civ.C.I
0 Lender's Name
z lenders Address
U O 1 certify that 1 haw Mad this oppression are sex a mu the show Informations is
C4 F' correct 1 at=to comply with all city and county Ordinances and sum laws misting On
pU building construction.and hereby authorize mptesmutivm of this city to enter upon the
{37 slaw-mentioned property for inspection purposes
G (We)agree a saw,indemnify and keep harmless sea City of Cupenir quirt
can liabilities.judgments.costa and exporter;which may in any wayacre«agaisnt said City
U Z A consequence of mo UNDERSTANDS
of this permit
s-a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date g+
SOURCE ! ULA7' ,p
--^ Re-roofs
Signuum of ApplicamtConuacar Dau
HA].aRDOUS MATERIALS DISCLOSURE Type of Roof
W01 du applicant«future building o"O"Outsam an handle
mm*o one"Ou l
ne
Ed by ftCupertino Municipal Con.Chapter 9.11,ad the Health and Safety -
.section 25531(')7MINAll roofs shall be inspected prior to any roofing material being installed.
Will Nc applicant rfulumroams a building by the Bt tau .Ai,Qu w dMara which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hrrNnm air cmuminsnu as deOned by IM Bay Am Air Quality Management all new materials for inspection.
D mcR
C]Y. M16Z
I ban read the hvardor mate,ialsreqummenu under Chmm,6.95 ofthc Califon, .
nia Health&Safety Code.Secu.25505.25533and255M.Irdeuundthmif0c building
does not currently haw a unarm.that It u my Msporibility te notify me occupwt of the
requirmcnu whi:;7 etpnor to Issuance of a crnirmam of Occupancy. Signature of Applicant Date
"�'
Owner Oe amhomcd agent Dau All roof coverings to be Class'ns'or better
" '