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00070018 CITY OF CUPERTINO . BUILDING DIVISION , :PERMIT CONTRACTOR INFORMATION: R I PERMIT NO ') OWNER'SNAIpea756 ALDERBROOK• LA A &' H HEATING APPLICATIOIZU2 ,M018 IWoNE, FRIESEN c .770' CHESTNUT ,ST sANJIARYN07/06"MOW- _ t ^ M ac D ARCHI'TfCTIENGINEER BUILDING PERMIT INFO ' BLDG ' ELECT PLUMB MEr'tf' r N Z LICENSED CONTRACTOR'S DECLARATION Job DOSCrIpCIOn 11 t O^�eZ ,r �on 700 )(iftintI tin,of the licensed Iunds pnrvnnm.ofn,Cod9ndutylenemg n " 's with fall 701ad aft Dniann3 of the BUSiness.Ind Prnf,asmns Cute,and my br,n,e is in full fdrer and cltcepp �1�j r , K 6 License Cl... U' La 9' (:' 7 _L . ,h , O a U Date (�L�.m V Cunlmtl.. �. 7� W zLLy 7 ARCUI-IFc'rsurcL u�7 r r/.�" — * NO CONDITIONS' * : ° ` "1 undentnnd my plans shall M used.a,pooh,rccurds W p o L,,etned Pnd..a..act . V' . OWNER-BUILDCIi DECLARATION - •, s , so 1 herehy affirm tho,1 ant exempt boar the Contractors Lire...Law lot he s H Z_S< follLa„(ng temtn siodi,n 7031.5,Buanrs,and Prolm.lun,Cod, Any any or wanly ' zF❑ whah oNtand,a pe(nn1 u,ton,tn¢I,alto,unpu,ve,dnnoluh,or repair any sruO a + ' • , Poll'"'a'nw nalo.ul....funds the uppb.unt La Inch pandit to file a signed statanmm aa"` mathenbttn.edpan,,Into,mepn,.a,t„n.onheConhatlnf,Id,enselmu,Chap,er9 Sq. Ft. Floor Area Valuation Icnmm crag with Section 7000)ufDoism ms n 3 ohlhe Bu. e and ProF..Inn.Cadre m That he is emm t therefrom and the bows for the Acrid exam loon An slalaunai .. of Section 9 than II any dppbcmn for a permit�nnlru,the apph,vm m u sled penalty ` m nos adore than me nanarea dollars ssnm .' ,APN Number ' L, ' " Occup4q;Mjge D L as,wnena lhe"to'ch&mmy employee with wage.a.Then ca,le"I ilonatiun; will do the work,and the surname is nu,immided or offered for sale(Sec.704-1; Bu.messand Prema„ods end, The Contacmds Llcen.e L,Iw does not apply to an' ' . . 369x-^^,0044. wired Inspections ' owner of properly Who hwW. n(mpon,s(hereon,and who doad such work Indoor {• .L or through Ills Lawn employee1 pnn(ded that such unit....unn are not inlcl&d or offered for sal, If,however,the budding oa Imprm'emaln Is sold W Nun one ycar of f einplennn,the awn, builder„dl hase the bu rden ofproving that he did m„bmld(It 204 — UNDERFLOOR FRAME,, mipmva for pllrFw,e of late l - 3011' , — 'ROU0H•-PLUMB I NG ' ') 111.as owaei of(I„pmpe ly,an,cxcin.oaly ou ra,lmg with licensed conarri m oust nal me pi„reet(See 7044,Basins and Ptobe.am,I Code I rn,Ccnlitacmr, t . .303 — ROUGH MECHANICAL ' i1„na,Lawdoes” applylnaan„ner(If Do”p,y Who build,otlmpro,.e,th,reon, X04 —'•TROUGH' EI_ECTRICAI_ and who contracts lot,inch prd3ee,a xnh a ontor (a IiLtoWd pu suanl to the ” . Contractor Luetne Law D l and exeanpt under Se .._ Bevctarthix reason 505 —= FINA L ELECTRICAL 'Lawn, s oat, .. . ,51217 FINAL AI_IIIMBING,, WORKER-S COMPENSAIION DECLARATION d' 508 — 'FINAL MECHANICAL Ios.by u11irin under,ponalty ur,erEr,one of the lnllnwmg J,Jumaion '+ I ,. Si.4• — 'FINIAL. P.JBI_IC WORKS 1 have and will mnnum a Certificate of Cameo,to(elf-slam", b;,Worker's mpemaumt„as pnrvuled'for by Saban 3700 of the'Labnr,Civic, rnr the petmt(nan,eofo,e work for 11,10 this perml l 1......ad • y - D 1 hose and will niamlaid Worker's Compemm�nn Iilinr hale,a....tared by Section .3700 of the Labor Code,for the performance at toe work fin which this pmmt'ts 1 r (rolled NIy W'orker's Compensation lnitoanee can 1 hcy,mm�bei,ac /� r - nth , `^ y a Camel' Il� 1 W -y.11ay Nn.:/✓L6/ G^©i?. •;-L CERTIFICATION ohMEMPHOt7 FROM\YORKERS' r+ COMPENSATION INSURANCE�y. :Tin,colon need not be n,inpledd II ilia pernnl as foi unc hundred Jnllan ' ISIfNll nr les.I I certify Or,,(in the perfmmance of Ina work for which Joe as i"red,I shall not employ an,person an Inv manner sit as m beuome.uh,bel gi the Workers ,. Compensation Laws of California Data APphrun( NOTICE TO APPLICAN'I'It.after mnkmg dos Cermi.a(c nr F.xempnnn,Ymi should 5 _ hoonme arNat In the Worker's Cmnro,indn p000nar,of the Liao,Cnde,J ou mua Q O forthwith comply with inch pi-wroons or this perm, had he deemed revoked' f •,f;' ” CONSTRUCTION LENDING AGENCY I he by affirm that there Iv.on,tru n on lending agency for(he perfmmanec q, r a" of the Work tar which this pennd Issued fSec 3197,Cis.C.) Leader,Name � Z Leader's Addidi I, - I V 1 candy that 1 have lead Iii,application and state[fiat the above inlnnnxuon Is r S- ` .• correct I agree to remply with all Lay and county nldmanees and state law,rcl.amg ail u,hudJmg conoraction,and hereby aithotz ,"Icenmme,ufto,city m enter upon ,�y ray the.abus e-mrnunned property for ln.pe.Imn purposes - Fat P. (We)agree it)save,mde(nmfy and kcnp harmles.the City of Cupertino against .. h liabilities,it dgmento costs and exp.ases which map in Ire)way nwrue agama mad V Op is consegnence of the Foralingof lhas patron APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issuedb Di1tC •'' x�� SOURCE REGULATIONS. r y: Signalate of Appl cantfConr actor ' Date. Re-roofs •.• HAZARDOUS MATERIALS DISCLOSURE + W,J,n,.aoplman,or future Fuildmga..upam aa(e or handle haz,rdous inal,nal Type of Roof.' In defined by the Culwn(n,Man(aipal Cade,Chaplet 9 I2,Imd the Health and Safety' Code,Seaton 25532W,I ❑ve, All roofs shall tie inspected prior to any rooting material being installed.. ' Will the applicant or Laurie httdJntg occupant fie ryuhunenlnr do"., fish -If aroof is installed without first obtaining inspection, I agree to remove. "enw h...Nmo air wmanun:mts m d,road by 0e Ba}Area star Quuhty Management L g p �' no"el I all new materials for inspection. Applicant understands and will comply with - all non,poili[ source regulations.. , .. I have reed the 11110lous minerals iequiren,en s under Chapter 695 of Ilea California Health S Safety Code,Section,25505,25533 and 25534 I understand that If the building does no,currently have a tenant,that,n mp(espon"hday to nap ly the ���� ' occupant at the rcymretrenu„,ich mud he mcf put.to issuance of a C, New f /� "ap " • a ore of pplicaldt '.' " ` 'Date d • t ' All'roof.coverin s to be Class "B" or better Owner of authorized agent Oct, , ! •OFFICE