07100160 CITY OF CUPERTINO t
BU[LDING DIVISION PERMIT ���� ��� °��������+
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pERMIT NO.
BUILDfNG ADDRESS:
10631 FAR.ALLONE DR TIMELINF: CONSTRUCTION 07100160 .
PERMIT ISSUE DATE
,. y/NER'S NAME:
CAMPBELL BRUCE AND DARLENE 14589 S BASCOM AVE � 11/16/2007
SAMTARY NO. COMROL NO.
PHONE:
(408) 35E�-1790
BUiLDING PERMTf INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
� � 0 �
u p � LICENSED CONTRACfOR'S DECLARATION JOU D8SCi1pL10I1
v� �►�yy �fC�m thai t am �iccnscd undcr provisions oC Chaptcr 9(commcncing
� z W with Sccdon 700U) of Division 3 of the Busincss and Profcssions Code and my iiccnsc is RE — ROO F:=NG , RE — S TRUC C O NEW W I NDOW S, REMODE L � F
�? y in full Carce and effec� , 5 THE
v� Z Licensc Cl�sa � Lic. N � •
>..o oe�� ~— PpRCH
: �"' � ARC TEC1'S DECLA A7'lON � ���A�
��< 1 undcrstand my plans shill 6e uscd as public rccorda
�yU
4 O y Licensed Rufcssional
y 3 OWNER-BUILDER DECLARATION
' � I�ercpy nlTirm that 1 am czcmpt Gum thc Conuactors Liccnx Law for thc
� p o following rcason. (Section 7b31.5. Busincss and Pcofcssions Catc: Any city or counry
K,°, � which requiccs a permit to rnnsuuc4 a��. �{��• dcmalish, or repnir any swcmrc
rior w i�s issuancc, also requims thc applicant for such permit to file a signnl sta�ement Valuation
�' �; r . Ft. Floor Area $ 2 5 0 0 0
< lhu he is licensc d pursuan t W t h c p rovi s i o n s a[ i h c C o n u a c m r' s L i c c n s c L aw ( Cha ptcr 9 �> q
Y F� (commcncing wi�h Scction 7000) of Division 3 of thc Busincss and Profeuions Cadc) or
i�� that he is exempt thc�efrom md the basia for the allcgcd exempUon. My violation o[ Occupancy Type
Secdon 7031.5 by airy applicant for a permit subjecu the applicam W a civil pcnalty of 3 6 9 3 9 0 3 3'.�'�� Number
n o t m o r e t h a n f i v e h u n d� e d d o l l a r s ( 5 5 0 0)•
� I. at owner o[ Uie propercy. or my employcrs wiN wages u �he'v solc compensadon,
wpl do Uw wark. ead �6e stcucwce is not intended or offered for sele (Sec. 7044. Busineas Required Inspections
and Rofessiona Code: 77u Conuxwrs License Law does not apply w an owner of
propeny who builds or improves �v�wn, and wAo does such work himseit ar thmugh his
own employces. providod tha� such improvemenls ue not intended or o(fered (or saie. If.
hawever, ihe building or improvement ia sold within one year of complcdon, the owna-
builder wiil have �he burde� oC proving U�at he did not build or improvc tor purpose of
sak.).
❑ I, u ownec of the property, am wcelusively conuacting wi�h licenaed rnnuutors W
conswct the prnject (Sec. 7044. Business and Professions Code:) The Contracmra Li-
cense Iaw docs not apply to an m�mu of propeny wha builds or impmves themon, and ,
who wnuacts far such projects with a comractor(s) licensed pursusnt w the Contncror's
' �unse Law.
t am exempt undu Sec. . B� P C for Ihis �eason
uw � Dau
WORKER'S COMPENSATION DECLARATION
I heceby affirm under penalty of perjury one o[ the following declsrations:
❑ 1 hsae and wil! mainuin a Cutificate of Consent to sel(-insure for Workc�s Compen-
satian. u provided for by Section 3700 af the Labor Code. [or ihe performancc of thc
wortc for which Uus permit is issued.
❑ I havc and will mun�sin Warkcrs Compensation Insurance, as required by Section ,
3700 of thc Labor Code. Cor the pcdortnance of the work for w6ich this pe�mit is issued.
My Workec's Gompensation Inwcance �T�ct num6er uc:
Cartier: �'Td�ZG Cf� � �� " l � T Poliry No.: � '?' 7
C
�� O XE1�TP170N FROM WORKERS' .
COMPENSATION INSURANCE
(This scctian necd not bc comple�ed if the pecmit is for anc hundred dollars (S 100) ,
or Icss.)
I cenify Wat in thc performancc of thc work for which ihis pertnit is issucd, 1 shall not
e:nploy any person in any manncr so as W bccomc subjeci w the Workers' Compensauon
l,aws o[ Califomia Da�e
Applicant
N077CE TO APPC.ICAM: !f, aMr making �his CcniGca�c of Ecempuon, you should
becane subjcct to ihe Worker's CompeasaUon provisions of �hc Labor Codc, you muu
� O foMwiW comply with such provisioas or this pecmit shall be decmed �ewked.
z "'" CONSTRUCf10N LENDING AGENCY •
(.~.� i..�.i � he�chy affirtn Uut thcre is a consuucGnn Icnding agcncy for thc perfortnancc u( �
p�., � ihe work [or which this permit is iscucd (Scc. 3097, Civ. C.) ,
W Q Lendcrs Namc
a z Lcndec's Address
V � I certifY Ihat 1 have read Ihis application and sia�c il+u 1hc abovc informatiun is
w � cortect 1 a6ree io comply wiU� all city and county onlinances and auk Iaws relating w
� U building consvucdon, and hemby wtharia mpresentaGvcs of U�is city to cntcr upnn �hc
� W alwvo-mcntioned propcny for inspecUon purposes
� (Wc) agrce to save. indcmnify and kecp harmless ihe City o( Cupertino against
�� liabilitiu, judgmenls, cosu and expenscs which may in any way accruc against said Cily ��
V� in consequencc of ihc granting of this permi� Date ,/(y' /
►� APPLICANT UNDF.1tS'C DS ND W1LL COMPLY WI'fH ALL NON-POINT Issued by;
SOURCE REG LA N . � �� �
Re-roofs
s� �� uco��a� �°'� T of B.00f
HAZARDOUS MATERIALS DISCLOSURE YPe
wll �he appliant or futws building occupant storc or Nandle harardous matcrid
,cfincd by the Cupectino Municipal Codc. Chaplcr 9.12, md cAc Heallh and SaCMy
.,,a� SccUon 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
� y� [�No
�11 the applicant or fuwre building accupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit harardous air comaminan�a dcfincd by the Bay Arca Air Quality Managcment gIl neW R.$[eT111S fOL Ii1SPCCC10f1.
District?
� y� No
1 havc read the hvardous msterials �cquimmenu unJcr Chap�r 6.95 of thc Califor-
nia Hcalih & SafctyCadc, Sections 25505, 25533 aru175534.1 undcrstand that iCthe huilding
docs no� curtently havc a icnan4 � it is my responsibili�y w notify �hc occupent nf thc
mqu' n�s w' h must he pcio issuar�cc of a C�� tc � Occu � S ignature of Applicant Date
All roof coverings to be Class "B" or better
Owncr or au ori�.c agco� ���