06080242 CITY OF CUPERTINO
BUILDING DIVISION PERT -
IVIIONTRACTORINF_ORMATIQn
BUIIDINGADDRESS: MARIE-JEANNE & JOEFF DYER PERMITN0.06080242
10955 BARRANQA DR
OWNER'S NAME: PERMIT LWE DATE
SNE: SANITARY NO. CONTROL NO.
BUILD PERMIT INFO
ARCHITECr/FN("INEER: BLDG ELECT PLUMB MECH
0 0
goo LICENSED CONTRACTORS DECLARATION Job Description
1 hmeby N ormel thu 1 w Hundprisions
o oof Chapv 9(mmm t P
.� with Secuoo 700M a0ivision 3 athe Busies and Ptafetamu Code,turd mY nems is
.�„ mrallrane nddxL REVISION: STRUCTURAL CHANGES IN MASTER BEDROOM
,tut cont ORIGINAL PERMIT #06050091
Dox C CantncC
ARCHI'IECIS DECLARATION
i�<< IuMerua«l my pktu shall be usdu Welk rtorda '
)aU
'off Lkvtsd Pmfusooal
0.(I..-Pt f DECLARATION
�r f I hcrtby tutTLm thin 1 m acmpt rrum,hc Cort Co, :Any c law rm tbu
0 0 following tenon.(Sxnan 78313,Busrcss aM Pmfetus«n Cak:by city«county
S$ vInkti tvTu,..a pmmlr m crmu«L.R«,impose.d OOORIO.«rtpsr My 4bueturt
: '< °riw lwiWljN�"'Peden,t�. mumePft ,iou.rhucitnu tnnco«r mrtLicc. ��(aPtct9 Sq. Ft.Floor Area Val$Sa)4092
(cwtnenang with Section 7000)aDswlon 3 adc Busneuud Prorani Code)« "1
_ thu M u etmrtp thcmltato n the bnu f«Ne L14 d doun,dea Any v Won a
Sedim q4 011Q ,
7031.5 by tumwiCIOL f«.pump objcw the ap hi to dell Pendry of APN Number Occupancy Type
two.man fort bimdrtd dam'ISSDB). 32601007 . 00
❑1,u owtc Pf the prapu4Y•arty rmpbyca wBh�W u thew sok rampmuloe,
w,m Wmc tit ccs Tbc core 1,n .I iccousc Law a DOLL LWY t Required Inspections
turd Prae..u,n.code The Caomciortu Lfmas lav dao ora wdy b tun owner a q P
PmRnY'aho bulla.«impvc,hmmn,aM vhodpa tu«h vett M'm..if«,Wwgh hit
own emplaym,peoNded thu»ah TmpOFflKnlf m ootu imevaea«oQetd r«t+le B, '
bovesv,ort buiMieg m unPtOwnmrn4 V wltl within ore lea ac«rplcum,me avow"
builder wiB tiR Us 4vdm of pmWng uua le dN rot Ooik a impose fa pnp�of
pal,u cater a lie mpdot"am acl®vdy co u,talnL w'vh Barnet mnu to
fomvon the pmjxt(STs.7044,Bueinm tund Ptofc LO—Cade:)T bo CcnO.mds LL
W1bo law don sol wpty jt tun caner a propenY who buJds or Imports uetanq cad
Lidc.[racu fors projmu Nthacmvam«(U fi¢rtetllwavammWe Caorranofs \\\V
0 1.law.r
❑Lam K Doc IT`
ERS COMPENSATION DECLARATION
1bdoby tufBrm uMer Paalty a podut,ono a the fallowing dccl mu:
In,u turdvWmdnWn•CmuOare of ftIal,o sl In,tfm Waornoud,of Li-
aumL u providcC for by Semon 37W a,he labor Code,f«the pr(«maree a we
work for which Nitu ptmrlt Ls lined
0 1 hoe ,o t MR msmsn Wout .CaupvuW on Inv a mpirtd by Scnlan .
1700 of the fab«Code,r«the pmfmmuec Of the wart f«wbicln Ronpnnit 41--1
My woni Cotnpe .Inc.artier turd Polity numbm m:
Ctun],dr. Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE '
RLI,scum need not burnnpk¢d a tbu pmnh U to,o«bunANdW m($100)
or )
1 T ry Nor in the pufmnarns of tK cash for wbkh thu r h h Wood.1 sluA not
cmplvu'tun>pc pan ter brmmc mbysLuoft WaMrs'C=PdccUm
Tawsaf Ctli
NOTCa
NOnCE U .IL ager,dwa o p Cenilkaac a Eaempuon.you tuhwlE
bttvartso y the iCampttvtlonpmsi,"or the Labor Cods you,rtm
.,O f«thwith anmp1Y caw sxi pm".caw«thu prmit shell he dccmN tcwkcd
zCONSTRUCTION LENDING AGENCY
N I Icrcby aRlon thu thea k.convrucdoo kMln$apxy f«tic pedonnm¢of
> the wort f«wNch tis p it a iaucd(Sx.3 .Cir.C.)
W Q Isndcrt Nuoc
7 z Lsukltu Admu+
U0 I cwtify chat I base,m thn aPWicwon aM suit ticu we stow id« afiun u
Ly P corrin I q,cc w comely with all dry and county otdhncu and to
ue laws tcl W ng 10
U burnu
ildingcoclionandbcebyauthodmmprexnwi.csorthuci,ytOcnterupnnue
W ahuvc menuuncd popcny for intrccuon WTos+
(Wd agree tO are,indcmnily and ixp humless the City o1 CuN...$mint
� Rtbiliuo,ju mew,cmuand v,pcwu which vuy in any way.cmue agaitw said City
U Z APPWC r FBSTANDS"AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SO(JR REGU ``
I�'� Re-roofs
art of HAZARDOUS MATERIALS DISCLOSURE D,th Type of Roof
Will the tupplkaot«Rin,.bulidmp anvpmt nate Of hadk htuurdooi OTU iW
u dcfndJ by tie Cup=.Muvicipd COdc.Chaper 9.I;ttd the Halth and Sdny
r10-k;Senka 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yc
If a roof is installed without first obtaining an inspection, I agree to remove
cam tic."Iln o,f Mot,accutunt.NujMcctatdewlas whici
emit hang sr annum defined by the Bay Arts Air QWity M=Vroont all new materials for inspection.
Diarim7
❑Yc,, ONO
I hase,cad t1,haradoua m 1,;r WJrO....uccCut,cr&95ordcCdifm-
oiaHalWcty 25505.25333 vel 25534.1 undmwd uwuuc building
ass not, y bort a oma tw k u my tn>po hiiity m mag the nawant or the
nyukcmPnnb'muv
our.wit cc a.Cmi to r ignature of Applicant Date
All roof coverings to be Class"B"or better