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CITY OF CUPERTINO
BUILDING DIVISION PERMIT C+tIT] CflII�CI � t�N,;
BulLI`r�cr�g PERMIT NO.
STEVENS CANYON RD MARINKO BALDE 07090042
OWNER'S NAME: PERMIT MUE DATE
MARINKO BALDE 10/09/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
OZ
LICENSED CONTRACTOR'S DECLARATION
a Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U L with Section 7000)of Division 3 of the Business and Professions Code,and my license is REVISE BEEM ON 3RD FLOOR MASTER BEDROOM, ADD
y in full force and effect.
Z Licensc Class Lic.p BASIN
�n Datc Contractor
ARCHITECTS DECLARATION IN GARAGE
a I understand my plans shall be used as public records
tyU
U.o y Licensed Professional
•y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
1 00 following mason.(Section 7031.5,Business and Professions Codc:Any city or county
%m which requires a permit to construct,alter,improve,demolish,or repair any structure
—r^ prior to its issuance,also requires the applicant!or such permit to frac a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
i 1--m (commencing with Section 70(x1)o!Division 3 of the Business and Professions Code)or $0
4 that he is exempt tbercfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of N Number Occupancy Type
not more than five hundred dollars(5500). 3 4 217101 .`ql7'
[11,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sato(Sec.7044,Business
and Professions Code:The Contractors License law does trot apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7041.Business and Professions Code-.)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exem der Sec .B x,P C rot is reason
Owner Date"declaraorm:
O 'S COM A"ON DECLARATIO -
I hereby affirm under penalty of perjury one of the followin
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
wont for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Codc,for the performance of the work for which this permit is issued
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS"
COMPENSATION INSURANCE
(This section need not be completed i!the permit is for one hundred dollars($10G)
or less.)
I certify that in We perfo an o!W worir far which this permit is issued,1 shall not
employ any person in any an cr so t «omc subj«t to 4oExc
o ens'C pcnsau _
Laws of California.Date
Applicant
NOTICE TO APPLICA ,after ng is ruficae ption you should
become subject to the Worker Compensation visions of the Lab r Co you must
forthwith comply with such provisions or this permit shall be deemed revoked-
0z CONSTRUC IGN LENDING AGENCY
[—c I hereby affirm that there is a constructionending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lenders Name
Lender's Address
a 2
U 0 1 certify that I have read this application and state that the above information is
LL, — correct.1 agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorim representatives of this city to enter upon the
Lea above-mentioned property for inspection purposes.
LL (We)agree to save,indemnity and keep harmless the City of Cupertino against
HC/) liabilities,judgments,costs and expenses which may in any way accrue against said City
(J Z in consequence of the granting of this permit.
H APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ((/
SOURCE REGULATIONS. A��
/Signature of ApplicanVConuRe-roofs actor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stoic or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.17,and the Health and Safety
Code,Section zss3z(a)7
Yes No
All roofs shall be inspected prior to any roofing material being installed.
❑ ❑
Will the applicant or future building occupant use equipment or devices which
-If a roof is inst ,thout first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all rte at eels for in pection.
District?
❑Yes C]No
I have read Ne by s ma 'eels requircmcns under Chapter 695 olNc Califor- ^
niaHcalth&SafctyCA coons255 .25533 425534.1understand that ifNcbuilding G�(f
docs n rtently have a ant.that it' my nsibility to noufy N Occup t of the
requi c s which must met p or t tan of a Certificate Oce p Slg re of Ap Date
nt b Da A roof coverings to be Class"B" or betler
ow rotator r'vrdagc
CITY OF CUPERTINO c ;
CUPEkTINO PERMIT APPLICATION FORM n -s0(0
070 q M4Q
APN# Date: 7, 10 , 07,n , 0 `�
Building Address: Mailing Address ((if different from/building address):
/0 973 .ST�UTNS C� d� �.0 - Cu jun-7,,, � e4 - iso/-
Owner's Name: Phone#:
MaFJAl� ��€ 0`?S
Contractor: � � License#:
Contact: Phone:LJV (f 8S "76014' Cupertino Business License#:
"i4AJ Fax: w VS- 76 Y-'
Building Permit Info: �,�,y, ; 'Z P
fl i N G- WAS,* 6-x$/^/ A r 4:9pm 46� co c 4-7-7`OAJ
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
12�
Type of Construction: Please check this box if the__project is a
--- - - - --
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major❑
antiFee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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