09010118BUILDING DIVISION PERMIT
BUILDING ADDRESS:
1228 WEYMOUTH DR
OWNER'S NAME.
ARCHITEC IENGINEER:
u 0 C LICENSED CONTRACTOR'S DECLARATION
16 F I botchy affirm that I am licensed under provisions of CLapta 9 (commencing
with Section 70D0) of Division 3 of the Business and Professions Code, and my Hants is
y in full forte and effect : 2
License Class i� Lc. I
9 Date I Comrectec -06 12
R H CTS DECLARATION
I understand my plans shall be used as public records
3'U
C t; Licensed Professional
aOWNER-BUILDER DECLARATION
I beneby siTirm That I am exempt from the Coniractor's License Law for the
0 O following morias (Section 7031.5, Business and Professions Code Any city or county
$ Pi which mquirea a permit to MM ---L alter. improve, demolish, or repair my stmcmm
Z prior to its issuance, alto requires she applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the B usbrts and Professions code) or
y .. that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the appfianL to a Civil penalty of
nen more than five hundred dollars (5300).
❑ L as owner of the property. or my employees with wages as their sok compensation,
will do the work. and the sanctum is not intended or offered for sale (Sen. 7044. Business
and Professions Code: The Contractors License Law does not apply to in owner of
property who builds or improves thereon. and who does such work himself or through his
mane employees, provided that such impmvements ate not intended or offered for ale. If,
however, the building or Improvement is sold within one year of completion, the owner -
builder will have the burden of proving tut he did not build or improve for purpose of
sal.).
[:11. as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sen. 7044, Business and Professions Code:) The Contractors I.i-
cum Law does not apply to an owner of property who bolds or improves demon. and
who contracts for such projects with a cont actors) licensed pursuant to the CDntractors
License Law.
❑ I am exempt under Sec B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby strum under penalty of pm jery one of the following declarations:
❑ 1 have and will madnuin a Certificate of Consent to elf -Insure for Worker's Compen-
sation, 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the wok for which this permit Is issued
My Workee Com�n insu artier and Policy n m err a
Cartier.--11{{//•�Z� r•`fJCLI Policy Na:
CMITIFICATE OF EXEMPTION FRO WORKERS'
COMPENSATION INSURANCE
(This section need not be complexed U the permit is for one hundred do0ars (5100)
or less)
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 bxxoma subject to true Workers' Compensation
Laws of California. Date
Appifcamt
NOTICE TO APPLICANT. If, after making this Certificate of Exemption. you should
become subject to the Workers Compensation provisions of the Labor Code, you must
.J Z forthwith comply with such provisions or this permit shall be deemed revoked.
q O CONSTRUCTION LENDING AGENCY
[—x 1 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.)
0 Lenders Name
Z Lenders Address
U O I certify that I have end this application and state that the above information L
(•L u�',c emrrect 1 agree to comply with all city and cority ordinaraea and state laws relating to
C) ' ` building construction, and hereby authorin representatives of this city to mux upon the
W above-mentioned property for inspection purposes.
py (We) agree to ave, indemnify and keep harmless the City of Cupertino agAma
H vy liabilities, judgments, costs and expenses which may in arty way accrue against said City
U Z in Contsequence of the granting of this permit.
r -a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SO 6 //Z 1J/®�(
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building aeupant Stam or handle hazardous material
as defned by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section 25532(1)7
❑ yes [P No
Will the applicant or Cum building occupant use equipment or devices; which
emit hazardous air contaminants at defined by true Bay Area Air Quality Management
District?
❑ Yea o
1 have stead tie materials requirements under Chapter 6.93 of the Califor-
nia Health & Safety Code, Somans 25305, 23333 and 235M. I understand this if dhc building
don not currently have a tenant. that it is my responsibility to notify the occupant of the
miuixerrcoisandiich must ba -Met to issuance of ■ C.murx ro of Qcnnpany). _
or tut riz d stent ° Date
ALL
408)946-4744
PERMIT NO.
09010118
PERMIT ISRIE DATE
A CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
0 0 0
Job Description
ADD TRELLIS, PATIO (ALUMINUM)& STRUCTURAL
Ft. Floor Area
36210035.00
Issued by:
Re -roofs
Type of Roof
M
Required Inspections
no
Valuation
Occupancy
7
Date t �
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
. All roof coverings to be Class'W. or better