07110128 CITY OF CUPERTINO ' : (�
BUILDING DIVISIOiV PERMIT �������� ��""�������
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BUiLDING ADDRESS: PERMIT NO.
21597 FLINTSHIRE ST TBD T� BE DETERMINED 07110128 .
OW NER'S NAME: PERMTT ISSUE DATE
BAUER DAVID E AND MARGOT L � 11/21/2007
PHON6: SANITARY NO. CONTROL N0.
,CH17EC[YEIVGINEER: BUILDING PERMITiNFO
BLDG ELECT PLUMB MECH
� � � �
u p p LICENSED CON7RACTOR'S DECL4RATION JOU DESCilptlOil
V I hcreby �rm that I sm licenscd undcr provisions oC Chaptcr 9(commcncinE
�z �+��aon7000)ofDivision3ofiheBusinessand ' C , y�iccnseis POOL DEMO/SPA ELECTRIC . LIKENS LANDSCAPE PD BSL
�� y in full force and eff
� z l,icensc Class [.ic. s 11210 7
'- ^ Da� Contractor
= � � RCHITECI'S DECLARAT ON
�� I undcrstanJ my plans shall bc uscd u public records
�yU
L O y Liccnsed Rufcssional �
y � OWNER-BUILDER DECLARATION
� � Meroby aliirm ihat 1 am excmp� Crom �hc Conuactor's Liccnsc Law Cor �hc
� p O following rcason. (Scction 7031.5, Business and Profcssions Codc: Any ci�y or cauniy
K,°, Pi whicd requi[cs a pcfmit w conswcc, ailcr. improvc. dcmolCsh. or �epair any suucwrc
y Z y prior W ils issusncc, alsu icquires ihc applicant for such pertnit to filc a signed s�amment Ft. Floor Area $ Valuation
� = 0 Uut he is IicenscJ pursuant to thc pmvisions a( thc Conuactar's Liccnse [Jw (Chaptcr 9 S9 • 13 0 0 0
� t- �(commcncing wilh Scction 7000) af Division 3 of Ihc Busincss and Profcssions Cadc) or
y �_. �hat Ik ia exempt themfrom and We basis for �he a�lcged exemption. My violation o[
SecGon 7031.5 by airy applicant tw a pem�it subjecu �he applicant w a civil penaity of 3 5 6 2 0 0 5 3'.°'�� Number Occupancy Type
rrot mwe thao five hundrod dollars{5500).
❑ I. u owner of tlie property. or my employcet with wages u their sole compensation.
will do U�e work, and ihe swclum is not intended or ollercd far salc (Sa. 7044. Business Re uired Ins ections
and Professions Code: The Canvactors License Law das not sppiy w m ownu of Q P
property who builds or improves �hercon, and who daes such worlc himsetf or through his
own employces, p�mldcd �a� such improvemrnts ue not intended or otkced for sale. If,
however, the building or improvement is sold within ane year of wmpkdon, the ownu-
builder will have the burden of proving that he did not build ar improvc for purpoae of
sak.).
0 I, as awner of �he property, am exclusively conhacting wilh 6cenaed conlrxmrs W
conswct We p�ojen (Sec. 7044. Business ana Processions Code:) The Conuactors Li-
ccnse [aw does not apply to an ownec of property wha buiids or improves themon, and .
who convacts Cor such projecu with a rnn�ractor(s) licensed purswnt to We Convactor's
License Law.
❑ I am exempt under See. . B dc P C for this reuon
Owner Date
WORKER'S COMPENSATlON DECLARATION
1 hereby affirm under penaity of perjury one of the faltowing declarations:
r"J I hsve and will mainuin a Cenificate o( Con�ent lo u!f-insure for Workcrs Compen-
ion, as providcd For by Section 3700 af the Labor Code, [or thc pecfarmance of thc
ric for which �his pertnit is issued.
❑ I have and will mumain Warkcfs Compensation Insurana, u �cquired 6y SccGon
3700 of Ihe Labor Codc, (w thc pcA'ormancc oC the wrork for which �his permit is issued.
My Workds Comp m'on Insuranx arti and Poliry n �� ��
/
Cartier. Policy No.:
ER'CI ICA OF EXIINPIION FROM WORKERS'
COMPENSATION INSURANCE '
(Ihis section necd irot bc complctcd i( t6e permit is for onc hundred dallata (5100)
or Icss.) '
1 cenity �hat in �hc performancc of Wc work for which �his permit is issucd, [ shall nat
amploy any person in my man�r m u W bccome mbject w �he Workcrs' Compcnsadon
Laws of Cali(omia Datc
Applicant
NOTICE TO APPLICAM: If, a11cr making Wis Ceniticatc of FxcmpGon, you should
become subject w thc Workcr's Compcnsadon provisions of thc L,6or Codc, you muu
� O forthwi�h comply with sueh provisions or this pccmit shall be dxrtkd mroked.
z "" CONSfRUCT10N LENDING AGENCY
(- i-�+ [ hcreby �rm Ihat them is a consuucdon Iending agcncy for �he performance o[ _
(� � thc work for which Utis permit is issued (Scc. 3097, Civ. CJ
W A Lendcr's Namc '
r z l•cnde�s Addmss
V � I cenifY tha� I havc read this applicadon and siatc ihu 1hc above in(ormatiun is
w� cortcc� 1 agrce to comply with all city and county artlinances and su�e laws relaun� w
0 U building conswction, and hercby authori�e reprcscntativcs of this city w cntcr upon �hc
� W aAove-mcntioned pmperty for inspenion purposes
a (Wc) agrce to uve. indcmnity and keep harmless �he Ci�y of Cupertino against
�� liabilitiu, judgmcnts, cos�s and expenses w' h may in any way accn�c agains� seid City
V Z in eonsequence oC ihc granting oC Nis pc .
�"� APPLICANT UNDERSTAN ND 1LL COMPLY WITH ALL NON o�rr►� Issued by Date i�'� "L��
SOURCE REGULATIONS. �� �
e-roofs ��
Signature of ApplicanU n wr Da T of R oof �
H DOUS MA7'ERIALS DISCLOSURE }��
Will Ihc app ' or future building occupant store or handlc ha•rardaus matcrial
' az defincd by rtino Municipal Codc. Chaplcr 9.I2, and �hc Hcalth and SaCctr
c� Section 25 zcen All roofs ahall be inspected prior to any roofing material being installed.
❑Ycs �o
�� If a roof i� installed without first obtaining an inspection, I agree to remove
wll �he a�licant or fuwre building occupant use eyuipmenl or devices which
cmit hai,rdous air coNaminants az dcfincd by the Bay Arca Air Quality Managcmcnt all new m aterials for inspeccion.
��s����
❑Ycs �u
16avc rea�i �he hvaMcws ma�crisls requiicments undcr Chap�cr 6.95 of �he Califor-
nia Hcalih & SafcryCode, Scctiass 25505, 25533 and 75534.1 undcrstand thm iCthc hu' ding
dacs irot curtcnUy havc a icnan4 it is my respontibiliry w rwufy the upant �he
rcquiremcnts which priorto issuancc of a ccnifica �r • Signature of Applicant Date
Owncroraul '� a n� / p„�.. All roof coverings to be Class "B" ar better