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09040045 - PUB10 40,01 v 0 4 File Edit Actions Details Links Favorites Help Permit Information Permit Number " 109040045 Status `j C - Closed Y-! Master Number Notes i 0] Project FF-- - - -- Apply Date ' 04/07/2009 P - Operator — - patg Permit Issue Date 04/07/2009 Operator ipatg Certificate Issued i09/14/2009 J Operator PA�j LM -- Certificate Type Certificate Number Permit ' Property I Zoning Applicant 11 Contractor' 1I Defined Fields I Permit Details Permit Type ' Usage Class' 11R3SFDREM j r SINGLE FAMILY DWELLING REMODEL II/III B, IVIII B, IV -HT V-B NEW Location Information — - - - Address " 22275 CANYON VIEW RD — City/State/Zip CUPERTINO CA 95014 APN 36641008, 00 I U nit j Ov-xier Entity Information Owner Name " AR TER WILLY AND NAOKO T Use Default Address - :Home - 22275 CANYON VIEW CIR -- r✓ —J City/State/Zip CUPERTINO CA 1 r� '95014.4839 Applied Value ' 35000', SQUARE FT. 290] Calculated Value E 0 Q US C-404 Type 1434 ALT: RESIDENTIAL_ Permit Form JAUTOPERM -PERMIT Ownership 1 Private V Project Size COUNTER - OVER THE COUNTER+ Enter the purpose or any special conditions for this permit Purpose/Special Conditions -- KTCHN RMDL WITHIN HXTNG SPACE 6 LANDRY, NO RE—RF61d STRCTRL FILMED— 2011I 1[QAdd Default T v } OK Back �.-,i Contractors Fees [�i Plan Reviews Inspections Ja Print Permit (Adjustments �f Holds J Copy Permit Close Permit l `4 u Overrides J Supplementalfields Notes 1 Attachments O R yo j Z j Z enYe F 7 U v y 7y� —?4 EFc s, 02 C v W? R� C UC u. (__ O� Fa .� v U2 CTTY OF CUPESION BUILDING DIVIS10iV PERMIT Tntrl� BUILDING ADDRESS:22275 CANYON VIEW RDOWNER'S NAME. P.RIvffT LSSUE DATE PHONE: A CONTROL NO. (408)436-5448 ARCHITECT/ENGINEER BUILDING PERMrr INFO BLDG ELI= PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 df the Business and Professions Code, and my license is in full force and effect C(S �9 KTCHN RMDL WITHIN EXTNG SPACE & LANDRY,_ NO License Class Lk. N Date contractor E-RF&NO STRCTRL ARCHITECTS DEC 1, I understand my plans shall be used as public records Licensed Prufessional OWNER -BUILDER DECLARATION I hereby aliirn that I am exempt from the Contractor's License Law for the rellowing reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Contractor's License Law (Chapter 9 S q. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (commencing with Section 70D0) of Division 3 of the Business and Profession Cade) or 3 5 0 0 0 that he is exempt therefrom and the basis for the alleged exemption Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (i500). 3 6 6 4 1 0 0 8.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q will do the work and the structure is not intended or offered for sale (Sec.7044. Business and Profession Code: The Contractors License Law does not apply to an owner of p property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements ate not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builderwill have the burden of proving that he did not build or improve for purpose of sale.L ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors L.i- cene Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractors) licensed pursuant to the Contractors License Law. ❑ 1 am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the fallowing declarations: ❑ I have and will maintain a Certificateof Cansent Loselr-insure for Workers Compcn- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Workers Compemation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued - My Workers Compe �76� once artier and Policy ur( 0, ry Z •y Carrier. Policy No.: W [� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred dollars ($100) or Icss.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provision of the Labor Code, you must forthwith comply with such provision or this permit shall be deemed mvolsd. i l CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) ' Lenders Name Lenders Address I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the about-mcndoned property for inspection purposes (We) agree to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may In any way accrue against said City in consequence of the granting of this permit. APPLICANT UND AND . WILL COMPLY WITH ALL NON -POINT Issued by: Date S G AIM Re -roofs Type of Roof Sig um or ApplicanU ontractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Mumcipal . Chapter 9.12, and the Health and Safety Cade, Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes o If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future buildin pant use equipment or devices which emit hazardous air contaminants as deli d by the Bay Area Air Duality Management all new materials for inspection. District? ❑ Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safely Code, Section 25505, 25533 and 25534.1 understand that if the building does not curendy have a tenant. III&L It is my responsibility to notify the occupant of the ro ircme w 'ch m or to issu of a Certifies of occupancy. Signature of Applicant Date �© All roof coverings to be Class in," or better sun authorvcdag t