09090159CITY OF CUPERTINO BUILDING PERMIT
Compensation laws of California. If, after making this certificate of exemption, I
BUILDING ADDRESS: 19500 PRUNERIDGE AVE BLDG 2 CONTRACTOR: MIKE ROVNER PERMIT NO: 09090159 CONSTRUCTION INC OWNER'S NAME: THE IRVINE COMPANY 1916 DUNCAN ST DATE ISSUED: I 1/1012009 OWNER'S PHONE: 9497205514 SIMI VALLEY, CA 93065 PHONE NO: (408) 453-6070 0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL 0 License Class Lic. # REMODEL STAIR, WALKWAYS 7 PRIVATE DECK REPAIRS; NO Contractor Date RE-ROOF(4000SQ) I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 12/22/10-REVISION #1-REVISE DETAIL 9/A5 TO SHOW RAISED DOOR THRESHOLD BLDGS 1,2,3,5,6,7,8,9.-ISSD I hereby affirm under penalty of perjury one of the following two declarations: 1/7/11 r have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $300000 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 ofthe Labor Code, for the performance of the work for which this permit is issued. APN Number: 3I606037.BLD2 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITIDN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Date 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 all new materials for
inspection.
0 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 & Professions Code)
I, as owner ofthe property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
declarations:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I
performance ofthe work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, se~~34.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Owner or authorized agent: ~ Date: I -7 -II
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's Z~N LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
become subject to the Worker's Compensation provisions of the Labor Code, I must
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATIONindemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point sOl~~ns per the Cupertino Municipal Code, Section Licensed Professional
9.18. ~~
Signatur~~/fffNr Date t-7-20 \I
/V
0
CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: MIKE ROVNER PERMIT NO: 09090159 CONSTRUCTION INC j~D~ADp~~~7~td~~E~~ B)dc, :L OWNER'S NAME: THE IRVINE C'bMPANY 1916 DUNCAN ST DATE ISSUED: 11/10/2009 PHONE NO: (408) 453-6070 OWN)2R'S PHONE: 9497205514 SIMI VALLEY, CA 93065 tI LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT r PLUMB License ClassJ Lic. # 79c;729 r r MECH RESIDENTIAL r COMMERCIAL ContractorMr'ftf f?l91/""~~ U.e.-$7:' Date II //~//)J JOB DESCRIPTlON:REMODEL STAIR, W ALKWAYS 7 PRlVATE DECKI hereby affirm that I am licensed under the provisions~~ .;/p ~f Ch pter 9 REPAIRS; NO(commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. RE-ROOF(4000SQ); MIKE ROVNER CONSTRUCTION PD FOR BUS LIC 9/22/9 I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $300000 permit is issued. APPLICANT CERTIFICATION APN Number: 31606037.BLD2 Occupancy Type:I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemni fy and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. e---j -Z-.... //'/~Issued b1(' ~ c Date:Signature Date~L--lJ/tojd9
("
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation, inspection.
will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business & Professions Code) Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous airpermit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance ~vith the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked. Ow~~ D.re,~J-
CONSTRUCTION LENDING AGENCYAPPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting ofthis permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATIONwith all non-point source regulations per the Cupertino Municipal Code, Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional