07070174 CIT�' OF CUPERTINO ' ` <
BUILDING DIVISION PERMIT �����T�� ������
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PERMIT NO.
BUI[.D 5�ESS DE ANZA BLVD TBD — TC BE DETERMINED 0 7 0 7 017 4 �
pERMIT ISSUE DATE
OWNER'S NAME: .
CURRY HOUSE 10 05 2007
SANITARY NO. CONTROL NO.
1NE:
BUiLDING PERMlT1NF0
ARCHITECTIENGiNEER: BLDG ELECT PLUMH MECH
0 0 0 0
i p Q LICENSED CONfRACTOR'S DECLARAl'ION JOb D2SCflpt1011
: V� I hcreby aCGrm tha� I am liccnscd undcr provisinns of Cttaptcr 9(commcncing _
; Z� with Sccdon �IXxJ) of Divisian 3 of thc Busincss and Profcssiuns C my iicensc is T I E/ M/ F' NON S TRUC TURAL ( JA PANE S E C URRY RE S TR )
�< a �n full (orcc and ellect � Q
j � Z Licensc pass �. �► �
• p p Conlracar /
; F' � ^ pR ITEC►'S DECLARA ION
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a 1 understanJ my plans shall bc used as public recordt
>yU
� w y �iccnscd Pcufcssional
; � < OWNER-BUILDER DECLARATION
� a� 1 hcrcby alTirtn that 1 am excmpl Gum �hc Conuactors Liccnsc Law Cor thc
p O following mason. (Sccdon 703I.5, Busincss and Professioas Ca1c: Any ciry or county
e$�i which requi�es a permit to conswc4 alter. impmve. demolish. ar iepair any structure
�" y prior �o its issuancc, also ccquires thc applican� for such permit to f Ic a signcd sutemcnt <� , Ft. Floor Area Valuation
� T � tha� hc is liccnscJ pucsuant to thc pmvisions of ihc ConuacWr's Liccnsc Caw (Chaptcr 9 `' $ 4 3 1 5 3 2
Y t- (commcncing with Sccdon 1000) of Division 3 oC ihc Busincss and Profcssinns Codc) or
y�� that he ia exempt thcrefrom and Uu basis Cor the allcgcd exempdoa Any violation o( Oceupancy Type
SecUon 7031.5 by airy applicant for a permit subjects the appiicant to a civil penaity of 3 6 9 4 0 0 0 �; �� Number
not morc than five hundred dollars (5500}
❑[. u owncr of tt�e propixty. or my employces with wages u their solc compensadon,
wilt do thc wurk, and �he structum is noeintendcd or ofCered for sale (Sec.7044. Business Required Inspections
and Professions Code: The Conuacwr's Licenu Law does not aPP�Y a sn m*'ner of
propeny who 6uilds or improves thereon, and who daes such work himself or through his
own employces, providcd U�at such improvemenls are not iniended or o[fered for sala IC,
however, the building or improvement is sold within one yesr of compleGon, the awnu-
builder will have �he b�rdu� uf proving U�at he did no� build ar improvc fw pucpox af
sale.).
❑ I, as awner of the property. am enclusively conuacting wi�h licensed convactors W
construct Uie projea (Scc. 7044. Business and Professions Cade:)'[Le Conuxwr's Li•
cense Law does not apply w an owncr of propeny who builds ar improves Wereon, md .
who convac�s Cor such projects with a con�ractor(s) liansed pursuant a the Convactors
License Law.
❑ 1 am exempt under Sec. , 8& P C for �his rcason
Ownu Date _ .. -:
WORKER'S COMPENSATION DECLARATION
I hercby �rm under penalty of perjury one of the falbwing declantions:
❑ I hsve nnd will maintain a Certifpte of Conscnt to sel(-insure Cor Workcr's Compen-
satian, as providcd for by Sectio� 3700 af the Labor Code. (or the pe6ortnance oC U�e
work for which this pertnit is issucd
❑ I have and will maintain Workefs Compensation Insurance, u reyuired by Section .
3700 oC �he Labor Code. Cor the per[ormance of the work (or which thu permit is issued.
M Worke�s Com ns n Insunncc carrier and Poliry numbcr arc:
Cartier. _ � � ' Policy No.: �'� �' ��
E IC OF EXE PfION FliOM WORKERS'
COMPENSATION [NSURANCE •
(ihis scction necd not be completed if the pccmit is for onc hundred dallazs (5100) ,
nrlcssJ
I cenify that in tAc performancc o( Wc work [or which Wis pertnit is issucd 1 shat� oot
employ any person in any manncr so u m bccomc subject a Uu Workcrs' Compensation
Laws of Cali[omia. Datc
Applicant
NOTICE TO APPLICAM: If, a(tcr making this CcniGca�c of Excmpuon, you shauld
bccomc subjcct to lhc Workcr's Compcnsation ptovisions of thc La6or Codc, you muu
, O forthwi�h comply wi�h such pravisions or this permit shalt bc dccmed revokcd.
z ►" CONSTRUCTION LENDING P.GENCY
(.�.� r�-� 1 hecchy afGrtn ihat there is a conswction knding agency for the perCormancc uf �
a 7 ihc wurk for which lhis permit is issucd (Stt. 3097. Civ. CJ ,
W Q LendcrsNamc
a � Lcnder's Address
U � 1 certify �hat I havc rcad this applieation and s�atc tha� thc abovc infocmatiun is
w ►-� cortcc4 I agree io compty with alI city and county ordinances and suu laws relaung to
� U building conswction, and hc�cby auihori�e mprcscniativcs of ihis ciiy to cntcr u�n thc
� a aAovc-mcntiuned property (or inspecuon purposes.
(Wc) agrce to save, indemaify and kccp harmless thc City o( Cupertino against
�� liabili 'u, judgmcnts, costs and expenscs which may in any way accruc againsl said City /,
U z in c ue�e oC thc gnnting of this rmi� Date ��/ f � 7
� AP ANT UNDER T DS AN WILL COMPLY W AL NON- !NT Issued by �
SO R GULAT7
/ O ° Re-roofs �'�"�
Signatu2 of Appli uc ��� D T of R.00f
HAZARDO MATERiALS DISCLOSURE YP
Wil( the applicant or futurc building accupant starc or handk harardous matcrial
az dcfincd by the Cupenino Municipal Codc. Chap�cr 9.12. and �hc Hcaleh and Safcty
Cak. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
� Ycs �No .
Will ihc applicant or Cuture building accupant usc cyuipmrnt ar dcviccs w6ich
If a roof is installed without first obtaining an inspection, I agree to remove
cmit harardous air contaminan�s az dcfincd by tAe Bay Area Air Quslity Managcmcnt all new rr.aterials for inspecrion.
Disuici?
❑ Y� �
1 vc read the ha�arGws maicrials ircmcn�s undcr Chap�cr 6.95 0( thc Cali[or-
nia & Safcry Codc, Sc � 25505, 255 3 and 25534.1 undcrstand Uiat i[ Ux building
Jocs t c rtcntly havc a tc � ai it is m rcsponsibiliry w nwify � n� �
rcyui m �s ich bc 'orto' ofa ' a�cof ` � Signature ofApplicant Date
�� � All roof coverings to be Class "B" or better
Owner or authorizcd gcnt ���