08080002 CITY OF CUPERTINO '+--
BUILDING DIVISION PERMIT N ,
BUILDING ADDRESS: PERMIT NO.
844 BETLIN AVE TBD - TO BE DETERMINED 08080002
RS NAME: PERMIT ISSUE DATE
09/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCH17EC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACnderp DECLARATION -
m 1 bemby affirm Nat 1 am IianaW under provisions of mapter 9(mmmcwing Job Description
4wiN5ecuw 70ld)).fDiviaion3of the BudsnesaM Profcssiom C.de.aMmylieeacla ADD 2ND STORY(784SQ) ,GARAGE CONVERS (48 . 5SQ)REAR
r
.Mon m full race and effca
5q: uceacOass Lia. PATIO CPVER(135SQ) &FRONT PORCH&REMODEL
'qq-aW Dam ARCNRECrSDIZCLARATION FIREPLACE, FAMILY RM,
.< 1 undmaund my Plans stall W used as Public records
g o In Liccnad Profcaio..I
5 OWNER.BUILI)ER DECLARATION
f 1 hereby affirm that I am exempt num the Con"clars Heenan Law for NC
p o following reason.(Secdon 703 1.5.Bulinus and Professions Codc:Any city or county
m which mquirn a permit to commun.blW.Improse,demolish..,mpul any mucaum
prior an its mantra.also tryuims the applicant forsueh permit to rite a signal sawmcnt
F that M is lwcmed pursuam to dm pmviswa of the Camrscwrs uccnc Law(Chapar 9 Sq.Ft. Floor Area Valuation
y��
(comm eming wiLb codon 7000).f Div ion 3 of Ne Busin aid Pm(eaiom Cade)of $105000
y 5$ that he u exempt thnefmm and the basis for tW alleged nnmpfioa Any violation of
SmUon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of p� anC
not mom Nan fist hundmd d.IlarsISM � 36927034yff Number OGGD: P yTyPe
1,u owrmr of Um papmy,amY employees with wagnathe'vmw wmpewuon,
will do dnwmk and the atmctum is not Inwndel or.ffemd(orale(Sec.7044,Business
and Professions Code The Conuacmra Liana law flan out apply in an owner of Required Inspections
propaty who Wilesaimpovn thmcoaand who doeswch work himself.,through his
Own emPloyan.provided thatmeh impmvrmants am not immnlcd oroRemd(axle.If.
however,the Wilding or impovemmt u sold within arc year ofcompleuon.Ne owner.
Wilda will have the burden of paving that M did not Wild or improve for Pumoss.f
sale.).
1.as mount of the property.w caclusivcf,contracting with Banned contractors to -
construct the pmjm(Sec.7044.Business and Pmfosioa Code:)The ComacbYs LF
cense raw don not apply an an owner of pmpwy who Wilds or improves Unrton,and
who cmu&ca for such projena with a conrsmna)licensed pursuant an the Contractors
Licnnm taw.
Olson. tundra See ,Bgc PC for this won
.
PENSATIONDECLARATION
1 hereby affirm under Family of perjury one of tbo following declamations:
❑I here and will mumu.a Cadfam ofCoram nt to mlf-insum for Wormer Comp.
sauon,a povidcd for by Section 37M Of do labor Cade.for the No...of Ne
wash for which this pmnit u issued.
1 have and will maintain Warkers Compaaumn InPuuaa,as agtuaed by Secuan
3700 ofthe labor Coda for the pRormana of do work fafwhwh Nu petit.iaw4 '
My Woriwer Compnation Instance carrier and Polity number art:
caurier, Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crha XCdw reed not be compkxd IIUe Amit is foronc hundred dollars(5100)
nr wss)
1 anify,Nat in Ne pvf.rmanc of lbw work for which this pcmiu is issued,l shall wf
cmPloyanyperso
Cnufcam of Eacmption,you Nould
became subject m O=
C. pnsstian pmruioa.f tW labor Calc you conn
.,z faahadthcomply ith awth prmvidoa or Nu Amit shall W dcmwd mmked.
z O CONSTRUCTION LENDING AGENCY
[—u I thereby aRm that Nem ia.construction lending agency for Nc p.f...f
6i
the wart fur which this Nmit is Usmd(Sec,3097,Civ.C.)
W� A tanner's Name
=z Landers Add.
L)Q 1 comfy that I haw mad this application and saw that Nc above information u
U, ^ corona I&gra m comply with all qty and comfy ordinanaa and saw laws mating w
C) Wilding communion and hemby mNoum up.nudvcs of this city to coon-upon the
r W above-mentioned pmpeny for inspection purpows
I„ G
(WO)ag.to save,indcmufy and saw,hammy dm City of Cuparuw,goat
(Z) liabilities,judgmcnu.cau and eapnues which may in any wayacnue against aid City
U z in consulAPPLIC ce of is granting of this permit.
~ SOUR UUERND WILL COMPLY WIT L�N-J INT Issued by: Date 2 u
�Z 8 Re-roofs
sugnu PPI onracmr
HAZARDOUS MATERIALS DISCLOSURE ows Type of Roof
WIII y t applicant n(Muni bottling c.Claintnore or handle Health
ad Salto l
a dcfu ec m 25 Cupeniw Municipal Codc.Chapmr 9.12,and Um HeaIN and Safety
.Sarson 25532(a)7❑Yes Arg. All roofs shall be inspected prior to any roofing material being installed.
Will the appfucmf or roam Wilding Occupant two crruipmem or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
Omit air cwumirunta//u defiwd by the Bay Ansa Air Quaitfy Management all new materials for inspection.
QYn Q Nu
I have read the haardan mawriaamquimmcrosunder Chaper6.95ofthe Califor.'
nia Hcal"Saint Cads,S= 2550 25533 uW 25334.1 unlcrmnd thmifilc Wilding
dans wt tomo asst a wnana then it my respomibility w wtify Ue occupant of the
myuirenents s moa Ors mer pig t i' uaac of a esw of Occupancy
Signature of Applicant Date
019,000,
owwa.r,athI dost All roof coverings to be Class';W'or better