07080117 CIT�' OF CUPERTINO ° `' ` ` '
BUfLD1NG DIVIS10lV PERMIT +���T� ��'�� z��'������N '
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BU1LD N D g ESS: PERMIT NO.
�l���l SCENIC BLVD TBD — Tc) BE DETERMINED 07080117 •
PERMTf LSSUE DATE
ER'S NAME:
JEFFREY W MYERS 10 26 2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMII' INFO
ARC HI'IECT/ENGiNEER:
BLDG ELECT PLUMB MECH
� � 0 �
i p Q LICENSED CONTRACTOR'S DECLARATION JOI� DeSCI'1Pt102] �
; v� t hcreby af(irm �hai I am licensed unJcr provisions o( Chaptcr 9(commcncing _
; z� wi�h Scction 70(N)) of Division 3 of �hc Business and Profcssions Codc. and my Iicensc is ADD 6 4 �� Q 1 @ � E� PORC H � F DETATC HED STUD I E
� e d in fuli force and e l fect
i, LicenscClass ��•� INTERIO]Z REMODEL — STUDIO BATH AND SOME MINOR
: F � Datc Contractar
ARCHITECI'S DECLARATION STRUCTU.'ZAL
i a Q I undcrs�anJ my pians shali bc uscd as public rcwnls
)yU
' u. F" Liccnscd Pn�fcssional
� � � OWNER-BUILDER DECLARATION
>' 1 hcrchy a17rm �hat 1 am cxcmpt Cwm �hc Contractor's Liccnsc Law for thc
j p o Collowing rcason. (Scction 7031.5, Busincss and Profcssions Cadc: Any city or county
<,°, � which requims a pertnic [o conswc4 ��*. �mprovc, dcmolish, or repair any swcture
� Z y prior ui its issuance, alw rcquims thc applicant for such pertnit to file a signed siatemcnt ��, Ft. Floor Area Valuation
-_ � that he is liccnscd pursuant ta �hc pmvisions o( thc Convacu�r's Liccnx Law (Chaptcr 9 `��] � 6 O O O 0
� t- (commcncing with Scction 7000) o( Division 3 oC �hc Busincss and Profcssions Cadc) or
L�� ihat he is exempt thcretmm and it�e basis Cor �he alicgcd ezemption. Any violation ot
Section 7031.5 by a�ry applicant for a pertnit subjects the applicant to a civil penalty of Number Oceupaney Type
not more than fivc hundmd dollars (5500). 3 5 7 � 2 � 1. '���
� I, as owner o( the property, w my employces with wages az the'v solc compensation,
wiil do she wark, and the stnsciure is noe intenGcd or o£fered (ar sale (Sec. 7044. Business Re uired Ins ections
and Pmfessions Cade: The Conuacwr's License Law does not apply to an owner of 9 p
property who builds or improves thercon, and who does such xrork himself or Uuough his
own employccs, provided �hat such improvemems are not in�ended or offered Cor sala If,
however, ihe buildiag or improvement is sold within one year of compleGon, the owner-
builder witi have ihe burden of proving It�at he did nat 6uiid or improvc for pucpose af
sak .
I, as owner of the property. am exclusively conuacting wilh licensed rnnvactors w
, conswct che p jett (Sec. 7044. Business and Professions Code:) The Conlncwr's Li-
cense Law not apply to an ner oF propecty who builds or improves thereon. and ,
who convac or ucfi p' cts ith a cronvactor(s) 6censed pursuant a U�e Convactors
License Law
^ I am u p , B& P f Ihis on
Date _. .
ORKE COMPENSATTON DECLARATION
he • affirm uader penalty of perjury onc of the foliowing declarations:
� ve and will maintain a CertiLcate of Consenl to self-insurc far Workcfs Compen-
sation, u provided for by Section 3700 of the Labor Code, (ot thc pertormancc of �hc
work for which �his permii is issucd.
❑ I have and will maintain Workei s Compensation Insunnce, az required by Sectian
3700 oC Wc Labor Codc. Cor thc performancc of the wak far which �his permit is issued
My Workets Compensauon Insurance carticr and Poliry number are:
Cartier. Policy No.:
CERTIF7CATE OF EXEMPl70N FROM WORKERS'
COMPENSATION INSURANCE
(This scctian necd not be complc�ed if t4e pecmit is for onc hundred dollars (5100)
or lcss.) �
[ ceni(y ihas in ihc perform af thc ork ich U�is permit is issucd, l shall no[
cenploy any person in any r so subject rkcrs' Compcnsafion
Laws oC Califomia Datc
Applicant
NOTICE TO APP . Mr making CcrtiCca�c of Excmp6on, you should
become subjcct �hc • s Compc n pmvisions of ihc Labw Cadc, yau must
� O forthwith eomp wi h provisions o is permil shall bc decmcd rcvokcd.
Z "' CONSTRUC7'lON LENDING AGENCY
(-�+ � I hcrcby a[firm that thcre is a consuvction Icnding agcncy Cor thc perfortnancc of .
�.� �hc work fur which this pertnit is issucd (Scc. 3097, Civ. CJ
W� A L.endcrs Namc �
� z Lcndcr's Addncss
(� � I certity �hat I have read this application and statc that �hc abovc in(onnatiun is
w � cortect. l ag�ce to comply wiU� all city and county ordinances and sute laws relating �o
� U building conswction, and hcrcby authori�e rcprcscnutivcs of this ciry to cn�c� upon Ihc
� W above-mentiuned ioperty for inspecuon purFwses.
a (Wc) ag to save, indcmni(y and keep hartnless ihe Ciiy of Cupcnino against
H � liabilitia, judg ents, costs an xpenses wAich may in any way accrue against said City
U,'� in canseque a c granti Ihis perm'
►'� APPLICA ER AN ILL COMPLY W1TH ALL ON-P INT Issued by: Date ' j� �Z C�
SOURCE A
� Re-roofs
sign u p uCon tor " e of R�of
H OUS MATERIALS D[SCLOSURE T}�P
appticant or future building occupantstorc or handic ha•rardous matcrial
1 incd by the Cupenino Mun' ipal Cade. C6apicr 9.12, and the Hcal�h and Salcty
. Scction 25532(a)? All roofs :,hall be inspected prior to any roofing material being installed.
❑ Y� NO _
wll the applicant or (uturc buitding accupam use eyuipmenl or devices which
If a roof i:, installed without first obtaining an inspection, I agree to remove
� cmit haiardous air con�aminants u ticfincd Ay Ute Bay Area Air Quality Managcmcn� all new m iterials for inspec*ion.
District?
Q yes Nu
I havc the ha�ardous ma�crials requiremcn�t undcr Chap�cr 6.95 of thc Califor•
niaHcal�h& C 'aRC255U5.25S33and25534.1undcrstandthatiCWcbuilding
docs not cu ha an4 U� '' my responsibility to rroufy thc upant o( �hc
reyu�rcm ch riorwissuaricco[aCcrtil'ica�cyffjc �7 Signature �fApplicant Date
��� � All roof coverings to be Class "B" or better
O n o a orizcd a nt ��