07120068 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �1TR.�. '.I'UR' NFURMATIa ?
BUILDI G OD S: PERMIT NO.
l�g4gFSCALVERT DR TBD - TO BE DETERMINED 07120068
NEWS NAME: PERMn L4UEDATE
02/01/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHI7EC,ENGINEER: BUILDING PERMIT INFO
'BLDGELECT PLUMB - MECH
( E 0
aJ
as o LICENSED CONTRACTORS DECLARATION U Description
1 hereby affirut m J 1 ane licensed under previsions of Gaper 9(commencing IO
with Section 7000)ofDiviaon 3 of the Business and prominent Code,anal my license is ADD M,STR BDRM & BTHRM(332)&ADD PORCH(119)
in full Assessed effort.
Z Uccnu Clan Llc.g
Date Contract,
ARCHITECTS DECLARATION
ee I understand my plan]shall he used az public records
Dgu
yo Licensed Professional -
OW NER-BUILDER DECLARATION
a� E 1 botchy alTres that I am exempt frem No Convector's License Law for the
O O following reason.(Section 703 1.5,Business and Prefcaions Coda:Any tiny or county
$ which mquirm a Permit no omswct,slot.Improve,dommitth,or repair any structure
is' prior In its isommeC.Wo requires lho applicant for such permit to file a signed summon,
gg�o that he is licensed puramt tree provisions of the Comment's uceom Law(Chapter 9 Sq.Ft. Floor.Area Valuation
9 (commencing wit gotten 7000)ofDivisim3ofthoBusiness and PrefeuionsCook)or $40000
y'3$ that ha is exempt therefrem and the buss for the alleged exempdon.Any vlobome of
Scotian 7031.5 by say applicant for a permit subjects the applicant to a civil penalty of ,�,pN Number Occupancy not more than fin hundred dollars(SIMI. 375 18 0 2' I7 y Type
❑I,u owmr of the property,ar my employees with wages u their into compeuadon,
wiB do dm wart,sod theswcium b notintended oronemd forsam(Sce.7044,Busirou
and Pref rumns Cade:The Cmumactr's License Law does act apply to sm we.of Required Inspections
Property who builds or i m prove,thereon,and who dues such work himself or through his
ownemployeas,provided that of improvements art not intended monered for tile.If,
however,the building or Improvement is sold wWin one year of compiction.the matter.
Wilder will hive the burden of proving that he did not build or improve for purpose of
sale.
s owner of the property am exclusively contradmg with licensed conumbas w
couwct the project(Sm 7044,Business and Prnfcuions Code:)The Continues U.
mve law does not apply se an owner of property who builds or improves doreon.and.
who contacts for such projects with a cormonno(s)licensed puauant t use Consumer
License law.
❑lamsee
CLARATIO
I hereby tribes under penalty of perjury one of the following decimations:
1 haw and will maintain a Cerdficnm of Consent to self-Insure for Worker'sCompen-
amtion,as provided for by Sectmn 3700 a the Ghor Code,for me Permwanse of the
work for which this peroit u trued.
❑1 haw and will maintain Worker']Compensation Wurma,as mgbred by Section
3700 ofthC Labor Code,for the performance ofthe work for which this permit Is issued. '
My Worker's Compensation Insurance carrier and Policy number art:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thasection need not kemsplead If the Permit is form hundred dollars($100)
or ins.)
I certify that in doe performan5 of Jon work for which Nis pewit is issued,I Yell not
employ any person in an
Applicant11
...
NOTICE TO APPLICANT:IL eMr making this Certificate amp y—uyoshould
become subject In the Worker's Compensation previsions of the Labor Cede.you muss
.J 0 Ambvith comply with such provisions w this Permit]hall he tamed mwked.
Z CONSTRUCTION LENDING AGENCY
1 Wmby alfnrm that them lis construction lending agency for the Performance of
CL> Ne work for which Ni]permit Is issued(Sec.3097,Co,C.)
W� Lendce.Name
2 tender's Address
V Q I certify Nat 1 haw read this application orb were the Ne above information Is
ly F cows 1 agree te comply with all City and county obioanas and mo hark relating In
O ti. Wilding contrarieties.and hereby aatWrize represenmiws of Nis city menu mor the
LL7 above-mentioned property for inspection Ferretti.
6. (We)agree he an,indemnify and keep hawlea die City of Cupertino against
rA Rabllities,Judgments,costa antl expenses which may in any my acenm airman said City
C)7 in cmmummue of the granting of this Permit.
i� APPLICANT UNDS$ISTANDS VD WILL COMPLY WITH ALL NON-POINT Issued by: Date q-,,--C/?'
SOUR
Re-roofs
Signuurt of Applica onROr OM
HAZARDOUS MATERIA tow of
Type of Roof
Will Ne,Cope
t or tfuture Wilding occupant stare or Indio Hied ossa mamrial
az defined by dm Cupertino Municipal Code.Gaper 1,12,and Nc Health aid Safety
'�tla.Semon 15531(a)7
Ely" All roofs shall be inspected prior to any roofing material being installed.
00 win the applicant or mom Wi mg aapam tax cyulpmeht or JeviLes which
If a roof is installed without first obtaining an inspection,I agree to remove
..It harabnu air conuminents u din sed by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 hoc mad Ne bsectom matrisis requirements mulerchapmr6.95 often Cation-
/Vl 11 it 1 .v—l(Jl Signature of Applicant Date
Owner or authmrimd agent —'Dam" All roof coverings to be Class B"or better /
— f