07100071 CITY OF CUPERTINO ' I�������QN* ;
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BUILDING DIVISION PERMIT �������� '
_;.<;. , :.:. . .......:...._
PERMIT NO.
BUILDING ADDRESS:
20635 NANCY CT TBD - TC� BE DETERMINED 07100071 �
pEgM]T LSSUE DATE
R'S NAME:
MR AND MS CASTEJON
SANITARY NO. COKRtOL NO.
PHONE:
BUILDING PERM11'INFO
ARCHITECUENGINEER: BLDG ELECt PLUMH MECH
� � � 0
� p � LICENSED CONTRACfOR'S DECLARA7'[ON Job Description
:� C I dcrcby affirm that I am licenscd undcr provisions oC Chaptcc 9(commcncing
; z� with Scction 7000) of Division 3 of thc Business and Prafcssions Codc ane my �icc�sc u REV I S I OP d- SHOW THE DETA I L FOR F LOOR JO I C E
�< d in full Corcc an d c C tecl
��z LicenscClass ��.x @ADDITI()NAL AREA-ORIG #07070177
= p Datc Conuacwr
: ~ � ARCH[TEC►'S DECI.ARATION
j a .�
Q 1 undcrstanJ my plans shali Ac uud as public rccords
JyU
' u. y Licenud Pn�fcssional
. � e OWNER-BUILDER DECLARATION
� a� 1 hcrcby alTirm thnt 1 am excmpt (rom ihc Contractors Liccnsc Law far thc
p O (ollowing rcnson. (Scction 7031.5, Busincss and Profcssiom Codc: Any city ar county
i$� which requires a pertni� io conswct, altcr, improve, dcmolich, or iepair any swcturc
�" y pri or ni ils issuancc, alsu r c quiccs �hc applicant for such pertnit w filc a signcd sulcment � q , F t. F l o o r Area Valuation
� Z < that hc is liccnscd pursuan� �o thc pmvisions of thc Conuacmr's L i c cnsc L aw ( C hap t cr 9 � O
r F� (commencing wiih Section 7000) of Division 3 of �he Business and Professions Code) or
i�� that he is ezempt thcrefrom and the bazit Cor the allegcd exemptioa Any violation ot qpN Number Occupancy Type
Section �031.5 by a�ry applicant for a pecmit subjecu Uu applicant [o a civil penatty of
n o t m o r e i h a n f i v e 6 u n d re d d o l l a r s ( 5 5 0 0� 3 5 915 0 2 �) � U
0 I, as owncr o[ [lie proputy, a my eroploycu with wages az ihe'v sotc compensation,
willdotlicworkand�hesuuaweisnoiintendcdorofCeredforsale Required Inspections
and Pcofessions Code: The Conuactor's License Law dxs not spply tn an ov+nu of
propeny wlw 6ailds w improves tlkreon, and who daes such work himself or theough hi�
awn employces, providcd �hat s�h improvements are not iniended ar o[Cered [or sala I[.
however, the building or improvemen� ia sold within one year of compteuon, ihe owner-
builder wjll have the burden of proving ILat he did nat build ar improvc ta pmpose of
�►+ � sak. ✓
u awur of the property. am uclusively conuacting with licensed conuxtas w
construct the project (Sec. 7044. Business aad Professions Ca�:) The Coutnctor�s Li•
ccnse Law docs not apply �o an ownv af propeny who builds or impmves Wereon. and .
who contcacls (or such projects with a conuactoRs) licented pursuant to Urc Conuuto�s
[,icense Law.
r"' I am uempt undu Sec . B� P C(ar a reas�n
v � �,s�'...��- . �• Date`rt -/2 �-- _ . _
'PION'VECI:ARATION
afl'iim under penalty a[ peQury onc of the fotlowin6 declarations:
Q I hsve and will maintain a CertiGcate o[ Conunt to self-insuce [a Workc�s Compen-
sation, as providcd for 6y Sectian 3700 of che [abor Code, far �he performancc o[ the
warl: for whicd this pertnit is issucd.
❑! havc and will maintain Workcr's Compensation Insurance, u requieed by Scction ,
3700 oC Uie Labor Code. Car the ce of �he work [or which this permit is issued.
My Workers Compensation niu carticr and Policy numbcr arc:
` Cartier - ��tl7icy No.:
�('E.pp�p(�I7AN-F�OM WORKERS' .
- " pEN�ATION [NSURANCE
scction nccd not bc compleicd i( the permit is for anc hundred dollazs (SI00) ,
or Icsa)
I cenify thet in �hc performancc of the work Cor which ihis permit is issucd. I sAall na
e.^.�ploy any person in any manncr so�w bce�o�mc sub �tnlha.�lNorkca' Compcnsation
L.aws o! Califomia Datc Gz— �
�. APPlicant
NOTICE TO APPC.ICAM: If, af�cr making �his Ccrtificatc of Excmptian, you shauki
bccome subjcct to thc Worker's Compcnsation provisions of the Labor Code, you must
� O foMwith comply with such provisions or this pccmit sha116c dccmcd ccwkcd.
z N CONSTRUCIION LENDING AGENCY
(� r-� 1 hcreby a(1'irtn ihat thcre is a conswetion knding agc�y for thc performanoe o�
p�., � thc wurlc Cur which this permit is issucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Namc
j z L.cnder's Address
V � 1 certifY that 1 havc read this application and siaic that thc abovc info�matiun is
w � corrcct. I agrce to comply with all city and county ordinances and sute laws relating to
� U building conswction, and hercby authorim represematives of ihis city [o cnter �pon thc
abovc-mcntiuncd property for inspccuon purposes.
�'' � (Wc) agree to save, indemnity and kecp hazmless �he Ciiy of Cupertino against
H � liabilitiu, judgmcnts, costs and ezpcnses which may in any way accruc agains� said City /� y
U z in cansequence oC thc granling of Ihis permiL DaCE �� �/ � t ' ,/
►-� APPLICAM UNDERS7ANDS A ILL COMPLY WI'I'H ALL NON-POINT Issued by
SOURCE REGULATtONS. �
� � � —�� Re-roofs ,
�,a�„ ppli ° sa T of R oof
�'° 7KAbOUS MATEIjIALS D[SCLOSURE YP ,
� aPPlicant or futurc build" occupant uore or handlc 6arardous ma�criat
'cfincd by 1he Cupertino Munici Codc. Chap�cr 9.12. �nd the Health and SaCety
.�, s��r' 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
�� x � If a roof is installed without first obtaining an inspection, I agree to remove
Wi11 thc applicant or futurc buildin upant usc eyuipmcnt or dcviccs which
cmii harardous air contaminants u dc d by the Bay Area Air Quality Managcment all new rr aterials for inspecrion.
a5u����
❑ Ycs �
/ Ihavcrcadthehvardous 'alsrequiremcn�sunckrChap�er6.95o(ihcCalitor
nia Hcal�h & Safcty Codc. Secdotis 5.25533 aru125534.1 undcrstand lhat it�hc 6uilding
docs not currcntty havc a' ifwt it is my responsihility to nodfy thc oaupant of �he Date
rcyuiremcn�swhic ri1'e[� issa I`sEITG� atc°«�"P"��7'• Signature ofApplicant
l� --� � Z' �� All roof coverings to be Class "B" or better
oW � oa�