00020080PERMIT
,HONE, �I wee A
ARCtIITECT /bNGINLER
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LICENSED CONTRACTOR'S DECLARATION .
"1 hertby .firm that 1 am licensed under provi'i"ns of Chapter 9 (commencing
F =CB with Section 9o0o)"fDwision3ofthe Bonnets and Prof <vi ... Code,aMmylicenui'
m hollforceadeffim
License Class Lia N
3 IU- Dam Contractor
t = O ARCHITECTS DECLARATION
zy 1 andenwW my plans hall be usd as public mrmrJ.
� n. ° °a Lrm."d rmres.tmw i.
ni = u• OWNER - BUILDER DECLARATION
Z G 1 hemby mfhm that 1 am exempt from the Comncmh License law for the
.O following -.,;.. (Section 703 1.5, Bminex ed Professions Code: Any city a county,
$ which reuse, a permit to c -mmuck alter. impve, dem"li'h, or repair my '"cure
prim to its issuance, alm esquires Ne mplicam fnrsuch permit m file. signd autemem
than he if liceved Pursuant to rue provisiam of me Contractors License law ( Chaper 9
(mmm<ndng with Section 7()y)) of Division 3 cruise, Business and Profesions Cole) or
Nan he Is exempt thmafmm and 'he buff for the allege exempts... Any violation of
Seen. 70315 by any aPpOmnt for a pemduabjam me applicant to a civil peW y of
.. am mom man fiv<hundrd dollars ('5()0) . -
❑ 1, as owner of me progeny, or my employee, with wages u meiriole compruadon,
will do me work, and! themucrure is not inundd or offeran, for .1.(See 7044, atorneu
and Pmfeuiom' Cade: The Comzelm's License law does not apply t0 an owner a
prOPeny who Wilda or improves form", and who does such work himself of through
his own employees, pro idd that mch insprovemeoll tie sot intend or oRere for
Ie. if eve; the butld'ng fop mend Id within one year Ofcomplenon the
c . a ilda I have the burden f proving dust he did "m Wild or impmve for Fm-
f sale
ow r of me property am I ivelY onta r g with Lcemd convectors to
' e pro3ect I tIN4 B n ad Pmt rw Code) The Contractor. Li
u law d t p to an uwna of progeny wlp builds m impr Merton, an d
who cat f A aawimec mr(s)licen'e unaentm eMZrols
amm Licento ws m3 P /�1pt
CONTRACTOR INFORMATION:
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CttMlt ryU.
0002bo g- p
SANITARYNO. APPLICATION SUBM
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•' '. Job Description
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`Required Inspections '
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owns err enm" m "" Vignature of Applicant. Date
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All roof coverings to be Class "B" or betier _
OFFICE
1 hemhy .nitro under penalty of prrlury otm o! Ne following dalaretiorr:
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❑ Ihave and will maintain a C<nificam ofComem to calf- insure fm Workers COmFm_
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cation. m provided for by Section 3900 of me Labor Code, for the performance of One
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t work for which this pe "ii is issue. -
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❑ 1 have and will maintain Workers C"mpcmanum Imanae, u nquitd by Sadon
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5700"fthe tabor Code for me perfarmanceofine work for which this permit is issue.
My Workeii COmpenation lnaurantt career and Policy numW art:
Carrier. - P"IicY No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
(This satin. rued non be compivdiime pe orit if foomm hudred dollen (sim)
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orleu.)
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Icourt, that in the performance Of the work for which this pemdl is iuoed. I sLdl
not employ any Person in soy so as.. hero" a.bj.,O the Worten' Contain-
'
ration Laws of Cabbomm Dam
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Applicant ..
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NOTICE JFD APPLICANT: If, after making this Cenificare of Eumpdon, you should
become subject m the Wockels Compensation Provisions of me Labor Code, you must
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fonhwim "I'll with orb provisions or this Permit dull be deemed mvokd,
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CONSTRUCTION LENDING AGENCY
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IherebyaRrmmmmertiseconnmcdoul ding ageneyformeperfomunceof
me work for which this permit is issued (S . Jo Civ. C.)
Name
F. 5
.Lender.
Iandel'Addle.
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Lcorrect.
territory mm 1 have red th u
c end m mm the shove information is
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men. I agrte to mmP1Y with all cit nn u tY and sate laws nbming to
co
building <Ona"ction. mJ hereby or o mprese amiv of this city no mmr upon me
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above g itnd proPemYfrnmoody,aul
(We)
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agree m nave, inde keep ha
and keep harmless me City Of Cupeng
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coda an xpros mid
ermiich they in any way ucrue again. said City
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�ys tr]
incomeIumee of the
inconfequenceormegrmdng "rthiapermit.
of this
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APPLICANT APPLC
. UNDERSTANDS AND W ILA: COMPLY WI of A 1.1, NONdPO1Ni
ICI
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SOURCE REOUTA'DfeNg.
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Sigmmrt"fAPPha UC"nne m Dam
HAZARDOUS MATERIALS DISCLOSURE
Will t1mmNicant or future Wilding ocmpantatomnr bamdlr hagaMOUa mnedel
Re -roofs
u define by the Cupertino llup(�I Coda, Chapter 9.1Z and the Hedm and Safety
Codc,Section 235J2G)1 vw` •
Type of Roof
Will he @plicmI or f uture Wilding a cup., to e,.ip..., or dr,wee which
cmn he d
Den Ime defend by the Bay Arcs Ami Quality Management
All roofs shall be inspected prior to anyy. roofing mat erial,being •'
installed: If a roof is Installed without first
❑Ye
Ihavebrc,ni minammerCh. 6
4h.=usial,no,
obtaining an inspection
I'agTee to remove all new materials for inspection. Applicant
understands and will comp ly with all non source
"fdm<Oeli-
fora Heelm 25305, 3 SJd and 23334.1 node cad Nat if the
point regulations.
huilding does rot, t 1meth rts m li mttq me acu _/ : i".. pi 7 Pant
., ..
owns err enm" m "" Vignature of Applicant. Date
D m�
All roof coverings to be Class "B" or betier _
OFFICE