07100048 CITY OF CUPERTINO " �p
BUILDING DIVISIO�i PERMIT ���������"������� `.
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_
PERMIT NO.
BUILDING D RFSS:
19$66 PEAR TREE LN LOVELAC:� CONST 07100048 •
pERMTT iSSUE DATE
�WNER'S NAME:
STEARNS DAVID M AND BONNIE J 10144 C.�MINO VISTA DR 1 4 7
SAMTARY NO. CONTROL NO.
iNE:
( 408 ) 25 �-4923
BUILDING PERMITINFO
ARCHITECt'/ENGINEER:
BLDG ELEC7' PLUMB MECH
� 0 0 �
i p p LICENSED CONTRACTOR'S DECLARATION JOb DCSCrIPtlOfl
%� I hcreby affirm that I am licenscd undcr pravisions oC Chap�cr 9(commcncing
;z� w iihSccuon700o)o(Division3ofiheBusincssandProtcssiunsCode , andmyliccnscis INTER' :ZEMODEL, ELECTRCL THRU-OUT, MASTR SUITE &
°� y in full forcc and ef �j
�� z[,icensc Clas Lic. p Z " 3 LALTNDRY
; F � pa� Contracwr
� ARCHI"f'ECI'S DECLA ATION
i a a I undcrstanJ my plans shall hc uscd as public rernrds
)qU
' tL F' Liccnscd Pmfcssional
� y � OWNER-BUILDER DECLARATION
1 hcrcby alTirm ihat 1 am cxcmpt Gom thc Contractors Liccnsc Law far thc
� p o [ollowing rason. (Sccuon 7b31.5, Busincss and Professians Ca1c: Any city or county
�,°, � which requircs a permit ta cnnswc4 altcr, impmvc. dcmolish, or �cpuir any swcture
� z} prior to ils issuancc, also tcquires thc applicant for such pertnit ta filc a signcd su�emcnt Valuation
�= 0 thal hc is liccnxd pursuant to lhc provisions of Ihc ConlracWr's Liccnsc Law (Chap�cr 9 3q. Ft. Floor Area � 1 O O O O
� t- (commcncing with Scction 7000) of Division 3 oC thc Busincss and Profcuinns Codc) ur
y�� that Ae is exempt Weccfrom and �he basis Coc the allegcd exempaon. Any violatiun oC
Section 7031.5 by airy applicant tor a permit subjccts U�e applicant to a civil pcnalty o( Number Oceupaney Type
not more than five hundred dollars (5500). 3 1. 6 3 1 � 1���
❑ I, u owncr of tt�e propecty, or my cmployces with wages u their salc compensation,
willdothevrork.andthestcuctureisnotintendcdoratferedtarsalc(Scc.7044,Business Required Inspections
and Ptofessions Code: llu Conuutor's License Law docs not appty to an owner of
propeny who builds or improves thereon, and who does such worlc himself or tlwugh his
own emplayces, providcd that such improvements are not intended or offered Cor sale. if,
however, the building or improvement is sold within one yeer of complction, We owner-
builder will have the burden of pmving that he did no� build or improvc [or pu�poae of
salcJ.
Q 1, as owner o[ the property. am ezclusively convacting wi�h licenud convactors w
consuuct the projm (Sec. 7044, Business and Protcssions Code:) The Contractor's Li-
cense Law docs no� apply to an owner of propeny who buiWs ar impmves themon, and ,
who conuacts for such projecu wich a conuactar(s) littnsed pursuan[ w ihe Convactor's
License Iaw.
❑ I um ezempt under Sec. , H& P C for this reason
Owner Date _. ,. _.
WORKER'S COMPENSATION DECLARATION
I hereby �rm under penalty o[ perjury nnc of the following declaraGons:
❑ i hsve and will mainuin a CeniGcate of Consent to self-insure for Workcr's Compen-
sation, u provided for by Secrion 3700 a[ the Labor Code, for the pe6ormance of �hc
wo�Ic for which this permit is issued.
❑ I havc and will maintain Worker's Compensation Insurana, u �cquired by Scctian
3700 of the Labor Code, Cor the pecformance a[ the work for which this permit is issued.
My Worke�s Compensauon Insueance carricr and Poliry number arc:
Cartier. ��7�7C ���.p Policy No.: '
CERTIFICATE OP EXEMP170N FROM WORKERS'
COMPENSATION iNSURANCE
(This scctian necd not bc completcJ if the pecmit is for onc hundred dallars (E 100)
orlcssJ
I cenify that in thc perfonnancc of ihc work for which ihis pertnil is issucd. 1 shall not
employ any person in any manner so u m become wbject �n U�e Workers' Compensation
Laws of Califomia. Datc
Applicant
NOTICE TO APPLICAM: If, af�cr making �his Ccrtiticatc of Excmpuon, you should
bccome subjcct to thc Workcr's Compcnsation provisions of thc Labar Codc, you must
, Z foMwi�h comply wi�h such pmvisions or this pecmit shall 6c dccmcd revokcd.
z O CONSI'RUCCION LENDiNG AGENCY
[-�i .�-� I hcrchy aff rm that thcro is a consuuctinn Icnding agcnry Cor thc perfortnancc uf
Q,! �✓ thc wurk fur which ihis permit is issucd (Scc. 3097, Civ. CJ
W� Q Lendcr's Namc
� � l.cnder's Address
U � 1 certiCy Ihai 1 have rcad this application and s�ate ihat the abovc info�maliun is
w � cortcct. 1 agree �o comply wieh all ciiy and county ordinances and sta�e laws relating lo
rJ � building conswction, and hcreby au�hori�e rcprescntativcs of this city to cntcr u�mn thc
� W abovc-mcntioncd property for inspcc�oa purEwses.
a (Wc) agree to save, indcmnify and kecp hartnless thc City of Cupertino against
�,�",,� � liabilities, judgmcnLt, costs and expenscs which may in any way acceuc againsl said City �
U z in conuqucncc oC thc granting of ihis permi� Date (/� �j —!f�
►-� APPLICANT UNDERSTANDS AN W1LL COMPLY WITH ALL NON-POINT Issued by; � (
SOUR EGULA ONS.
� 4 Re-roofs �
Sig awre ofAppli UCon r a � T of F.00f
HAZARDOUS MATERIALS DISCLOSURE }��
Will Ihc applicant or futurc building occupant storc or handlc ha•rardous ma�crial
as defincd by thc Cupenino Municipal Codc. Chap�cr 9.12, and the Hcal�h and SaCety
c� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs �+o .
Will the applicant or futurc building occupant usc eyuipment or Jevices which
If a roof is installed without first obtaining an inspection, I agree to remove
emi� ha•rardaus air conuminants ac dcfincd by the Bay Area Air Quali�Y Managcment all new rr aterials for inspec�ion.
District?
❑ Ycs �Jo
I havc rcad the hazardous maierials rcyuircmen�s unAcrChapter 6.95 o(thc Califor-
nia Hcalih & Safcty Codc, Secrions 25505, 25533 anJ 25534.1 undcrstand �hat iC ihc bold�nB
docs not curtcntly havc a �cnan4 �at it it my responsibili�y �o noul'y Uu occupant of ihc
rcyui which uu bc m rior tu i uancc oC a Ccrtificatc of Qccup �r. Signature of Applicant Date
� All roof coverings to be Class "B" or better
Owncr or autharir agcm Daic