06010012 CITY OF CUPERTINO '?+'- � ''' ' `
BUILDING DIVISION PERMIT CONT nCTQR IIVFORMATIQ
eU1LDINGADDRESS: PENINSULA BIBLE CHURCH INCPERMIT NO-06010012
1060
NE0.'S NAME: PERMIT ISSUE DAM
PENINSULA BIBLE CHURCH INC 2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDINO PERMIT INFO
BILCG ELECT UMB Mac"
C= O PLIC O
30G LICENSEDCONIRACTOR'SDECLARATION ]obDeacrition
1 Mreby affirm that I am licensed under provisions of Chapter 9(commencing P
who Section 700E)uf Division 3 of the Business and Professions Code.and my license is
in mu fora andCBCCL TENANT IMPROVEMENT-REPLACE STAIRS
j@Z LicxmcClan Lk.g ADD 3 DOORS
Dam Contractor
ARCHITECTS DECLARATION
�y I undersand my plansshall be seed u public=in&
O
sad Licensed Professional
OWNER-BUILDER DECLARATION
+E 1 hereby affirm that 1 am exempt from the Cd License Law for the
E fallowing mason.(Sadao 7(131.!,Business and Profession
nians Codm:Any city m county
12 2o O which requires a permit in construct.alar,improve.demolish,or repair any svucure
prior in its induce.also requires de applicant for such Permit m file a signed staemem
C dol heislicensedpursuantmlMprovisionsoftheCo^uactor'sUansCLaw(CNpmr9 Sq,Ft.Floor Area Valuat CD000
$ (commencing with Secdon 70D0)ofDivision 3 or the Business and Professions Code)to
that he is exempt therefrom and the basis for the alleged exemption.My viohdon of
Section 7031.5 by any applicant for a permit subjects the apPlkant m a Civil Penalty of APN Number Occupancy Type
not marc than five hundred doll.(5500). 31602085 . 00
O 1,as owner of the property,or my employees with wage u their min compensation.
will do the work.and the strunure is net intended of offend fa sets(Sm.70a,Business Required Inspections
and Professions Code:The Convector's License law dos tet appy m an Maar or q P
property who builds m im proms thereon.and who does soh wank himeel r ar through his
own employes,provided that such improamenu we not intendW oroRefed tassels.IL
however.the building or improvement is sold within atm year of completion,the owner-
builder will he"the burden of proving that he did ant build or improve for purpose of
sale.).
O 1.u owner of the property,am exclusively convening with Ikensed convacmrs m
Construct the project(Sec.7044,Business sad Professions Code:)The Convenors U.
C.Taw dao no apply an as ewmer of Property who builds or improve,thenen,and,
who compacts For such projects with a canuecmKU liarted Penanlm the contractors
License Law.
❑I amexemt under See. ,B&P C for this reason
e� D.e'7--2-06
OMP 4SATION DECLARATION
I hereby affirm under Fealty of perjury arc of the fallowing decluations:
I ba.mai will ammain aceNOcate of Conant m self-insum fm Workers Canadian.
cation,as provided for by Section 37W of the labor Code.for the performance of the
work for which this permit is issued.
❑1 have and will maintain Woseb Campemrsam.Insurance.u required by Secdon
37W of the Labor Cade,for the performance of the wait for which this permit is Issued.
My Warless Compensation Insurance carrier and Policy number ase:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This motion need nolbeeomplomd ifthe permit Is forme hundreddalla.($10)
ort e.)
1 unify that in the performance of the wars fa which this permit is issued,I shall not
arnpiny mypermn in any mu^er—'w u m8^me subjW m rM Wokori Compcwtio^
Laws of Califomla.Dam � �— !
Applicant
NOTICE TO APPLICANT:IL after making'IT,Cen emption,you should
become subject m the Wmisn's Compensation provisions of the Labor Cadc,you mus .
.J O forthwith comply with such provision or this permit shall M deemed invoked.
r CACONSTRUCTION LENDING AGENCY
[.r Ihereby affirm that then i..cmwuml^^lending agency far the lmrfman.of
CS> the work:fur which this permit is must!(Sec.3077.Civ.C.)
QLanders Name
z Lender's Address
U 0 1 unify that I have red max application rob sum OR,the above informadon is
{S. ER
I.grec m comply with
that city and county ordinances and sue laws totaling m '
O building construction,and hereby aumodn mprean.tivea of this city to enter upon the
{t1 eMve-nemianed properly fm inspection Purpaes
(We)agree in ave,indemnify and keep harmless the City of Cupertino against
li.bilidu.judgmenta,cats and expense which may in my way scenm against said City
V7 In consequence of do granting of this Permit.
Fry APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOAR "GULATI f
Re-roofs
Slihoamm-al"ApAgNinsQuilisimair RIDatayOf Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant ams or handle haardoa material
as defined by the Cupc)rOO Municipal Cade.Chapter 9.13,aM the Helth and Safety
7e,sCC an3ss3:(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONuWill the applicant or future building occupant ue equipment tar devices whichIf a roof IS ins[211ed without first obtaining an inspection,I agree to remove
hasNaa air COoWduants as domed by the Bay Ana Air Quality Management all new materials for inspection.
ict?
OYes ONu
I have mW the haardousnu mdals requirements underCMpmr6.95 orthc Califonealth&SafetyCodc,Smdav25505,35533 and 35534.1 understood thatifthe building
not.immul,love a tenant,that It u my responsibility ta nmll'y de acupant of the
remanu which my prior m in..of.Cerdfrom of Occupancy. Signature of Applicant Date
ner ore s I Data f' All roof coverings to be Class"B"or better