07090158 CIT�' OF CUPERTINO ' � ;
BUILDING DIVISION PERMIT ��������A�' ������
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, PERMIT NO.
BUILD � r ��� o � ES BROOKWELL DR STERLIN�� GENERAL 07090158 .
OW NER'S NAME: ' PERMIT LSSUE DATE
MERCER SHERRYL E 1727 DE:�L AVE 10 05/2007
SANITARY NO. CONTROL NO.
1NE:
(408) 8'71-1372
BUILDING PERMITINFO
ARCHTIECC/ENGINEER:
BLDG ELECT PLUMB MECH
� 0 � 0
i p p LICENSED CONTRACTOA'S DECLARATION IOb DESCLlptlOil
%� 1 hcrcby afGrtn that I am ticcnscd undcr provisions of Chaptcr 9(commcncing
;Z � withSccdon700(J)afDivision3oftheBusinessandProCcssiunsCodc. �]Ij�jD�V� �ic INTER DOOR MODFCTNS & ADD 1 SKYLIGHT.
°= y in fuli fomc and cfCec�
j v� z Licenx C1ass Lic. N
: F � Datc Contractar
� ARCHITECI'S DECLARATION
7 a� 1 undcrs�and my plans shall Ac uud as public reconls
)yU
' a. F' Liccnscd Pn�fcssional
� y � OWNER-BUILDER DECLARATION
1 hcrcby a�Tirm thal 1 am cxcmpt Gum ihc Contractor's Liccnsc Law for thc
� p o follawing rcuon. (SccGon 7031.5, Busincss and ProCacsions Cafc: Any city ar county
�,°, �i which rcquires a pcmiit to conswct, altrs. improve, dcmolish, or repair any stiuctmc
�� y prior ui i�s issuancc, alw rcquires ihc applicant far such permit �o Glc a signcd swcmcnt , F[. FlOOC ACe3 Valuation
y � that hc is IiccnscJ {wcsaant to thc provisions of ihc Contractur's Liccnsc Law (Cha��cr 9 �q � 2 O O O
u t- �(commencing with Scction 7000) ot Division 3 oC Ihc Business nnd Profcssions Codc) or
,, �.. that he is exempt thcrefrom and U�e buis [or the allcgcd exempdon. Any violation of
Secrion 7031.5 by a�ry applicant for a pecmit subjecu ihe applicant to a civil penalty of Number Occupancy Type
not more than 6ve hu�red dollars (5500). 3 6 9 2 1 0 3 3��
❑ I. as owna of Uie propertY• ar my cmployces with aaga as their solc compecwtion.
willdotheworkand�hestcucwceisnotintendedoro[Ceredforsalc(Sec.7044.Business Required Inspeetions
and Professions Code: The Conuactor's License Law does not apply to an awner of
propeny who builds or improves thercan, and who does such wort himsolf or Uuough his
own employccs, providcd that such improvemen�s are not in�ended or oRemA Cor sale. [[,
however, the building or improvement is sold within one year of complction. �he owner-
buiider will have the burdee of proving �hai he did not build or improvc Cor pwpose of
salc J•
1, as awner of �he property, am acclusively conuacting with littnsed convactors W
c tnut Uie project (Sec. 7044. Business and ProCessions CodeJ Tl�e Coauactnrs Li-
cense Law docs aot apply �o an owner of propeny w6a builds or improves Ihereon. u�d ,
who conuacts for such projects with a contractoKs) Gcensed pursuant a �he Conuactols
License Law.
❑ I um ezempt u du Sec. . B dc P C f� '
Owner ���-!•-'!9 Date J� _... _:
WOR 5 MP SATION DECLARATION
I hcreby �em under penalty o[ perjury one of the following dxlarmions
❑ I have and will maintain a Certificate of Consent to self-insure for Warlrc�s Campen-
sation, as provided fm by Section 3700 af [he Labor Code, far �he petformarce of the
woric for whicd this permit is istued.
❑ 1 havc and will maintain Worker's Compensaaon Insurence, u�cyuired hy Scceion ,
3700 0( tAc Labor Cade. for the peRormance of the work for which ihis pemiit it issued.
My Workels Compensation Insurance carticr and Policy number are:
Cartier. Poliry No.:
CERTIF7CATE OF EXEMPflON FROM WORKERS'
COMPENSATIONINSURANCE
(ihis sectian necd not be completed it �he peemit is for onc hundred dollus (5100)
nr Icss.)
I cenify that in thc pertom�ancc af thc work for which this permit is issucd. t shall not
employ any person in any manncr w ta bc mc fuhj t tq_th rkcrs' Compcnsatian
Laws o( Cali(omia. Datc ��
Applicant � (sL�
NO'fICE TO APP�CAM: If, aftcr aking U�is Cc iGca�c of Excmpuon, you should
become subject to �he Worker's Compensation provisions aC �he Labor Code, you muu
� O forthwith comply with such provi�ions or this pecmit shall bc dccmcd ccvokcd.
z """' CONSTRUCTION LENDWG AGENCY
F r ► I hecc6y aCGrm U�at there is a conswction lcnding agcncy for thc performance of
p�., � �hc w�rk fur which this permi� is issucd (Scc:. 3097, Civ. CJ
� A Lendcr's Namc . �
� z Lcnder's Address
V Q I certify �hat 1 havc tcad lhis application and s�atc ihat thc abovc in(ocma�on is
�� corrcc�.1 agrce to comply with all city and county ordinances and suk laws relating to
� U building conswction, and hereby authori�e representatives of ihis ci�y m enier u{xm the
� W above-mentioned property for inspecuon purFwses.
a (Wc) agree to save, indcmai(y and kecp harmlcss thc Ci�y oC Cupertino againtt
H � liabiliues, judgmenLt, costs and expenscs which may in any way accruc agains� said City
(� z in consequence of thc granting of �his permit. D1Ce
� APPUCANT UNDERSTANDS AND WILI. COMPLY WITH ALL NON-POINT Issued by O � �
SOURCE LATIONS.
����� /U�S' 0 7 Re-roofs
Signamrc af Applic�y onvactor' �� T e of R oof �—�
HAZARDOUS MATERIALS DISCLOSURE }rp
Will thc appticant or future building occupant sarc or handlc haracdous nu�ial
as defincd by the Cupertino Municipal Codc. Chapter 9.12, and �he Health and Safety
Code, Scclion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
� ycs �No
�11 ihc applicant or Cuturc building accupant usc cyuipmcnt or ckrioes w6ieh
If a roof is installed without first obtaining an inspection, I agree to remove
emii harardous air con�aminan�s az dcfincd Ay thc Bay Area Air Quality Mamgcment all new rr aterials for inspection.
Disuict? �'"
❑ Ycs �nu
( '
1 havc read the ha�ariCous maierials rcquiremcnts undcr Chap�cr6.95 of Utc Calilor-
nia Hcalth & Safcty Codc, Scctions 25505, 25533 and 75534. l undcrsund thaz if ihc 6uilding
docs not curtently ha�c a tcnan4 �ha� it is my rcsponsibiliry �o notify ihc occupant of �he
reyuircmcn�sw ic muubcme�priorwissuanccaCaCcrtificatco(Ckc Signature ofApplicant 1 Date
'� ���—��✓ � U -� All roof coverings to be Class "B or better
Owncr or authorizcd agc�i� � �