04030043 CITY OF CUPERT[NOx"°" " ''
BUILDING DIVISION PERMIT ONT, -TOR INF,ORMATIQN:
OU ILDINGADDRUS: ABCO CONST PERMn'NO04030043
18801 APATA WAY
OWNER'S NAME: PERMIT ISSUEDATE
MARY TRAN 14880 LLA E: SANITARY N0. CONTROL N0.
(408) 779-7577
HITER/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+'+alp LICENSED CONTRACTOR'S DECLARATION
1�F I hereby afMn Our 1 on Ganud under movitlom of Chapter 9(commencing Job DOSOrIp[I00
^�`uj with Section 7M)).f Division Sof NC Business and Promminm Coda.and my license is
N infull force and effect. DEMO
�? License Class Lm.g
=££w Date Cone sc or �s
?W I understand my plans shall used aspublic DECLARATION
Utl
l Licensed
Profcstionel
OWNER-BUILDER DECLARATION
+�oo 1 hereby affirm that 1 am exempt from the Contncto's License law for the
i p O following mason.(Section 713 1.5,Business and Professions Code:Any city or county
y_� which requines a permit to construct.alter,improve,demolish,or repair any muctumSnn000
FZiprior w its issuance.also requires tie applicant for such permit to file a signed comment
that be is licensed pursuant to thc provisions of the Contruwr's loons,Loo(Chapter 9 Sq.Ft. Floor Area Valuation
Xp (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y $
that he u exempt therefrom and um bass for the alleged exnmpdon.Any violation of
Section 7031.5 by airy applicators fora permit subjecu Ne applicant On•civil penalty of e10,0 Occupancy Type
ret mom Nan eve hundred dollars(SSM). P Y YP
0 1,as owner of the property,or my cmploycu with wages a their sole compensation,
will do the work,and the structure is not muchi d oroffened forage(See.7044,Business
and Professions Cede:The Convectors License Law does nos apply N in owner of Required Inspections
Property who banks;or improve demon.and whodoessuchwmkbimself orthrough his
own employes,provided Nu such improvements tic not intended w.frood forsale.If.
however,the building or improvement is sold within one year of completion.Ne owner-
builder will have the burden of proving that he did not build or improve for Purpoe,of
som I.
as.woer of the property,am exclusively contracting wish licensed convectors in
onsu ict Ne pmjeci(Sec.704A,Business and Professions Code:)The Convector's Li.
ceme law does not apply to an owner of property who builds or improves dseuan,and
who contracts for such Pmjecs with a contnemrf if licensed pursuant N the Consistencies -
LRenu law.
0 1 ss,exempt under Sec. .B&P C/for this reason
Ow Date
WORKER'S COMPENSATION DECL K NST
I hcmby afrsm under penalty of perjury om of the Loll. dechusi m e
haw and will maintain a Certificate of Coment to self-insure for WorkerSCompen-
'on.as provided for by Section 37M of de labor Code.for the pedonname of the
for which this permit is issued.
I have and will maintain Worker's Competsation Insurance,wa required by Section
37W of the labor Code.for Ne unform ism of the work for which this permit is issued.
My Wmli Compertandm I.ra.cartim and%licy number m:
Cartier. Policy N..: ,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
rods Imam need tent becomplesed ff the Permit is form=hundred dollen($IM)
or Less.)
I comfy that in be performance of the work for which this permit is issued,l shall not
employ my pers.n in any more,so as in became subject o she Wmkere Compensation
Laws of California.Dow
Applicant
NOTICE TO APPLICANT:IL after making this CoMfieam of Exemption,you should
become$Object to the Worker's Camperwtion provisions of the Labm Code,you must
.J O f.Mwith comply with such Provisions or Nis permit shell m doomed m,o ked.
Z 7) CONSTRUCTION LENDING AGENCY
[—ice I hereby a=nt,that there is a construction lending agency for the performance of
!Yi 7ftwork for which this permit is issued(See.3097,Civ.C.)
25 tangoes Name
CL Lenders Address
U 0 1 certify that I have mad this application and sale that she above information is
W F•' correct.I agme to comply with all city and county ordinances and state laws relating to
O V building consuuction,and hereby authors=mpmsenulixcs of Nu city in enter upon the
aabowtmcnuoned property
un fond CX
cction Purposes.
(We)agree w sew,indemnify and keep humless the City of Cupenino against
HZ in
equencef th,count and expcns,smit. may in any way acres,agunst said City
C)z A consequence of UNDERhe STANDS
of this permit. Issued by. ate
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
S URGE REGULATIONS.
(v 10 b Re-roofs
norma of Applican CcintrtemeDale
HAZARDOUS MATERIALS DISCLOS Type of Roof
Will the applicant or future building oaupann slam or handle hacamous mawn.1
iid&Las defimd by do Cupertino Municipal Code,Chapter 9.13,and Ne Hca11h and Safety
rete.Secd.n�ss33(aI?
❑Ye IN NO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant sex equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it Inummous air cmuscro arts u dcfired by the Bay Am.Air Quality Management all new materials for inspection.
wict?
❑Yes No
Ihewreadthehvardou mawialsmquimmensundcr CWpwr6.95ofNeCalifor-
nia Hcxlth&SdetyCWc,Sectio¢25N)5.MS33 rad 35534.1 undersand Ihw if the building
dors not cu ratty hast a tenanL that it is my=ap.mibility w notify tM=upmt of thc
¢quire to which most to met poor wittumere mixCccWmi e an . Signature of Applicant Date
Mf�Tgn' T2.M'til b� All roof coverings to be Class "B"or better
Cheer or authorized Dale g