08050152 CITY OF CUPERTINO -' z�: .a f' ��" e 'W"W1 "
BUILDING D tvr SION PERMIT TOR,
BUT L.filPERMU NO.
dQRESS:LVES DR TBD - TO BE DETERMINED 08050152
WNER'S NAME: E1 PERMTLSUEDATE
YOUNG MEN S CHRISTIAN ASSOC 06/02/2008
ONE!" SANITARY NO. CONTROL NO.
ARCHMT IENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
tZQ 1= Ih
uoa LICENSED CONTRACTOR'S DECLARATION Job Description
g1 heroby affim dor I wo ll¢ under provisions of Chapter 9(commencing P
nith Scotion 70t10)of Division 3 of the Butlneu anal Professions Code.and my license is MDFY INDR SWM POL FLTRNTN SYS PLMBNG TO
run Tome and effect
Sq? Linnlfrocca Lic.w 5 (oZ31Z ACCMDT ULTR VLT DSNFCTN SYS FOR SWMPOOL. SYSTM
F, Dam 1.. crmramor 14x]RA H]rtytvagLNt
ARCHr1ECrS DECLARATION RQURS PLMBNG MDFCTN& PWR CNNCTN. KNORR SYS INC
T undoruand my plaru adult he used as public recort4
BUS
C Licensed Pmf.W.nel
y5OWNER-BUIIDE0.DECLARATION
I hereby,atnrm than I am comepl from Ne Conlncmfs License Law far the
iso o rallowing mason.(Sadao 1831.5,Business and Professions Code:Any city of county
inquires pcm
<w�i which uires a it m emoun ctI aims,impmve,imoo li h,m repair any met..
poor to its equation,also requires theapplicant far such parol,to rile a signed statement
< Nu tie is licensed Numerous the proviffins of the Conuxmr's Li¢vn law chapter 9 Sq.Ft. Floor Area Valuation
Y�$ (commencing with Section 7000)of D0vuion3nf the Business and Professions Cede)or $39000
that he is exempt therefrom and the bssu for the alleged contortion.My violation of
Section 7031.5 by any applicant pull permit subjects the applicant to sold penalty ofNumber
iron mon dun Rw bundled dellas,(S500). 3263203.9 .E Occupancy P Y Type
I,as Dorn.or the property,car my employees with wages as timb In compcnssdnn,
will do the weak.and the structure is out intended or offered for We(Sm.7041,Bush—..
and Professions Cade:The Conuacmes Lutea Law don not apply to an manor of Required Inspections
property who buildsor(mpawstherwRandwhe ams smthwmkhimv3ror Wough his
own amplayeea,provided that such improvements art not intended oroffemd for We.Ir,
howevv,the building or impmuemnt 4satd within on Year of campletiun,the owner-
tuitional will hare the When of Peeving that he did iron Imild or improve for purpose of
sale.).
❑1,as owner M the Ii p.ty,am reclusively contracting with Iim ored contractors in
or et tate project(Sec.70,14.Business and PmfeiSons Cade:)The Communal U. .
cenm Law dos or apply m an Dorno of property who builds or improv thereon.and
who contracts for such projects with a contractor(s)licensed pursuant to the Corrientes
Litems Law.
❑I am corrupt under Sec ,B&PC for this mason
W, Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Mr.node,pemlly or perjury am or the following declamations:
❑I hsw and NI maintain aCenifinteaf Consent mself-ituurt fm Worked Compete
salon,W provided for by Section 3708 of the Isbor Code.for the perroamanm of the
wart for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as acquired by Section
3700 ofthe Labor Code,for site pcafermance ofthe work for wbiclr Nis permit is Issued '
My Worked�.aC�o�m,�pae(m��a,ti�on Insurance cooler and Policy number am:
Camm`Ek1D1yR{ln)CG I,-3$• PolityNo.:tnX'N002Z'722—
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Chis mctlan veed not beemnpleted if the pewit is(marchuMmtl deilam(SIO)
or max)
I nrufv that in the p.formams of the work for which this Permit is issued.l dull act
employ any person in any manmrm as an become subject to the Worlmn'Cnmpenntien
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL aticr making this Certificate of Eaempuen,you shrug
become subject to the Workers Compensation provision of the Labor Code,you mmu
,J O foMwith comply with such provision w it this permshall be deemed noodled. '
z 4 CONSTRUCTION LENDING AGENCY
[—r Ibarrels,affirm that Nem as construction coding agency,far the pMurm.or
C'> f work for which this Pewit or issued(Sec.3097,Civ.C.)
�W A Lender's Name
z Landers Aad.
U O I nnffY that 1 hats read this applicauan and some thu the above information is
^. cancer I agree m comply with all city and county eminences and atom laws misting nt
.� building construction,and hemby uuhoum miseentl of this city in order upon the
abewtmenudmd judgments,
c costs
for ie penioa purpowhich my
H y (We)agree to ane,indemnify and keep haonlev the City of Cupertino against
res in
eal quode or the roaming of this Permit. may in my vnyamrm agasmt said City
t.)z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
SOU EG TIONS. —
(o z o8 Re-roofs ^�
Srgnmun of ApplicsHAZARDOU Date
HAZARDOUS MATERIALS Dacl.osundl Type Of Roof
Will ft Cupertino
licarst no(Municipal
un buildinge.Charal ptroteor handle HoaNaand safety q dcOnnd by the Cupcnino MuniciW i Cade.Chapter 9,u.and rhe HesIN and Surety
ode.p�n532(a)a .pwill the applicant or future building occupant tate equipment or devices which N. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining P an inspection,I agree to remove
..it hovagom air cmumimnm u do rod by The Bay Ana Air Quality Management all new materials for inspection.
District?
❑Yea ISI No
1 have mad the hvaadmm m ncluis mquimmenm under Chapter 6.95 or the Califor-
nia Health&SafetyCndo,Sections 25515,25533 vg 25534.1 muccarand thq ifthe building
deterrence nay haw a anent that it u my mryonsihility m merry tic recurrent or the
require n high W%Ftpdormiuuannafacmri oranpancy. Signature Of Applicant Date
to-Z-98
Own.or mthoarcdagcm D,te All roof coverings to be Class'W'or better