00080026 CITY OF CUPERTINO " - - ; ..
BUILDING DIVtstory PERMIT CONTRACTOR INFORMATION: ' r
'BUILDING ADIIRE}$ ' < ' 8 �) S • , y PERMIT N�:It!I t!I�I�gl t!If�Cr
J.(::1 /1.. fARA1 A Wlfl "
OWNERS NAMN n APPLICATI NIVfit!14b"P.!1<Aq
t-
LEE
PHONE'. -' r 4 SANITARY NO. CONTROL NO. 4
ARCl11TEC1/ENOINEPRq _ t ° `r BUIIAINC,PERMIT INFO
_ ,1 •BLDG ELECT' PLUME- MECH
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z O m 3 If rebLICENSED CON IRACfOR S DECLARATION ' c `' Tob"Description
ozio y ffaromm Imas live ed aide,p if Chapter 9(ionionorad, , C -
r I-a m9 m1n9ogp rD .nt3enmeml dP r e,nrnamdnyb ire r S)I p1f1L .1.1' LL)I+I (1p >I T)WI_.,
¢m j 11 fill fare and effect. r
O e. Date - C i' I .. t
Ftp ARCHIECrSDFC1ARAlION 9 - , -
_ m 1 d I d y p1 hall bo use 1 p bl series, , x' s
z
Xco m OWNER BUILDER DECLARATION
w M I hente,aftiommm I pit d C t el License L - for the
C'�a
miliewo, Secumn 7031.5,Ba� e,,had Prefir, :Code An,ra,or carm, -.
fxo
which NoUlorl.tworit"I lonounif,'ahm,harmer,demolish. p' r: I r .r
i3 Prot l 9 ' _ih 'pPl 1f hPenl fl si dga n
that h d p l i t P : f II C t a 1 G Law(Chapter 9 S 'FC. Floor Area '`tftd TiTSilt%1 .
(co 7000)1 D'
engw'Ih Screw.7000) vWon 3 of he Bmaini d Professions Coda -GIC ,,
orflail arts esmam thumb J dis KA,for h Ilog d efews,tecan Any v nl(
of S CG '103156yuy pplc tf'r' prmt- hj I:the apll n,ao'vlp by
of but.,art their live incurred d dWr:(5500) .�.r.. .3 -
-Type
P.N6.`6 et '
E11,it,owner of me pmperi&ar my employees with wage"oe their sole cmnPenxatum.
w II do the k d thestructure' t intended or offmod for sale Sed,9044
Bvai a Professions Cad The c 1 w a, hot apt lrto sf.(11511Pf1uLr�fE�P>FPE
owner fp p tyWl builds improves theater,and win 1 h kh' self
or through gh his ow t ctneeyecsprovided that such an,recm,nds ire not intended or ^
mitered for sole If,however,the building ocinipe vement is sold within one year(if' ,• -
ipit Ili hide will 6v,(lie hunkf pomang that lie did nothld or - } ,
m
p
fin P m . r . ) , t
Y .
1 f the pro,airt,am exel asa,ely enatmeting with licensed contractors.to
construct the protect(See.7614,Business d Professions Code)the Contractors
License Law Joe,not apply It,as owner of pr.,M,ty ishe builds or cop nvei thereon, , 'r• - .
and who curibso, for such PnJUP with mat orfs)ferried pue,im,u t (he
Cm1 1 `I' Lw i
❑I a.exempt hard,Se B&PCbar this tersest f r
p
.Ow Dal V /L y' r ,
WORKER SC PENSATIO U CLARAfION - 1i
I herebyaff d pnit ofperiuqoiicof,tlie,fullgdeeltioiis:-
SM
❑ I havemeareme a Ceniffican6 of Cession l l . f Worker's
` ^ t
Cramp : t P 'd d f by Section 3700
f th 1L 6 Code r in,
,if m ftl nrk I r h'lith' p ml . issued u J. -
Ed I base and will maimmin Worker's Cop f Insurance,its requiredbySctii
3700 if the Labor Code f r thePe f rp n it the work for which thu,perm t isissued My W kery Compensatuou Insurance carrier mad Poly 6hubm are. 'e• -Carrier Policy No
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - -
r
"
(This sectionneed not he completed it permit Is fill one hundred doll -
($1 far or,to,,
I c ert i fy tlrl'in(he perform f t h e workf luhih'. lie t ..issued,I
shall not employ fay person in ary mannerse is m become smseea3o'the Workers n
ColpnmenLuisetClu irllare
I ''Applcant : .. ..
. NOTICHTOAPPLICANI If oft ak bth'.0 If to fH PI Y h uld i3 ,3 , ^ '
Z he2emcsuhlennithoW k C Pe i provision,ofthe Luber Code yeaanni ♦ ;,
forthwith comply with suchpnvsensc this perms shall hedecmred revoked'. s
4 'CONSTRUCTION LENDING AGENCY
a Ile shy Bim that hn is u aravorrepear ensfir,abs cr fel the pelf irarmea e Y c of the workf h'1 this pml ,issued(See 3099 Civ.C.) - -
LTa Lead Name r '
Turnder s Ad ones- .r - ..
11'fy lh llhlJlh- ppl t dlteancei h f smining
LTi eey car i.f g t rally ply :tl 11 p d county d e d it rel ing
cp V Io,at, c du l W he'eby auihn 1 epra entnt c,c 101 c ry,n sole{ rnn •• -+
r� the b en t pr nedlpetyr p t nP p ' ., .e.
Re (W) g i f 'fy dk pl I:.ih'6ry fC led eg na •'
4 V1 liah lifer ludo vent t and .pen. h h t y fit any way,acrue against said
V z City in v eyuence of Ili grxnYng of 1his permit
APPLICANT UNDERSTANDS AND Wks COMPLY WITH ALL NON PpppINT
SOURCE REGULATIg ; _ .'-/,L p/���1 ie ISSlled I)y. Date .
Signature of Applicant(/C,1trace - nic" - Re-roofs a s t -
-IIAZARDO S MATERIALS DISCLOSURE
'
Wilthe applicant or future building remittentmm
ant sor handle
hozoidous mmcorl '-Type,of Roof' ' - lY f.
.1 per, dbylle Ctpe! M ledCore,Chapter9.12 and ileo Health and Safety
Cod S i 25532(x) - - _
°V )No Alfroofs shall bevnspe,eted prior-to.-any roofing material being installed.
Will t1 pp11it future bild' g pat use temporal I 'l which If a roof IS installed Without first obtaining an inspection,T agree to'iemove t°
"mitt a d tv cam t o oro a efned by Bay Are.A 0 m I'p Manage a - _
Diet toY -' all new materials for-inspectlon. Applicant understands-and-will comply with
es No i all-non-point source regulations.t .
1 h c rept the b . 1 t q I:and Chapte 695 r Ih - -
Cattle i Health&Sat ty C 1 Sections t u 25505 25593 tJ 25534.I J :t d Ili t
d life building does tot cerrnndy have a tenant that if is ill responsibility to notify the - _ -
'
occupum of the requ ry t h h must h I p' r ioiss a f Cenll¢s f -
OccuPaneY' .'r •. - - `
Signature pf Applicant ;; Date
o
All roof coverings to be Class B"onbetter
owner nr amm�r red ae. g ..
;'OFFICE