07100027 CITY OF CUPERTINO ' ` ` '
BUILDING DIVISION PERMIT ��������Z����T
,;: . ,_: .., . ... . . _
PERMIT NO.
Bui � ° � r �O� ES �ATALANO CT LOT 2 GREATER BAY CONSTRUCTION 07100027 .
PERMIT LSSUE DATE
R'S NAME:
PANCAL CATALANO 4125 BL�,CKFORD AVE � 10/16/2007
SANITARY NO. CONTROL NO.
PHONE: �4OH�24�
BUILDING PERMIT INFO
ARCHITECC/ENGttJEER: BLDG ELECT PLUMB MECH
� 0 � 0
i p Q LICENSED CON7'RACTOR'S DECLARATION JOb DCSCilpt1011
� V U I hcrcby aCficm �hat I am liccnacd undcr provisions oC Chap�cr 9<commencing
; z� wilh5cction7000)ofDivision3ofihcBusincssan ��c���.a Imy��censcis REVISIOPI—TRUSS CALCS ORIG PERMIT #07030255
�� y in full force and cffec4 �
� v� Z Licensc Class ��. #
p Daic ConuacWr
: � w ARCHITECI'S DECLARATION
j a .�
a 1 undcrstanJ my plans shali Ac uscd as pu6lic records
)qU
' u. y Licensed Professional
: a a OWNER-BUILDER DEC(.ARATION
� a� I hcrcAy alTirm Ihat 1 am excmpt (rom ihe Canuactor's Liccnsc Law for ihe
p O Collowing rcason. (SccGon 7031.5, Business and Profaccions Cafc: Any city or rnuniy
�,°,, �i which rcquires a pertnit �o conswc4 alter. improve, dcmolish. or repair any suucturc
prior w i�s issuance, alsu rcquires ihc applican� for such pertnit to file a signed suu�mcnt �' pt. Floor Area Valuation
-?< that he is licenscd pursuanl �o thc provisions oC ihc Conuacwr's Lictnsc Law (Chaptcr 9 •� c" O
,� F� (commencing wi�h Section 7000) of Division 3 of Ihe Business and Professions Code) or '�
L�.. that he is exempt the�cfrom and the basis [ar Ihe allcged exemption. Any viotuion of
Section 7031.5 by a�ry applicant (or a permit subjects ihe applicant to a civil penalty o[ 3 6 218 0 6 f; �� Number Oecupaney Type
not more chan five 6undred dollars (5500).
❑ I, as owncr of ttie property, or my cmployces with wages az their wlc compensaGon,
willdoihcworka�d�hesuuaureisnotintendcdoratferedforsalc(Sec. Required Inspections
and Pro[essions Codc: The Conuuwrs Licenu Law docs not apply w an owner of
property who builds or improves Ihereon, and who does such work himulf or Uuough his
own employces. providcd �hat such improvemenu are not intended or otTered [or sala IC.
however, building or improvement is sold wi�hin one year oC compledon, ihe owner-
builder Il have the burden oC proving Wa� he did not build or improve [ar pmpose o(
sak
I, as owner o[ the propeny, am exclusivdy conlracting wi�A limnsed rnnuactors W
consuuct the projen (Sec. 7044. Business and Profcssions Cade:) The Conuu.wrs Li-
ccnse Law dacs not apply to an owner af propeny who builds or improves 16e�eon. aod .
who conuac�s tor uc projects with a conuactaKs) Iicensed puesuant w ihe Conuactars
Litense Law.
❑ I am aempt r Sec . B& P C for this reawn
� Date ��I _ . -
WORKER CO ENSA'I70N DECLARA170N
I he by �cm under penalry of pery'ury nne of the following declaruions
❑ I haoe and will mainuin a Certificate of Consent to self-insuec for Worlcers Compen-
sation, u providcd Fw by Section 3700 of the Labor Code, for the performancc of the
work far which this pertnit is issucd.
❑ I havc and will maintain Worker's Compensa�ion Insurance, as tcyuircd by Scction ,
3700 of �hc Labor Codc, Car thc performancc of �he work for which this permit is issued.
My Worke�s Compensauon Insurance cartier and Poticy number are:
Carrier. Poliry No.:
CERTIF[CATE OF EXEMPI'[ON FROM WORKERS'
COMPENSAT[ON INSURANCE
(This section nccd not bc campletcJ if the permit is for onc hundred dallars (5100)
or IcssJ
1 cenity thxs in the performance af �he work for which Wis pettnit is iswed. [ shalt oot
e.^.�ploy any perso i any manncr so as omc subject w We ork�rs' C ��
Laws of Cali(om' tc •
Applicant
NOTiCE TO A PLICANT: If, ftcr aking �his Ccrti(icatc of Ezcmption, you slauW
become subjcct a thc Warkcr' Compcasa6on provisions of �c Labor Code, you must
� O foMwi�h comply wi�h such provisions or �his pccmit shall bc dccmcd n.wokcd
z ' ' CONSTRUCI'lON LENDING AGENCY
(.~.� r-�r I hcrehy aflirm that thcre is a construetina Icnding agcncy for thc performancc af .
a� thc work fur which �his permit is issucd (Sc�:. 3097, Civ. CJ ,
W Q Lendcr's Namc
L.ender's Addrcss
V Q 1 certify thal 1 have rcad this applitadon and sutc that thc abovc infamation is '
�� correct. I agrce to comply wi�h all ci�y and county onlinances and state laws relating w
� U building conswcuon, and hereby authori�e representatives of ihis city to enter u�n the
� a ahovc-mcnuoncd proper�y for inspccuon purposes.
(Wc) agrce to save, indemnify and keep harmless ihe City af Cupertino against
„F„� � liabilitiu, judgmcn�s, cos�s and ezpenscs which may in any way accruc against said Gry
V z in consequencc oC thc g ung of this permi Date �„ �'�'
� APPLICAN'C UN ANDS AND COMPLY WITH ALL NON-POIIY� Issued by
SOURCE REGU NS.
' Re-roofs
Signaturc of A icant/Conuactor � T of R oof �
HAZARDO MATERIA[.S DISCLOSURE J��
Will U�c applicant ar [uturc buil ' g occupant uore or handlc ha•rardous materiol
icfincd by �he Cupertino Munici Codc. Chap�cr 9.12. and the Health and SaCay
:. Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs No ,
WiII ihc applicant or future b ding occupant usc cyoipmcnt or dcviccs w6ich
If a roof i� installed without first obtaining an inspection, I agree to remove
cmi� harardous air contaminants dcfncd by thc Bay Area Air Quality Managcment all new m aterials for inspecrion.
District?
❑ Ycs No
1 havc rcad the ha�ardous ma�crials rcquircmcnu undcr Chaptcr 6.95 of �hc Cali[oo-
nia Health & Safety C , Secuons 25505, 2553 and 25534.1 undcrstand thaz if ihe 6uilding
docs rroi current a tcnan4 �at it is ponsihiliry eo noti(y thc occupam a! the
rcyuircmcnts w i must bc me prior w i of a Ccrtifica�c af Occupa�rcy. Signature of Applicant Date
�� All roaf coverings to be Class "B" or better
Owncr or aut orizcd agcn� �