07100030 CITY OF CUPERTINO �s n
BUILDING DIVISION PERMIT �����"'��� �����
PERMIT NO.
BUIL n j rc �B�� ES �ATALANO CT LOT 5 GREATER BAY CONSTRUCTION 07100030 .
pgRb(IT ISSUE DATE
R'S NAME: •
PANCAL CATALANO 4125 BLPCKFORD AVE 10/16/2007
SANITARY NO. CON'fROL NO.
P"o"E: (408) 24�-6600
BUILDiNG PERMIT INFO
ARCHITECC/ENGINEER: BLDG ELECT PI.UMB MECH
� � � �
j p � LICENSED CONTRAGTOR'S DECLARATION IOU DeSCflpL10❑
' v�', I�rcby afGrtn that I sm licenscd unJcr provisions oC Chaptcr 9(rnmmcncing REV I S I OT - TRU S S CALC S- OR I G # 0 7 0 4 0151
; Z� wiih Sccdon 700U) af Division 3 0( ihc Busincss and Profcssions Codc, and my liccnsc is
�� y in full force an d e C tec �
� v� Z Licensc Class Lic. #
p Datc Contracwr
: E' u� ARCHITECI'S DECLARATION
a
j a 1 undcrstand my plans shall Ae uscJ as public rccords
)yU
� a y Liccnsed Pm(cssional
- � a OW NER-BUILDER DECLARATION
� <� 1 hcrcby alTrm ihat 1 am cxcmpt from ihc Convactors Liccnu law for thc
p O tollowing reason. (Scction 7031.5, Business and Profcssiont Ca1c: Any ciiy or county
�°�, � which requires a pcmiit to conswct, altcr, improve. dcmolich, or repair any swctucc Valuation
°' y prior w i�s issuance, alsu requires thc applicant Cor such permit w file a signed statcment �' Ft. Floor Area O
- Z < that hc is IiccnscJ pursuanl to thc provisions o[ ihc ConuacWr's liccnsc Law (CAaptc� 9 `'q' $
� F� (commcncing wiih Sccdon 7000) of Division 3 0( �hc Businrss and Profcssions Cadc) or
��� �a� he u �umpt thecefrom and �Ae buis for �he allegcd ezemption. Any violation ot QCCU 2TIC T e
Section 7031.5 by arty applicant (or a pamit subjecu �he applicant to a civil penalty of 3 6 218 0 6�> �� Number P Y yp
not marc than fivc 6un dm d dallars ( 5500�
� 1, u owncr oC tt�e property. or my cmployces with wages as ehe'v solc compensadon,
will do thc work and ihe suuawe is not inter.dcd or atTued for salc (Sec. 7044. Busioess Required In spections
and Pcofessions Codc: The Conuacwr's License Law dacs noe apply w an ownu of
propeny who builds or improves thercnn, and who daes such work himself or through dis
own emp yces. Pro'ndcd that such improvements are not intended or atCered Cor sale. I[.
howe . �he building or improvemmt is sold wiehin one year of comptedon. U�e ownu-
build will have the burdu� of proving U�at hc did wt build or improvc for pmpoxe of
�� .
I. as owner o[ the propeny. am ezclusively contrac�ing wiU� licensed convxtors w .
construct the projen (Sec. 7044. Business and Pro[essions Code:) The Convxtors Li-
cense Caw docs not apply lo an owner of propeny who builds ar improves ihneon. snd ,
who contracu for such prajects with a contractor(s) liansed pursuant to the Contracro�s
License Law•
Q I am exemp u r Sec. . B 8c P C for this rcuon
t Date _ . °
WORKIIY NSATION DECLARATION
I 4 by afCirtn under penalry of pecjury one ot the following declaralions:
❑ t hs.x and will maintain a Cutificatc ot Conscm to sclf-insum Cor Workcls Campen-
sation, as providcd for by Section 3700 af the Labor Code, for �he pedormancc of the
work for which Wis permit is issucd.
❑ I havc and will maintain Worker's Compensation Insurana, u �cquired by Scction ,
3700 aC �hc Labor Code. Cor thc performance of �he worr for which this permit is issued.
My Workets Compensalion Insucance carricr and Policy number aze:
Carrier. Policy No.:
CERTIF7CATE OF EXEMPITON FROM WORKERS' .
COMPBNSATION INSURANCE
(This section nced no[ bc complctcd if the pecmit is for onc hundred dotlacs (5100) .
or Icss.}
I cenify thet in thc perforn�ance of the work for which �his pertnit is issuc4 I shall not
employ any pccson i any manncr so bs to bc subject �o ihe rs m 'on
Laws of Calilomiz tc ���
Applicant
NOTICE TO AP AM: If, aftc m g ihis Ccrti �catc of Eaccmption, you shou�d
bccome subjcct �hc Worker's o pcnsa�ion provisions af thc Lahor Codc, you must
� O fonhwith com y with such provisians or this permit shall bc dccmcd mrolccd.
Z �-�" CONSTRUCTION LENDING AGENCY
(.�..� i-�. i hereby alTirm Wat there is � constnxdon Icnding agenry for the perCurmance of '
�Y., � �hc work fur which ihis permit is issucd (Scc. 3097, Civ. C.) -
W A Lendcr's Namc
a z L,cnder'S Address
U � I certi(Y �hal 1 have read this application and siate �ha� the above infortnauun is .
w F cortcct. 1 agrce to comply with all city and county ortlinances and state laws rcladng to
rJ U building conswction, and hercby authoriTe rcprescnu�ivcs of ihis ciry to cntcr upon thc
abovc-mcnuoncd property for inspccuon purpoxs.
�" a (Wc) agrce to save, indcmnify and kcep humless lhc City of Cupenino agtinst
��, � liabilities, judgmcn , costs and ezpcnxs which may in any way acccuc against said Gty P
U z in conscqucn e c gnnung of this pc Date d�� V Y'�7
►� APPLICA DERSTANDS AN I COMPLY WITH ALL NON-POINT Issued by:
SOURCE LAT[ONS
c u Re-coofs ,/��
Signat ofApplican�Con or �� T of � :OOf
HAZA OUS MATERIALS DISCLOSURE YP
Will the applicant or futurc buil ' g occupant scorc or handlc harardous mucrial
�cfincd by �he Cupenino Munic�i Codc. Ct�aptcr 9.12. and thc Hcal�h and SaCcty
C
:. Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installe .
� If a roof is installed without first obtaining an inspection, I agree to remove -
Wlll thc a�licant or futurc ding occupant usc cyuipmcnt or dcvices which
cmi� haratdous air contaminants cGncd by �he Bay Arca Air Quality Maoagcment all new r laterials for inspection.
Districi?
Q Ycs Nu
I havc rcad U�e ha�ardous maicrials requiremcros undcr Chapter 6.95 of ihc Califar
nia Hcalih & Sa(cty . Sccuons 25505. 33 and 75534. I undcrstand �haz it �hc 6uildio8
Jocs nol cumen�l avc a tenan4 lhat i y tcsponsi6ility W notil'y thc occupan� af Ihe 11 Date
rcyuircmcn w h must met prio to i uance o(a Ccrtificatc of Occupan�y S�gnatllC� � of Applicant
�°' All roof coverings to be Class "B or better
Owncr or thorized agcn� Datc '