04090101 CITY OF CUPERTINO �;�
BUILDING DIVISION PERMIT CO NTRACTORINFORMATION" .
..rmk �.'vA`,wi'�£ „s 9,�..I•a :a.n3 C?�
MING ADDRESS: PERFECT TOUCH CONSTRUCTION PEaMrr1vo04090101
8-11 RAPIRANCA MR.
W NM'S NAME: PERMIT ISSUE DATE
ONE:
SANITARY OL NO.
11 (4QA) 2SA-49?R
ARCHI'IECffENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L O'z LICENSED CONTRACTOR'S DECLARATION Job Description
ZC I thereby grim that I am licensed under provisions of Chapter 9(cammcceing p
<b with Section 7")of Division 3 ofdrc Biomass and ProfessionsCode,and my liunu is \
^ u, in full fore and affect.Lj? LicenseClass Lic.N REVISION--ADD UNDERFL. ACCES DOORS
Dam cmianar NO NEW PERMIT ISSUED ORIG. 403100216
ARCHITECTS DECLARATION
1 understood my plans shall W Mind as public mcmds
.)yU CC
o S t Licensed Professional
OWNER-BUILDER DECLARATION \)
2 1 hereby affirm that I am exempt from the Contractor's Licanu law far the
QC fallowing matin.(Section 7031.5,Business and P hlcssions Codd:Any city or county
y$ which requires a permit to concoct,alter,improve,demolish,or repair any succors
Fiepilar to its issoanco,also mWima the apNicam for such permit m file a signed atotemcnl
Malhd isliceroud purmanuo the providiomofMc Conaacmrs Licome hw(Chapmr9 Sq.Ft. Floor Area Valuation
Faro (commencingwith Section7B(lO)of Division 30f NC Businusand ProfusionsCode)ur Q
i that he is eumpt Ihaefrom and the basis for the alleged Gumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil porosity of APN Number Occupancy Type
not more than five.hundred dollar((5500).X . P y YP
❑I.uowmraf Ne property,ormy employees with wagesutheir sole compensation, 32601016 . 00
will do the wont,and thestructem is wt intended w oRcnN for We(Sec.7045.Bud.
and Professions Code:The Contractor's Lianas law does not apply in an owner of Required Inspections
property who builds or improves common,and who does such work himulf or through his
own employee,provided that such improvements art Maintained oraBeled for We.If.
however.Ne Wilding or improvement is old within one year of completion,the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
ask.).
❑I,as owner of me property,am exclusively contrasting with lica n ed conuacmn to
construct the project(Sec.7044.Business and Profusions Code:)The Contractor's Li.
cense taw docs not apply to an owner of property who Wilds M improves thereon.Lid
.he contracts for such projects with a contractors)Resound pursuant m the Contractors
License law.
❑1 ex�eempt under Sec. .B&P C fof diminuendo
W 0 ER'S COMPENSATION DECLARA ION
1 hereby aRnn under penalty of perjury ons of Man fol ng declarations:
1 have and will maintain a Certificate of Continuo self-insure for WorkcrsCompcn-
cation,as provided for by Section 3700 of me labor Cade,for the performance of the
wormi
k for which this pert is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37010 of da later Code,for me ponformance of orc work for which this perm,is issued.
MY Walkers Compewtian I..carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
ohissection need not W cdmplemd if IW penal is forcre hundmddollata(5100)
lGia)
1 certify mol in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner u as m become subject o the Warton ComNmadon
Laws of California.Dao:
Applicant
NOTICE TO APPLICANT:If.after making this Comficau of Facmption,you should -
become subject do One wwkei s CmnpolL5ati0a provisions of the Labor Code,you must
wJ Z farmwim comply with such p.,an..or mis permit shall W dcemeA rooked.
Z O CONSTRUCTION LENDING AGENCY
1-+ I hammy affirm dust dart is a constmctinr lending.,my for me pmfurnmma,of
6xi > thc works for which this panni,is issoed(Sec.3097.Civ.C.)
{Td Q Leader's Name
jZ Kone,:Address
U 0 I certify that I have lead this application and sante mat the move informed n is
Iy f" cOrrdel.I agree to comply with all city and county ordinances and sum laws¢lacing no
DU Wilding construction,and hereby aMarku mpreamativesaf mis city m cn¢rupnn me
W move-mentioned property for impaction purposes.
Q. (We)agree Io save,indemnify and keep hemlless me City of Cupdr iroa against
CA Iiabilicadjudgments,casts Lid expenses which may in any way acome agalm,said City
(„)Z in co accitanco of me granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Datcl/6v�'�
SOUR S.
REGULATIONS. 9
E
i nawreofA,1i VCmneme `Dau Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding oceuputsmm or haM1e hvardous material
as defined by the Cupertino Munici al Code.Chapter 9.12.and me Health and Safety
IDisdic,'
le,Oyoe4n 255]2la)7 Na` All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
Will the aP di t or Lulu ilding occupant use equipment or devicas which g
1 ha'raMous air tsmirum.as defined by the Bay Acre Air Quality Managcmenl all new materials for inspection.
❑Yes Nu
1havemad me hvaNtmsmaterkals nequimnanuuderChaptM6.95ofme Califn
Health&SafctyCode Sectors 25505,25533 and 25534.1 unckod nd Ihaifthc Wilding
s not currently hast a innate that it 01 mY mumessibility m nofy the metudoM of dad nswhichmusIs, poormi vanacoraCanlfamteofOccupan Signature of Applicant Date
caner or authorkm agent D,te All roof coverings to be Class"B" or better