Loading...
00030036 CITY OF CUPERTINO - PERMITNO. BUU,nttv0 DIVISIONPERMIT CONTRACTOR INFORMATION: ��O 2 - BUILDING ADDRESS: ' . Ave— SANITARYND. APPLICATION SUBMYITALDATE VA". kA4-a-)I*t {4Tl•*} / OWNER'S N \ yHONG ., ' C L�� /' 9 S--/ I , _ •NIC ,CONTROLg RCHITELTENGINEER1 J l� ❑ BULDING PERMIT INFO Roo az N66 LICENSED CONTRACTOR'S DECLARATION ' Z O El 3 1 hereby aRrm Net 1 am licensed order provisions of Chapter 9 comenewin o z Pr ( L Job Description in I torrential Diviaion3of the Busineke and Rokuiam Coda,and my license is Q Y in full force ard eRmyyrr s a uce CI `a'�O Lc.g 3 Ds¢ Convector !� ARCHR DECLARA ON yt![Mirytlgplans shell bee U used u puNk recrrda - i a R Ucmned• f/Le^ala �, uxS_ OWNER-BUILDER DECI-hRATION !' < 1 hereby airm that 1 am exempt from Ne Catharines Ucenu Law for the O following resat.(Section MI 1.5.Basins and Profanities Code:Any city a only c. m which nations a pam,it w co imum a ar,improve,demtilim,or ocianr my nt mere Sq. Ft. Floor Area Valuation Near to its i"uwce,also requirea the applicant fasurh Perrot to file asigned shote em Nn._ et he is licensed Personal to ft of Ne Cmlrsnm't License Law 9 �.J -C cJ IconurcvcivL wiNSection l00o)of DivisiooJolile Busineu ed Profeuions cal that he is exentPt therefrom and Ne buffs(a the akLd mption.AVY N / I 0 O�Qer . Occ� Type Section 10313 by any applicant for l sea " is of 6 na mom Nan f,,e 1 Required Inspections u en n p of .. .. Th gh his a Belt.1 �wne- pDie a ❑1, k w n v/ Lie c I Pu s as zo Deck Q WOR 'S COMPENSATION DECORATION ' Ihereby affirm under possaity.fitebocairl.cto,Coyone.t tf.j following dinmr,. ah ]Ihove and will mor by SCn37M of CaaemrCoda.wree Woarearaceof - ion,u provided For by Section J]00 of 0r labor Code,fm the perfomumr of ile fa which ilia permit is Workers .. 1 have and will maimaWohee n a Compen"tion Intax.,which h his Nord by Section of Ilse Tabor Code,for the peefarmane<of ile wink fur which Nie permit is iuud. MyWCerneorYrla OO P. wr Policyand I'o AiII1 7ye3 /� 1 CERTIFICATE OF EXE ION FROM WORKERS' COMPENSATION INSURANCE (This section oned not be.onnPletd JNe Penial Is fatinc hundred"Ithre($100) IX less 1 ready deal in the Performanceofile work fee which Ninpermit is iuud,l dull not employ any pereon N say manner w an in become subject w the Wodrtn'Compery "tion Laws of California,Dai r Applicant NOTICE TO APPLICANT.If,after making Nie Cenifscate of Exemption,yrs ahr ild hecomc subject to the Worker'a Compensation provitions of the Labor Code.you must forthwith comply wiN such provisions or this permit shall be deemed revoked. OZF. Nrr CONSTRUCTION LAGENCY adame is2eohoncodyfar Ne pefomunee of ' 09 O UVA wok(inwhichthis pincer is issued(Sta,] 1,Civ.C.) 00Z Laders a Name Q IerdcfI W 1 ceNty,ilea 1 hove reed iliaty and for y o stun that the above iws ralmanto \ / 4 corrwl.I agree to comply with ell city ed munhY mdiunma wed shoe laws rtleting m U Obuilding wnwuction.and hereby amnion repro"neatives ofthis city to enter upon ft .w alar,,.-mentitined NiNay far inspection purpoaee W FO (We)eine to save,inem dnify and keel,harmless the City of CupaNna agent[ O (� Iisbihties,judgrnenu.cain adnpen"a which may in any waywrmeageimt said City - } W in consequence of Ne granting of this Permit F APPLICANT UNDERSTANDS AND WILL COMPLY WITH At.[.NON-POINT t..) z M v R U NS. Sig of Applin omr"Ion ^Date HAZARDOUS MATERIALS DISCLOSURE Will Neapplicamorfaore Wilding twos...."teorhwdlehuard...metric Re-roofs t as defined by the Cupertino Municipal Code,Chapter 9.12,and the Healil strand Safety Core,section 25552(a)1 Type of Roof ❑Ya ©No Will Ne applicant of/fmtabrilding aectptt on equipment or derices which All roofs shall be inspected prior to any roofing material being cmit hamMous ate contaminants u defined by Use:Bay Arca Ah Quality Management installed. If a roof is installed without first obtaining an inspection itarric'?❑Yes [}No I a ree to remove all new materials for inspection. Applicant / Ileavc read the hevrWua mamrite aquimmcnu oder Chap¢r 6.95 of Ne Cai- understands and will comply with all non point source regulations: famfv Health &Safety Cade.Sections 25505,M533 and 255]0.1 undmstard that if the Fulldao s nes currtmfl,feaveetenant,Nuit is my mponabiliry an (Y Neorrupwt G of du ch mut be nrt Prim m issuance eniforApplicant. DateOw !_, edegem , All roof coverings to be Class"B"or better OFFICE