07090042 CITY OF CUPERTINO ' ' '
BUILDING DIVISION PERMIT �����"'������������� `
,. , ,:: ,...... ;:_...._ . . :
PERMIT NO.
Bu ��� U'! �I � CANYON RD MARINKO 3ALDE 0 7 0 9 0 0 4 2 .
PERMTT LSSUE DATE
OWNER'S NAME: ,
r 'IARINKO BALDE 10/09/2007
SAMTARY NO. CONTROL NO.
�E:
BUILDING PSRMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
� 0 � �
i p p LICENSED CONTRACTOR'S DECLARATION JOb DeSCTIPU011
: V C i hercby afGrm that I am licenscd undcr provisions o( Chapicr 9(commcncing
; z z with 5cction 7IXlU) of Division 3 of the Business and Profcssiuns Codc and my licensc is REV I S E B EEM ON 3 RD FLOOR MA S TER BEDROOM , ADD
�� y in full Corce and cfCecL
��? Licensc Class Lic. N BAS IN
: f o Datc ConuacWr
� ARCHITECI'S DECLARATION I N GARAG E
j a a i understand my plans shall be used as pu6lic reco�ds
)yU
' u. y Licensed Pmfcssional
: � < OWNER-BU�LDER DECLARATION
' r� 1 hcrcby atTirm ihat I am ezcmpt from ihc Contraaar's Liccnsc Law for thc
� p o following mason. (Scctian 71131.5, Busincss and ProCessions Calc: Any eiry or county
�,°, � which rcquires a permit to conswct, alter, improvc, dcmalish, or repair any structurc
rior u� i�s issuancc. also rcquires �hc applicant for such permit to filc a signcd sta�mem Valuation
_? r � Ft. Floor Area
< �hat hc is liccnscd putsuant to thc provisions oC thc Conlractur's Licensc Law (Chaptcr 9 S a• � O
,� t �(commencing with Section 7000) of Division 3 aC thc Busincss nnd Profcssinns Cadc) ur
y�.. that he is ezempt Nciefrom and Ihe basis for the allcgcd ezemption. Any violatlon af
Section 7031.5 by a�ry applicant for a pecmit subjccts the applicant to a civil pcnalty of ��} p Number Oceupaney Type
not more than five hundmA dollazs (SS00). 3 4 2 17 1 � 1• �`J
❑ I, u owner of tlie property, or my employca with wages az theic sole compensauon,
will do �F.c work. and Ne suucture is noc intended or otfered for sale (Sec. 7044, Business Required In spections
and Professions Codc: The Conuutor's License Law does not apply to an owner of
property who builds a improves theceon, and who does such work himself or through his
own employces. providcd that such improvements are not imended or offered for sale. If,
however. ihe building or improvement is sold wi�hin one year of complction, the ownu-
builder will have the burden o[ proving �hat he did not build or improvc (or purpou of
sale.).
0 I, as awner of the property, am ezclusively conuacting wilh licensed convactors to
constnut ihe peojen (Sec. 7044. Business and Professions Cade:)'[]ie Conuactor's Li-
cense Law dacs oot apply to an owncr of property who builds or improves �he�eon, and ,
w6o contracts for such projects with a contractar(s) licensed pursuant to �he Convactors
License Law.
� 1 am exem du Sec. , B P C far is rcason
Ownv Date b � _ .. _;
ORK 'S COM AT70N DECLARATIO
I hereby �rm under pcnalty af perjury one of the tollowing ded ons:
❑ I hsve and will maintain a CertiGcatc of Consent to sel(-insum for Workcr's Compen-
sation, as providcd for by Secuon 3700 ot the [abor Code. far the pcdormance of tAe
woric for which this permit is issued.
❑ I havc and will maintain Worker's CompensaUon Insunnce, az rcyuired 6y Sccuon .
3700 oC �he Labor Codc, Cw thc performance of the work far which this permit is issued
My Worke�s Compensation [nsunnce cartier and Policy number arc:
Cartier. Policy No.:
CER7'IFICA7'E OF EXEMPIION FROM WORKERS'
COMPENSATION INSURANCE
(This scctian necd rrot bc complcud if the pc[mit is for onc hundred dollus (S 100)
or Icss.)
1 cenify that in thc perfo an of work (or which �his {xrtnit is issued, I shall not
employ any person in any an r so comc subjcct to U�e Wo rs' C pensatian
Laws of Califomia Datc
Applicant
NOl'ICE TO APPLICA , aftcr ng is rtiCicatc o Face ption you should
become subjcct w thc Worker Compcnstition visions of thc La r C , yau must
� O forthwitti eomply wiih such provisions or this permi� shall bc dcemcd revokcd.
Z '"' CONSTRUCCION LENDING AGENCY
[� �-�+ 1 hcmby afLrm U�at thcre is a construction lending agcncy for thc perfortnancc uf -
�G ��hc work Car which ihis pertnit is iuucd (Scc. 3097. Civ. C.) ,
W A Lendcr's Namc
a z L.cnder's Address
V � t certify ihat 1 have read this applieation and :iatc �haz the abovc infortnation is
w � corrcct. I agrce to comply with all city and county onlinances and sute laws rclating �o
� U buildi�g conswction, and hereby authori�e rcpresenutives of ihis city to enter upon the
� W abovc-mcntioncd propcc�y (or inspccooa purposes.
� (Wc) agrce to save, indcm�ify and kccp harmless lhc Ciiy of Cupertino against
H � liabiliuu, judgmcn�s, cosis and expenses which may in any way accruc againsl said City ^
�} z ia consequence oC tAe granting of this permit. Date rL� '��"
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS. �
Re-roofs
Signatuce of ApplicandConuactor � T of Rc �of
HAZARDOUS MATERIALS D[SCLOSURE YPe
wIt thc applicant or futurc building acupant storc or handlc harardous matcrial
as defi�d by thc Cupertino Municipal Cadc. Chap�cr 9.12, and �hc Hcalth and SaCety
c«�, s�uo� zss32ea�� All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs ❑ Na ,
Will ihc applicant or futurc building accupant usc cyuipmcnt or dcvices which
If a roof is inst 'thout first obtaining an inspection, I agree to remove
emit ha•rardous air con�aminants as cicfincd by thc Bay Arca Air Qualiry Managcmcnt $]] ne i'� als for in peczion.
o�s����
Q Ycs ❑ No A
� X
1 havc rca�i the ha�a s ma 'als rcquiremcn�s undcrChap�cr6.95 of thc Califor• �
nia Flcal�h & Safcty Codc, ctions 25 , 25533 d Z5534.1 undcrs�and thaz iC ilu huitding ��
docs n rtently havc a nan4 �hat it' my nsibility w noufy occup c nf NC
rcyui c �s �which must me� r uan o( a Ccrlifica�c C Occ S�g Te ��f Ap " Date
b A roof coverings to be Class "B or bet er
Ow r or aut rized agcnt ��