07110100 CITY OF CUPERTINO
BUILDING DIVISION PERMITCO1' TRACTOR I,AIFORMATION
BDIIMV§"'kCLELLAN RD LOT 1 TBD — TO BE DETERMINED 07T1N8100
'A'S NAME: PERMIT ISSUE DATE
03/27/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
Y00 LICENSED CONTRACTOR'S DECLARATION
1 Mmby affirm thvt 1 w IicemeA under provisions aI Clupmr 9(commencing Job Description
with Section 7")ol'Diviumn Sof the Business and Profesaiom Code,arWmy licensers NEW 2 STRY SFDWL, 4284 LIVNG, 672 GARG, 131 PORCH-
in full force and affect
License Class Lic.0 LOT
g q
Dam.Convenor
gsQ- ARCHITECTS DECLARATION 1
Wu I understand my plans shall be,umd as public records
g C G Lieanxd Professional
5 OWNER-BUILDER DECLARATION
.� F 1 horchy affirm Nal 1 am exempt from the Conlnclors License Law for the
C O O following moon.(Section 7031.5.Busirss and Pmfesmom Calc:Any city or county
which requires a permit to cmrolract.AW.improve,demolish,as repair any strw.tum
priori its irsarcc.alaareactninsm10te pmvisio of for sochpctor's 0lcasipcdauemcn
pp
that he is nanud pureeanuothcpe,ap,lam the sucnuxmitslik.si,runstammem Sq.FI.Floor Area Valuation
Y�$ (commcnring with Scene.7")9 Division 3 of the Business and Profasiom Centel or $961292
Nae he is a ompt thaesfrom and the boors for the alleged conception.Any violation of
section 70313 by any applicant fora pe.I,subjects Ne applicant m It civil penalty of Number OCCU
.1 mom than fivefivehundred dollars fI5Dd). 35608027 .AWJ Occupancy Type
❑I,a owner of the propemy,or my employm with wages as their sole compensation,
will&the work,and the structure u not intended or offered for sale(Sce.7(W,Business
and Pmfesdons Coda:nt,Canuacmra License law,daec not apply in an..of Required Inspections
propenywho W ill orimproves thereon,and whodoessuch work himself or through his
owo employara,provided that such improvements are not intended Interested forsa c.If.
hounna.the Wilding or imp ounment is sold within ane year of completion.the owner-
Wilder will have tar burden of proving Nat he did rot Wild Or improve for purpose of
sale.).
1,as mma of the property.am exclusively contracting with licensed contractors ta
truer the pmjen(See.7014,Business and Professions Cale:)The Contrac ces U.
cause law does not apply m a owner of property who Wiles at improves thereon,and.
who contracts for such projects with a eonun:mr(s)licensed pursuant to the Cenuaclors
Lanese law.
lam
DECLARATION
I hereby alarm unaf penalty of perjury ane ofd¢following dechratiou:
❑Ilunand will meinuina CeniOom of Covemmxlf-iaurt fa Wadmrs Compen-
sation,a prcvided for by section 37(gl of the Labor Code,for the perfammuae of Nes
work for which this permit is issued.
❑1 ban and will maintain Workers Compensation Insurumce.as occurred by Section
3100uf the,labor Coat.for the aufarmance.fdo,warts fm which Nu permit is issued.
My Workers Contra. m I,..artier and Polity number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if tae permit Is foram hundred dollars($100
or Icss.)
1 certify Wt in the perfwmance of Nes work for which this Permit u issued,1 shall not
employ any'person in an roamer becomew "act
lawsm the Wor4cn'Compewdom
ta.
labor Code,you most
.,O foMwith comply with such Provisions or this permit shall bu dcomed revoked.
z CONSTRUCTION LENDING AGENCY
(~ I hereby afloa that Mete is a comuwction lending agency for the pefformrua of
(1' the work rte which Nis permit u issued(Sec.3097,Civ.C.) _
W Landers Name
z Lender's Address
V 0 1 certify Nat I hart read this application W sum Nn Nes above infomtauou is
gy ^ carteLL I asam m comply with all Clay Nalare Inn,county onlinaol and fws relating m
-0 SV' Wilding construction,and hereby authonce rtpmxnuuva of this city m enter nine One
Hatrow-mentioned property for inspection purposes.4 (Wes)agree to saw,indemnify and keep harm.tK City or Cupertino against
fn in
of him
paving expevawhich ivyN ay nyacctuc agurutsud City
U Z, in consequence oftheginning Sthepermit.
^ APPLICANT ATIO TANOS.ADID WI PLY WITH ALL ON-POINT Issued b :
SOURCE RE N 6' Y Date
Signore
" ° Re-roofs
AZARDOUS ALS DISCLOSURE Dam Type of Roof
WIII Nes applinnt orf��um ilding occupantstorc orhandle hamrdom material
fined by tae Cupertino Municipal Code.Chapter 9.13.and the Health and Safely
.section zs532p11
Ya Jt]No All roofs shall be inspected prior to any roofing material being installed.
❑
Will the+pplicant or future building occupant use equipment or avica which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air conuminanu In,alined by the Bay Area At,Quality Management all new materials for inspection.
District? \/
0Yes �Nu
I hon read the haaamdwsm\s cmd,requirements under Chapter 695 ofdm Califor-
nu Hui"Wary Cam Sections 25505.25533and 25534.1 understood used if on,Wilding
does not cuncndy 0.it u my respmmuMlily m notify Ne occuppp+++ggga of dt
, Dam IAll roof coverings to be Class'W'or better
C