07100197 CITY OF CUPERTINO ' '
BUILDING DIVISION PERMIT ���� ��� ��������+ '
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PERMIT NO.
BUILDINGADDRESS: TBD — T�) BE DETERMINED 07100197
7863 LILY CT •
PERMIT LSS[IE DATE
(ER'S NAME:
O QUIN H M AND MACALLISTER � 11/13/2007
SANiTARY NO. CONTROL NO.
PHONE: r T
BUiLDING PERMITINFO
ARCHI7ECIYENGiNEER: BLDG ELECT PWMH MECH
0 0 0 0
a p � LICENSED CON7RACTOR'S DECLARATION JOU DeSCTIpU0i1
� V� I hcrcby aftirm that 1 am liccntcd undcr provisions of Chaptcr 9(commencing
�� with Section 7000) of Division 3 of ihc Busincu and Pro[cssions Code. and my licensc is S FDW AD: � 3 � S Q K I TC H EN , S EW I NG ROOM & REMODE L
��y infullforceandeftec�. �� � KITCHEN & HALL� LIVING ENTRY. D O U G L A S K I R K N E ED S
� v� Z Licensc Class Conuactar
y F , � Datc B S L
� ARCHITECI'S DECLARATION
-� 1 undcrstanJ my plans shall be wcd as pubiic �ccords
w<
` � y Licensed Pnifcuionat
y � OWNER-BUII.DER DECIARATION
� I hercby atlirm that 1 am excmpt Gum thc Canvactar's Liccnx Law for thc
� o O following rcazon. (Scction 7(I3I.5, Busincss and Profcssions Ca1c: Any ciiy or couniy '
y� Pi which ccquiros a pcimit to �a�swc4 attcr. imProvc, dcmalish M R�Wit elly EWCl11fC
�rcior io i�s issuancc, alsc� rcquims thc applicant for such permit ta filc a signcd su�cment �; Ft. Floor Area Valuation
� _ � that hc is ticenscd pursuant to ihc pmvisions of ihc Conuactar's Liccnsc Law (Chaptcr 9 • $19 6 0 0 0
Y F- (commcncing wi�h Scction 7000) of Division 3 of Ihc Busincss and Profcuions Cndc) or
y�� ihat he ia exempl the�efrom �nd �he buis Cor �6e allegcd exempdon. Any violation a[
SecGon 7031.3 by arry applicant for a permit subjecu Uu applicant W a civil penalty of 3 5 9 0 3 012 �� Number Occupancy Type
not mme ihan fiw hundmd dollars (5500)•
0[. u owner of tt�e properry. or my emptoyces with wages u their sole compensaUon,
p,�p ��he work, and �he saucwee is notintended or offered for sslc (Sa. 7044 a�;� Required Inspections
and Professiona Cade: 7he Conuactor's Lianae Iaw does not app�Y to m ov"ur of
propeny who builda or improves thereon. and wM does such wart himself ar �hcougA hia
own employccs, provided ihat such improvements ue not intended or ofleeed Cor sale. if,
hawever. �he building or impcovement is wid within one year oC compleGon. the owneo-
buildu will have the burden of pinving �ha� he did not build or improve [or purpose of
sa�J.
I. as owner of Ihe properly. am wcclusively conuacting wi�h lianaed rnnvactors to \
constnut the p�njea (Sec. 7044. Business and Professions CodeJ 7Le Conuxmr's lr-
cenx [aw docs no� apply w an owner of propeny who buitds or improves �hereon, and ,
who contracta for such pmjecu with a conuactor(s) licensed pursuant w �he Contracwr's
License Iaw.
�"1 I am exemgt under S.c . B& P C for �his n
OL�r.J�^►L.�1 /1 �.3 07
;u �6G�T Dau
OR R'S G MPENSATION DECLARATION
I hereby �mi under penalty af perjury one o[ the following declarUions:
❑ I hs+e a� will mainiain a Cenifiate of Conaent to self-insum fw Workcr's Compen-
sation, u provided for by Sectian 3700 of the [Bbor Code, far �he pecformance of �he
woric far which �his permit is issued.
❑ I havc and will maintain Warkcts Compensation Insurancc, az required by Sccrion ,
3700 oC thc Ubor Codc. Cw the pedormanu of the work for which this permit is issued.
My Worker's Campenaauon Insuranm carticr and Poliry number azc:
Cartier. Policy No.:
CERTIFICA7'fi OF EXEMP'170N FROM WORKERS'
COMPENSATION INSURANCE
(Chis scction need wt bc compieted if �he permit is far onc hunNed dollars (5100)
ar Icu)
1 ceniCy that in Wc performancc af thc work Cor which ihis pertnit is issucd. ( shall not
employ any person in any manner so az to bccomc wbject io ihe Workcrs' Compenulion
Laws of Cali[omia. Datc
Applicant
NOTICE 7'O APPLICANT: If, aftcr making ihis Cenifica�c of Excmpiion, you should
become subjctt w thc Workcrs Compcnsation provisions af the Labor Codc, you must
�,�,' forthwi�h comply with such provisions or this pexmil shall bc dcemcd ccvokcd.
z � CONSfRUC170N LEtVDWG AGENCY
[.~.� ►�. 1 heecby aRrtn ihat ihcre is a conswction knding agency for ihc perfarmance o( •
�„ . Uu work for which this permit is issucd (Sa. 3097, Civ. C.)
W A Lendcr's Namc
� z Lcnders Address
V 0 I cenify U�at I have rcad Ihis appliw�ion and sutc �u t4c abovc infamatiun is
w� cortcct I a6rce w comply wi�h all city and counry oniinances and sta�e Iaws relaung w
� U building conswction, and de�cby suthorine RprescmaGvcs of �his ciiy to entcr upon the
� W abme-mcntio�d property for inspection purposea
a (Wc) agrce to save, indcmnify and keep harmless �he Ci�y o( Cupertino against
H � liabilitiu, judgmcnls, costs and expcnscs which may in any way accnic against said Ciry J �� �)�
(� z in conxquence aC the granting of ihis permiG Date /1 / �
►�+ APPLICAIII' UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by
SOUR RE ULATlON . ��[�g �
Re-roofs
Sign arn •�u ��a� ° a� Type of Roof
HAZARDOUS MA7EitIALS DISCLOSURE
wlllhe applicant or futurc building acupant storc or handlc ha•rardous ma�crial
�fefincd by the Cupertino Municipal Codc. Chap�cr 9.12. and the Health and Safety
�. Scction 25532(a)? � All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs L�f no
Wi►i thc applicant or future building accupant usc cyuipmcnt or deviccs which
If a roof i� installed without first obtaining an inspection, I agree to remove
emil hvardous air coniaminants u dcfincd hy the Bay Arca Air Quslity Managcmcnt all new m aterials for inspection.
District? �/
❑Ycs �N�
1 havc rca�i ihe ha�ardous ma�crials requiremcnu undcr Chap�cr 6.95 of thc Califor-
nia Hcaltlf & SafctyCode, Sections 25505.25533 anJ 25534.1 un�d that if �he 6uilding
dacs rwt curtcn0y havc a �enant, U�ai it is my maponsi6iliry to nou(y �hc occupant o! �he �
rcquircmen w' h bc t'or � orac �r��r� P�r. SignatureofApplicant Date �
� r u All roof coverings to be Class "B" or better
Owncr or au ori�td nt D