07120191 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAGAORANI'ORMATIO,N a^a'
^en;m
PERMIT NO.
""fIdYTT ESTATES DR CRAFTSMEN ROOFING CO 07120191
NER''S NAME: W PERMIT ISSUE DATE
1412 DENTWOOD DR 06/30/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHr1ECfIENGINEER: BUILDING PERMIT INFO
ADDITION 743 ' BEDROOMS, BLDG ELECT' PLUMB MECH
O O O O
u O p LICENSED CONTRACTOR'S DECLARATION '
1 bemby allure that 1 w licensm
ed under provisions of Chapter 9(commencing —^'^-•^^^-'^ - ------- ^•• •'�'+'�eSCrIpIIOn
with Section 7MsB.fDiAsior3ofd¢BUM.and Prufuleou/Colqe.and my he,.is
in full forte and elf Se 7/J
;�� Licenw Class Lte.0 .
t•aDa¢ 9 Con Da I, G� D1iv 6
uuuyttt T� RCHITELTS DECLARA IOY -.dam
lis d yplans shmlhnsndupublic mcoNs
,°t; Lktncd Porfeesional
OWNER-BUILDER DECLARATION
I I hereby aRrm Nat I am amnipt from the Conlracmrs Lice..Law for the
O O following teaser.(Section]071.5.Bosinnss and Profession Cock:Any city or county
i m fl! which requires a permit to cnnsvucL after,improve,demolish,or repour any eweture
o;'^ prior to its issuance.Win mquity the applicant for such permit to ole a signed statement
Z''2 that heulicensed pursuanttoNcpmvisiomofNeContractor's LiceneLaw(Chapter 9 Sq.Ft. Floor Area Valuation
x�S (commencing with section 70M of Division S of dmc Business and Professiotu Code)or
Q that he is exempt Nomfmm and Ne huts for the alleged emmpdon.My violation of
Section 7031.5 by any applicant for a permit subjects Use applicant to a civil penalty of APN Number Occupancy Type
not mart than An hundred dollars(S5(IW). P y YP
01,uownerofthepmpmy,mmyemployeeswithwgauN kmkcmnpensauon,
will do the wok and Meats tum is motinmuded m ofremd Rambo(Sec.7014,Business
and Professions Code:The Contractors License Law does not apply to an OWoer of Required Inspections
propeny who buildsorirepovu Merton,and whodoessuch work himselfor Waugh his
own employees,provided thatse ch imprawmenu amnotinmnded mattered fora e.B,
however.Ne building or improvement is sold within one year of completion,the owner.
build¢will have the buNen of proving Nat he did not mdd m improve for putpoe of
sola.).
0 1,as owns of the property,am exclusively contracting with licensed contractors to
construct to project(See.7(i14,Business and Professions Code)The Comruewrs U.
cense law dem not apply to an owner of property who Wilds or improves thereon,and.
who contracts for such p ijeets with a eom.ctor(s)licensed parson,in the Contractors
Lum.Law.
I am exempt under See .B&P C for this¢awn
Data
40- WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury nee of the following declinations:
❑Ibaa and will maintain a Certifinm of Conant to self-insure for Workeri Compen.
.tion,a provided for by Section 3700 of the labor Code.for the peefmmwa of Use
work fo ieh this permit is issued.
hart and will maintain Workers Compensation hommunce,as roquired by Section
37M of to lab¢Code,for Ne petformanee of the work for which NCu pmen,is tissued.
My Workers
Policy
oli No.:
CE IFICATE OF FXEMPIION FROM WORKERS'
COMPENSATION INSURANCE
(ITu suction need not W completed if the permit u Wow hundred dollars(SIM)
or less)
1 ecnify,that.in the pmfonvoc of the work for which Nis permit u Wood.I Nall nm
employ any parson in any manner m n w become abject to th,Worker'Compensation
Laws of California Dau
Applicant
NOTICE TO APPLICANT:If,aper making this Certificate of Escmption,you should
become subject to Ne Worear's Compensation provision of the{.atter Cabe,you most
0,z feMwiUm comply with such provisions or this permit shall W deemed rooked.
z O
r CONSTRUCTION LENDING AGENCY
F I thereby affirm that emite'uaed(Sec.3 lending agcmy for six performance at
C'
the work for which this permit u issued(Sec.709],Civ.C.)
MW 0 Landers Name .
] z Lenders Address
U Q 1 county Nat I have road this application and Mute that dm above informed..is
D. F corm.l agree to comply with all city and county oreinanaes and sum len relating in .
0 U building constmction,and hereby auNorim¢pmxnutives of this city to color upon Ne
abow-mcmidgedpts.co for inspection foupowhich ms
F W (We)agree to save,indemnify and kap harmless the City of Cupr .against
rq in
aunce of tts,cru and expenses which may in anynyacmue against said City
t.)z in consequence of the granting of Nu permlL
SOURCE GUNDERS'ANDS AND WILL COMPLY WITH ALL NON�-POINT Issued by:9 Date O
foo
utgnuure of APplkanUC� a Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atom m hurdle bamdoa material
u def ed by Use Cupempat Municipal Code,Chapter 9.12,and the Health and Safety
.Sector 25532(01
❑ B/ All roofs shall be inspected prior to any roofing material being installed.
Ya
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ne applicant or fuwm building occupam esu equipment or devices which P g
Coati ha udnns Mir conuminsnts as defined by the Bay Area Air Quality Management all new materials for inspection.
0y.
I have real the hvatdwsmateriab roquiromcnts under Chapter6.95 ofJm[alifor-
nis Health&Safety Code,Secumu255U5,25533 and25534.I understand!Natif to building
dos rot cuncondy have a tum,than u y.seepmuNi'y to mnufy time occupant of the
myuirtm Occepusy. Signature of Applicant Date
o N d s �� Dam All roof coverings to be Class'W or better