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04110048 CITY OF CUPERTINOBUILDING DIVISION PERMIT ,` �CONTRACTQRINFORMAIQN . BUILDING ADDRESS: PERMIT NO. 04110048 A PERMITISSUEDATE SANITARY OL NO. ARCHITECffENGINEER: BUILDING PERMIT INFO BLDG - ELECT PLUMB MECH Loo - LICENSED CONTRACTOR'S DECLARATION Y I thereby arfnn Nat I am licensed under pmvisiom of Chapter 9(commencing Job Description <Z6 with Section 70M)of Division Sof the Bud.and Professions Code.and my license is - - ''^Zm in full fotmand effWL A�z License Clara Lm.0 -FENCE (71HIGH) _ __ _ pp Dae t ARCHITECT'S DECLARATION CONTRACTOR: ARMANDOS FENCE W T undersand my p Ws shall be usnd as public retards - .'�G Li=.d Pm(casional 3 OWNER-BUILDER DECLARATION - - - I hereby affirm that I am exempt from the Convenor's License Law for the _ ❑D following renson.(Section 11131.5.Business and Professiom Cade:Any city or county $ which requires a Permit to construct.aiur,improw,demolish,ur repair any suoctum FZi prior b its lssuonce.also requires the applicant for such Permit to Me a signed susement Fie That he is licensed pumremm the provisions of de Convenor's Manse Law(Chapter 9 Sq.Ft.Floor Area Valuation MH (commencing with Section 7")ofDivision 3ofthe Business and Professions Code)or $4000 e;§ Net he u therefrom and therefroand the bur fm de alleged exemption.Any violation of Section 7031.5 by mry applicant for a pem it subjects the applicant to a civil penalty of APN Number Occupancy Type mot mare Nan five hundred dollars(5500). P Y YP ❑I.uownn ofdu propeny,mmy employees with waguu Nem sale compensation. 1494c;ni4 nn will do Ncwork and thesuucture is notinended oronered forsak(See.7061,Business and Professions Code:The Conveners Liam Law dam not apply in an owner of - Required Inspections property who Wilds orimproves thereon,and who does such work himselforthrough his " own employees,provided thansuch improwmen a are not intended sublimed fmsale.It. however.the Wilding or improwment is mid within We war of rompleuon,the owner. builder will have the harder,of proving Nat he did nm Wild or improve for purpose of sal.). S ' ©V owner of the property,am exclusively contracting with licensed contactors to con n the project(Sec.7W,Business and Professions Ced,:)The Convumr's Li- \J came law does not apply man owner of property who builds er improves thereon,and who contacts for such pmjects with a conuamogq licensed pursuant a the Contractor's Lire law. ❑ I.gcmpt under Sjp/. B At P C for this moan Ow /p 11fi Data �NIPTTNSATION DELLA � 1a1 hereby affirm under penalty of perjury one of the following decimations: arc and will maintain a Certificate of Consent m self-insum for Worker's Compen- n,as provided for by Section 3700 of the Labor Cedc,for the perknormcc of the - - work for which this permit is issued 1 have and will maintain Worker's Compensation Insurance,u required by Section 37W of the Lobar Cad,,for the performance of the work forwhich this permit is issued. -- My Worker's Compensation Insunn¢cerin and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed not 4 completed if the permit u far one hundred doll ars(SIM) leas) 1 certify that in the performance of the work for which this permit is issued 1 shall not employ any person in any mannerm as N become subject o the Wofkeri Compensation Laws of California.Date _ Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should become subject be the Worker's Compcnution provisions of the Latour Conic,you most .J O fotdrwith comply with such pmvisiom our this permit shall he deemnd revoked. Z71 CONSTRUCTION LENDING AGENCY F+ I hereby affirm that Nee is a construction lending agency for the performance of ,Y, the work for which this permit is usucA(See.3097.Civ.C.) aA Lenders Name z lender's Add. V Q I cenify Net 1 hast read this application and state that In.above information is - lycorrect.l agree to comply with all city and county ordiumm and sum laws relating to Q V Wilding construction.and hereby authoris mpresenuties of this city to enter upon Nc W a Ww-menuunnd property for inspection pugmses I I„i y (We)agree in saw,indemnify and keep harmlras the City of Cupenin,against cl�Z inconseque ceoftheeasuand,xpeummit. may in any way ettme againstsaid City („),'� in consequence of the gmming of this permit 9PPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date OU E RE TI S. It/y16 gi Re-roofs Signature ontanor e HAZARDOUS MATERIALS DISCLOSUR Type of Roof Will the applicant or future building occupant store orhandic haeardous maurlal as defined by the Cupertino Municipal Code,Chapter 9.12,and use Health and Safety Code.Section 25532(a)? _ _ El Yes ?N. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtainingan inspection,I agree o remove Will the applicant or future Wilding occupant sett equipment or devices which ret P g - ' ha,ardnus air contaminants m defined by the Bay Area Air Quality Management all new materials for inspection. 76�; kt? ❑Yes No 1 haw mad the harare mrsmauriais requirements underClumer6.95 of 1M Califor cal"SafetyCode,Suedues 25N)5.25533 and 25334.1 undersand Net if the Wilding trot cmrendy have a mneme Net it is my responsi ility to nouly the oaupant of the immcntaw ' unbcmetPoor to issuance ofa ftamorfkeapan Signature of Applicant Date our n,adagtm !t o All roof coverings to be Class "B"or better