06020004 CITY OF CUPERTINO �•
BUILDING DIVISION PERMIT CONTRrC'TUR TNir'U'CtMA'fI0 �� •
x fids:a;r-, .a, #, K$.,i-.""° `%u et➢iT d#K•D
BUILDING ADDRESS: C & D FREITAS CONSTRUCTIO PERMITND.06020004
10390 MALVERN CT
R'
23610 MORREL CUT-OFF RD 02/27/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 353-1228
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
0z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affmm Net 1 am lieevns o
cd under provisioof Chapter 9(commencing
with Section]Pepe)of Division 3 of the Business and Profession,Code.and my license Is
n� infullforceandenec 1 g �os�7 REVISION—KITCHEN LAYOUT/WINDOW/SHEAR WALLS
oeraNe Clw CavtLic.graemr ORCH/TITLE 24
Stt$$p� ARCHITECTS DECLARATION
1
65 I undenun my plans shall o used u public records _
g�] L.iecvcd Professional
OWNER-exempt from be RATION O f\
r� I hereby.(Sero(Section n 1 am exempt Dom dtc Conlns Co :Any c Law for the
i p o which ng muun. ermitt7(D L5, 4 shuts and Fe.de oli Calc:Any city or county
$Pi which requires a Permit re wruvuc4 aoc Mfor such
h Permit or mash any ommunt
primmiuunsed pursuant
in the ftapplicantof for mchpemitto Rkse,Lawd hmm,9
$< that(comma cingwiitpurtuantmthcprovisionsofof ueBuacwrsnicerUonsCodter9 Sq.Ft. Floor Area lata ion
(commencing with Section 7000)of Divislon3 of the Business and Rofculnna Code)or
.. that he m exempt themrmm and the buss for the alleged exempdm.Any viowd, of
S"don 703l.5 by arty applicant for.P.Il wbjcM to sppla i m a civilPevl'y ofecu aney Type ppN P
not mac than five EutMmd dolWa($M 3691�I1�1 b,�r 00 e
❑1,as owner of the property.or my employces with wages u dwir sole compenado t
will do thework.and theaunum is rot intended oraffered Tonal.Sec.7044,Busiwasa Required Inspections
aha Professions Cabtrc
:The Coomra U.law does roer e nst apply W 4n ownof q P
property who Witch or impawa thereon.and whodoessuchwerk Mm ce forthmugh his -
tow employees,provided that such Improvements amnot Intended stuttered f ersale.if,
however,the building or improvement is told within one your of completlon.the owner. '
builder will have the burden of paving dost he did not Mild or improve for purpose of
sate I.
❑1,as everter of the pmpcny,am exclusively muscling with licensed mnu.non to
construct the project(Sec.7014,Business and Profusions Cade:)The Contractor's LI-
came law date not apply to an owner of properly who Wit"or impovem women.and,
who mntrats for such project with a ccwumwr s)licensed pursuant to the Customers
Liceua Law.
O lamuemptunder See ,Bk PCforthiaruamn .
Dale
WORKERS COMPENSATION DECLARATION
1 thereby affirm under pculty,of perjury ars of that following declu tions:
❑eNva and will for by
Section
37M of Consent r Cooleuum far WororaCampn-
sation,for
far lose Satia 7]00 of the Lobster Code.far tiro perfonnawaa of tite
woo for which this pennil is issued.
❑1 how and will maintain Workers Compensation Insurance,u required by Section
370D of Ne Lahr Code.for the Performance of the work for which this panni,is issued.
My
Policy No.: /ZsS916 3
.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(iNb secdm wand ant tscanpleted'sf the Peunit u far au hundred dollen(S I W)
or its.)
1 certify that in to prRmname of the work for which this permit is isswad,I shall not
employ any person In any manner an as in became subject to dm Worker'Compensation
Lawn of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CmiRum of Exemption.you should
become subject to the Worke s Compensation provisions of the labor Coda you most
vJ Q foMwith comply with such provisions or this Permit mall o doomed nvvked.
y CONSTRUCTION LENDING AGENCY .
PI thereby tuitiontuitionthat them is.construction lending.ancy for the performance of
C4
the work for which this permit Is Issued(Sea 7097,Civ.C.)
�^n. Landers Name
.7 z Lenders Address
U O 1 miry that I haw read this application and sum that the also.Informal.b
Is, coned.I agree 0 comply with all city and cutely ordinances and sum lawn misting in
O Wilding construction.and hereby authorim mpommadea of this city to cola upon the
LU move-memmed property for iupectim pugmuea
gy (We)agree to saw,indemnify and keep humlea the City of Cupertino against
% Imbiiides,judgments.casts and expuu which may In any way accroe against said City
U 7 In consequence of the granting of this permit.
G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POIrT Issued by: Date
of AppliesHAZAR HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy the C icon or future bulldog ucupant r me 9.12.and the
h Health and material -
fined by the Cupemno Manic Code,Chapmr 9.12.antl the Nesith and Safety
Section 25533(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya Na
Will the applicant or ratan building occupant esu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conurrinanbass ned by dos Bay Area Air Quality Management all new materials for inspection.
District?
❑Yu u
1 haw mad Ne haardous materials requirements underChapmr 6.95 or dm Collier.
nla Health @ Sdety Code,Satiorts 25305,25533 and25534.1 undenwA thairdm building
CeniResm of f. Signature of Applicant Date
12d
Owner or autharived.ens Da All roof coverings to be Class"B"or better