Loading...
10050084 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10321 PHAR LAP DR CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10050084 OWNER'S NAME: FREERKS FREDERIK W AND LOUISE DATE ISSUED:05/10/2010 G BR'S PHONE: 4082570652 ' PHONE NO: G LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class� C,b 111)-91 Lic.# 7 h Q r'-7 7 Date_ MECH 7 RESIDENTIAL I— COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JO B DESCRIPTION:CHANGING FRONT DOOR ROUGH OPENING FROM 38X82 (commencing with Section 7000)of Division 3 of the Business&Professions TO Code and that my license is in full force and effect. 627% 82 WITH NEW FRAMING.REPLACING TWO(2)WINDOWS SAME SIZE I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq. 7t Floor Area: Valuation:$15792 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APP Number:32639045.00 correct.I agree to comply with all city and county ordinances and state laws relating Occupancy Type: to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for i s ction u indemnify and keep P?pPses. (We)agree to save fY p hafmless'tt►e CiCupertino against liabilities,judgments, costs,and ex s which may Y c e against said City fn consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting o this p it. Additid ly,the applicant understands and will comply 9.18with Laon-poin sourceMgui sper the Cupe o Municipal Code,SectionWITHIN 18O DAYS OF PERMIT ISSUANCE OR 1.80 D YS FRO T CALLED INSPECTION. Sign -u-�=--� �,z� - _ Date `��- /o Issuc d by: v Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: I,as owner of theproperty, All ro ifs shall be inspected pri toany roofng material being installed.If a roof is es u my employees with wages as their sole compensation, install ti without first obtay an inspection, ec to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the roe P P rtY>am exclusively contracting with licensed contractors to Signat are of Applic �-��. construct the project(Sec.7044,Business&Professions Code). s to Date: I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by Califon nia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compli ince with the Cupertino Municipal Code,Chapter 9.12 and the Health& permit is issued. Safety --ode,Section 25532(a)should I store or handle hazardous material. I certify that in the performance of the work for which this permit is issued,I shall Additic nally,s Id I use equipment or devices which emit hazardous air not employ any person in any manner so as to become subject to the Worker's contyyam' is as defined b eBay rea Air Quality Management District I will Compensation laws of California. If,after making this certificate of exemption,I wealth 3VSafety Codfl e ,Sectitl ons 2550he 1,25533jno ,iand 25534icipal e,Chapter 9.12 and the become subject to the Worker's Compensation provisions of the Labor Code,I muLe'r forthwith comply with such provisions or this permit shall be deemed revoked. author'" agent: Date: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) ups^the above mentioned property for inspection purposes.(We)agree to save Lender'; Name i. iify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the Lender': Address ing of this permit.Additionally,the applicant understands and will comply wan all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ARCHITECT'S DECLARATION Signature Date I underst nd my plans shall be used as public records. Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10321 PHAR LAP DR I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 10050084 1 OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class 13 Cb V dJ1 Lic.4 7 Y° 7-7 7 Contractor?0'5*5"1'-" t4 Date /o 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 above mentioned property for i s coon pappses. (We) agree to save indemnify and keep harrn eI'ss the Cit f Cupertino agafyst liabilities, judgments, costs, and exp s which may ac a against said City in consequence of the granting cr this permit, Additio Ily, the applicant unddrstands and will comply with ayl� 0X-1 o ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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 sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I mt forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatu Date PHONE NO: BUILDING PERMIT INFO: BLDG l- ELECT F_ PLUMB F MECH r— RESIDENTIAL F_ COMMERCIAL JOB DESCRIPTION: CHANGING FRONT DOOR ROUGH OPENING FROM 38X82 TO 62X 82 WITH NEW FRAMING.REPLACING TWO(2) WINDOWS SAME SIZE Sq. Ft Floor Area: I Valuation: $15792 APN Number: 32639045.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D YS FRO T CALLED INSPECTION. Issued by: Lers S " Date: RE -ROOFS: All roofs shall be inspected pri -to -any loofing material being installed. If a roof is installed without first ' -Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, skQuid I use equipment or devices which emit hazardous air contamoot as s defined b e Bay rea Air Quality Management District I will m.i twin compliance ' the Cupertino Municipal Code, Chapter 9.12 and the q/ I Date: r o r a CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records.