07080082 CITY OF CUPERTINO ���,���,�,�� ���������'� :
BUILDiNG DIVISION PERMIT ;
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PERMIT NO.
BUILDING g D .i� ESS:
20y1.5 ALVES DR RAY LEC�NARD J TRUSTEE 07080082 .
PIIthIlT ISSUE DATE
OWNER'S NAME: ,
RAY LEONARD J TRUSTEE 20913 �.LVES DR 11/29/2007
SAMTARY NO. CONTROL NO.
)NE:
BUILDING PERMfI'INFO
ARCHiTEC['/ENGiNEER: BI,DG ELECT PLUMB MECH
0 0 0 0
u p Q LICENSED COKfR.4C'1'OR DECC.nRnnoN Job Description
� � I hcrcby aftirm �hat I am liccnscd unJcr provisions o[ Chaptcr 9(commcncing
_z� w iihSccGon7000)aroivision3oftheBusincssandProtcssiansCodc.andmylicc nscis pROPOSF: ADDITION REAR SIDE 1379 SQFT ANI� PORCH43
��y infullforceandeffect L � � SQ FT �'O ADD KITCHEN� MASTER S U I T E A N D T W O M O R E
j v� Z Licenac C1au
:t =� °a � / ° � CO BEDROOPIS
� ��� ARC�HIT6CI'S DECLARA770N
t 1 undcrsland my plans s6a11 bc uscd at public records
?yU
4 o y Liwnsed Rvfcssional
y � OWNER-BUILDER DECLARATION
I hereby aCGrtn that 1 am excmpt Gom thc Conuactors Liccnx Law for �hc
� p o following icason. (Section 7031.5, Business and Profcssioaa Calc: Any city or counry
�$� which mquires a permit w conssuuc4 a�tcr. impro�c• d�molich, or �cpuir any suucwrc
�'� �' prior w ils issuancc, also tcquires thc applicant for such permit to filc a signcd sutement Valuation
^< that he is licensed pursuant to I h c provisions o C i h e C o n u a c a r' s L i c c n s c [ a w ( C h a p t c r 9 S q. Ft. Floor Area $ 2 9 7 0 0 8
Y I Z -� �(commencing wi�h Section 7000) of Division 3 of ihe Business and Profcasions Code) or
i�,. that he ia exempt thetctrom and the buis for t6e alicgcd exempuon. Any violauon of Occupancy Type
Secuon 7031.5 by a�ry applicant for a permit subjecu �he applicam w a civil penairy af 3 2 6 3 0 0 �) 3�'� Number
not mrne elun fiw hundied dollars (5500).
❑ I. es ownu of tl�e property. or my employcea with wsges as their solc compensadon.
w ilid o theworkandthestcucweeisnoiimm�dedorottmedforsale(sa. 70 o�t.susi�rcss Required Inspections
and P�ofessions Code:'Itie Conuacwr's License Law daes irot apply w an owner of
pmperty w6o builds or improves tlurcon, and who does such work himself or tluough hia
own employccs, provided �hs� such improvemrnts are not imm�ded or otkred Cor saia l[.
however, t�e building or impmvement ia sold wiihin one year of eompledon, the owner-
builder will have the burdee o[ proving that he did mt build or improvc for purpose of
� � I. as awmr o[ the property. am exclusivdy conuacting wi�h liceneed convut�s w
consuuct the project (Sec. 7044. Businesa and Pro[cssions Code:)'�he Coatracwr's Li-
cense Caw docs not apply m an m�mer o( propeny wha builds or improves �heRan. and ,
who conuacts Cor sucA pmjecls with a convactor(s) Iiansed purswnt w �he Convac[ors
License Law.
❑ I am exempt ad ee . B& P C for this reaaon
� Owner Date �
5 OMPENSATION DECLARA170
1 hercby under peoalty ot peryury one of the toilawing declaraGons:
J I hsae and will maiMain a CutiGcate of Consenl to self-insuro fw Workets Compen-
sation, as provided for by Section 3700 of �he Iabor Code. (or the parformance of the
woric for which Ihis permit is istued.
❑ I havc and will maintain Worker's CompensaUon Insurana, u required by Scction ,
3700 of ihc Labor Codc, for thc performance of the worlc for which this permit is issued.
My Worke�s Compensatioa Lisurance nrrict end Policy number ate:
C Poliry No.:
CERTIFICA7E OF EXEMPrION FROM WORKERS' .
COMPENSATION 1NSURANCE
(This section need not be canpieteJ if the pecmit is for one hundred dollars (5100)
or Icss)
i cenify ihat in �hc perfarmancc of t6c wark for which ihis pertnit is issucd. 1 shall not
employ any person in an manner so u m bccomc wbject w the Workccs' Compensa�lon
� Laws oC Cslifomi au �
Applicant
NO?ICE TO A CANT: r making ihis Ccrtitica�c of Excmption, you should
become subject to ihc s Compensadon provisions of ihc Lalar Codc, you must
�"'� fonhwi�h comply wi such provisians or this pecmit shall 6c deemed rewked.
� O CONSfRUC170N LENDING AGENCY
E.-i ►-. I hcteby afCirm Ihat thcre is a consuucGon knding agcncy for ihe performance uf �
pC, ✓ ttu work for which this permit is issued (Sce. 3097, Civ. CJ ,
W Q Lendcr's Nunc
� z C,cndets Addmsc
() 0 1 certity that 1 havc resd tltis applicuion and statc thst thc above informatiun is
w F cortcct. 1 agrce w compty with all city and counry ordinances and sum Iaws celadng w
� U building conswcdon, and hereby authorin mprcsentatives of �his ciiy to cn�cr upon thc
� W ahove-menuoncd propcnyforinspecrion purposes
a (Wc) agree to uve, indcmnify and kecp hacmless �he Ciry of Cupertino agains�
�� liabilidu, judgmcn�s, cosu and expenses which may in any way acccue against seid City
V z ia consequence oC the granUng ot this permi� �
� APPLICANT UND NDS AND W1LL COMPLY WITH ALL NON-POINT Issued ty: Date �� L—' `�7
SOURCEREG ONS
l� '" Re-roof > ,��-�
Signature of ApplicanUConuac ��� T of Roof
H S MATERIALS DISCLOSURE YPe
wll We applicant o ture building occupant uore or handle haiardous matcrial
u defincd by �hc Cupertino Municipal Codc. Chaptcr 9.12. and rhe Hcalth and SaCcty
c«k Scction 25532(a)? All roof s shall be inspected prior to any roofing material being installed.
o Y� t� .
Wi11 Wc applicant or fuw�c building occupant usc cquipmrnl or dcvices which
If a roo: is installed without first obtaining an inspection, I agree to remove
nit haiardnus air contaminan�s aa defincd by the Bay Area Air Quslity Managcment all new materials for inspection
a����
❑ Ycs �o
1 havc rcad the hvardau materials requircments undcr Chaplcr 6.95 of ihc Califor-
nia Hcallh & Safcty Codc. Sections ZS505, 25533 and 25534.1 uncicrstand thuif Uic huilding
does no n0y havc a icnan4 �e� it ia my rcsponsibility w notify �hc accupant o[ �he
n:quireme�a ich must be ��;o� a�uu�« ora c�r�� or o��w��r. Signatu •e of Applicant Date
'� �� All roof coverings to be Class "B" or better
Owncr or au d agcnt D�