07100028 CITY OF CUPERTINO ` ` ` -p ' T `
BUILDING DIYISION PERMIT ���������`
>" _;. ,,,.,. ... . _ : _
PERMIT IVO.
BUfLD NG DD ESS:
�158� CATALANO CT LOT 3 GREATER BAY CONSTRUCTION 07100028 �
PERMIT LSSUE DATE
R'S NAME: ,
4125 BL��CKFORD AVE 10 16 2007
SAMTARY NO. CONTROL NO.
PHONE:
(408)24�3-6600
BU(LDtNG PERMIT INFO
ARCHI7ECT/ENGiNEER: HLDG ELECT PLUMB MECH
� � 0 �
j p � LICENSED CONTRACTOR'S DECLARAT[ON JO�J DeSCTlPt1017
: v� 1 hcreby af(icm �hat I am liccnsed undcr provisions oC Chapicr 9(commcncing
: Z� wiih Sccuon 70(xI) of Division 3 of thc Busincsc and Profcssions Codc, and my �icensc is REV I S I O] J— TRU S S C A LC S O R I G P E RM I T # 0 7 0 3 0 0 7 4
�� y in full Coree and cffect
� � ? Licensc Class Lic. #
= p Da�c ConuaMr
: F � ARCHIT6CI'S DECLARATION
7� . �
� I undcrstand my plans shali Ac uscd as public rccords
)yU
° u. y Licensed PmCessional
; � < OWNER-BUILDER DECLARATION
'�� 1 hcrcAy alTirm �hat 1 am excmpt Gom tLc Conuactors Liccnu Law for chc
� p O following rcason. (SccGon 7031.5, Busincss and Pro(cssio� Codc: Any city or county
�$� which rcquires a pertnit ro conswct, altcr, improve, dcmolish, or rcpair any suucture
rior w iL� issuancc, alsu rcyuires Wc applicant for such permit to filc a signcd stalcmcm Valuation
°_ z � � `q . Ft. Floor Area
< � h a t h c i s l i c c n s c d p u rs u an� �o thc provisions oC thc Comractor's Lic�cnsc law (Chaptcr 9 �q � O
r t �(commencing wiih Section 1U00) of Division 3 of Ihc Busincss and Profcssions Codc) or
y�� ihat he is exempt thcrcfrom md the buis Cor tlie allcgcd exemption. Any violation o(
Section 7031.3 by arry applicant Cor a pecmit subjects �he applicant w a civi! penalty of Number Oeeupaney Type
not more than fivc hundred dollars (5500)• 3 6 2 1- 8 � 6 ���
0 I. as owner o[ ttie propcttY. or my employces witN wages az the'v sole compensadon,
willdotheworlc.andiheswaumisnatirttendtdoroftemdforsalc(Sec. Required Inspections
and Professians Code: The Conuactor's License Law docs not apply to an owner af
propeny wha builds or improves thercon, and who daes such work himsel[ar thcough his
own empioyces, providcd that such improvements are not intended ar oRered for sala I[.
Aowever, e building or improvement is sold within one year of wmpletion, the owner-
builder ill have the burden o[ proving Ihat M did no� build or improvc tor purpax of
salc.
I, as awner o[ �he propecly. am exclusively convuting with liansed rnnvactors to
nstmct �he projm (Sec. 7044. Business and Profcssians Code:) The Convacar's Li-
cense [aw docs not appiy to an owncr of propeny who builds or improves Um¢on, and .
w6o conuacts Cor such projects with a con�ractor(s) licenaed pursuant ro �he Contnctors
License Law.
❑ I am ezemp er Sec . B� P C for this rcuon
:r Date _.. _
WORKER' C EPISATiON DECLARA170N
1 hereby affim� un penalty o( perjury one ot �he following dalanlions:
❑ I hs.x and will maintain a CeniGcate of Conscnt lo self-insure for Workers Compen-
sation, as provided (or by Section 3700 of the Labar Code, for the pedormance of U�e
woric tor which Ihis pertnit is issucd.
❑ I havc and will maintain Workcr's CompensaUon Insunnce, az rcquired by Scction .
3700 of �e Labor Code, Cor the performance of the work for which this permit is iuued.
My Workers CompensaGon Insurance carticr and Policy number a�c:
Cartier. Poiicy No.:
CERTIFICATE OF EXEMPI'[ON FROM WORKERS'
COMPENSATION INSURANCE
(This section necd not Ae comple�cJ if the pecmit is for anc hundred dollazs (Sl�)
nr Icss.)
1 cenify thas in thc performancc at thc work for which ihis permit it issucd, l shall not
employ any person in y anncr omc bj �o the Workcrs' Compensation
Laws of CaliComia a
Applicam
NOTICE 7'O APP ANT: If, a m' g �his Ccni(icatc oC Excmption, you should
6ccome subjcet to �hc Worker's C pcnsaGon provisions of thc Labor Codc, yau must
� O foMwi�h comply wi�h such pr �sions or this pccmit shall bc dccmcd mrokcd.
z '"'' CONSTRUCTION LENDING AGENCY
[-�r .�-� I hcreby alTirtn ihat thcre is a conswcrion knding agcncy Cor thc perCormancc o( .
p�., � ihc work for which this permit is issued (Scc. 3097. Civ. CJ ,
W Q Lendcr's Namc
Lender's Address
V 0 1 certifY U�at 1 havc rcad ihis applicaiion and staic tha� thc abovc informatiun is
w ►� cortect. ! agrce to comply with all city and county arclinances and siate laws rclating w
� U building conswction, and hereby authori�e reprcxntativu of this ci�y to enter upon �hc
� W ahove-mcntiuned property [or inspecuon purposes.
a (Wc) agree to save, indcmni(y and kecp harmless thc Ciry o( Cupcnino against
r ,H y � liabiliues, judgmcnts, costt and expcnscs which may in any way acccuc agains� said City
(� z in conxquence oC the granung of thi rmit. �
►-� APPLICA DERS"fANDS WILL COMPLY WITH ALL NON-POIIYf' Issued by: Date D.� t!J
SOURCE LAT[ S.
Re-roofs ��
Signaw arn�����uco � T of F.00f
H RDOUS MATERIALS DISC[.OSU YPe
Will ihe applicant or future buil ' g accupmt storc or handle harardous ma�erial
4efincd by �he Cupenino Munici Codc. Chaplcr 9.12, and the Hcalth and Sakty
�. S�xtion25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ vu o .
�11 ihe applicant or Cuturc b ding occupant usc equipmeM or dcvices whic6
If a roof i s installed without first obtaining an inspection, I agree to remove
cmit ha air contaminan�s fincd by U�e Bay Arca Air Quality Managcment all new R iaterials for inspection.
Districc?
� ya Nu
t havc rcad the ha�ardcnrs mauerials re' mcnts unckr Chaptcr 6.45 of �hc Califor-
nia Hcalth & afc Codc, Scctions 25505, 3 J 25534.1 undcrstand that iCihc building
docs not c havc a tcnan4 Uiat it' my nsibility m naify chc occupant of �hc
rcyuiremc ichmustbcmetpriort issu «arac�,;r�a�oraNP�r. Signature ofApplicant Date
� All roof coverings to be Class "B" or better
Owncr authorized agcnt �