04200015 CITY OF CUPERTINO '�:�s /;a�° ' —
BUILDINGDIVISION PERM $ CONTRAC�TORMORM, .
BUILDING ADDRESS: MOCELIN CONSTRUCTION PERMIT""04100015
OWNER'S NAME: PERMIT ISSUE DATE
YOSSI & AWA
E:
SANITARY NO. CONTROL NO.
(408) 732-66139
7. D
ITECfIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
1 hereby affirm that l am licensed under previsions of Chapter 9(commencingpiection 70XI)o(Division Softhe Buslnasan rofessinm Code,andmyliccnxisIo 4ndcfltt 5q � �!O REVISION--FL PLAN TO NEW ADDITION- -
�� in NO NEW PERMIT ISSUED/ ORIG. $,04090001
Co.,.RCHTIELTS DECLARATI
�y < IundcrsunJ my plans shall W use as'.Alia n s '
DyU
o(n
Licensed Pmfcssianal - -- -
4y
OW NEBUILDER DECLARATION 0 1 Wrtey ammo Nat 1exempt from the Contractors License Law for the
`
00 following reason.(Section 7031.5.mt, he'. and Profession Cole:Any city or county
K m to which us isa n e.also re care atmee epee improve,derenfilh Permit t in.,.it til mmnuaa
yii poor to issuance.also requires the applicant for such Termite"talc asigncdnsmmem
that W is liccnxdrursuaest m the provisions of the Contrmur's License Law(Charmr9 Sq. F[.Floor Area Valuation 0
yes (commencing with Section 7")of Division 3 of me B usineu and Pmfeuions Code)or
'y $
that he u exempt therefrom and the basis for the alleged cxemptiou Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant or a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(SSW). '
01.as owner of the proprty,or my employees with wages as their sole compensation, 36921082 . 00
will do the work end menterma is not intended or o11crW forma,(Sec.7014,Business
and Pmfemma"Cade:TOO Chalmette.Larissa Law does not apply m an wner of Required Inspections ._. _
pmpeny who builds orimproses thereon,and who doessuchworkhimxl(or through his
own employees,provided that such improvements are not intended oroRered forsole.If.
however.the building or improvement is sold within one year ofcomplction,the owner. "' -
builder will have the burden of proving that he did not build or improve for purpose of `
talc.). ow
0 I,as wner of the properly am exclusively contracting with licensed contractors m
construct the pmjeci(Sec.7044.Business and Profession Code:)The Contractor's Li.
cane Law does not apply to an owner of plurally who Wilds or improver mereon,and.
m
who memos for such projects with a cortractor(s)licensed pursuant mine m
Canmers
ac o" _ .
Iexempt enempt under Sec. B&P C for Nas
is reon
, Or Date
WORKER'S COMPENSATION DECLARATION
1 hereby afEm under pclexty of perjury can of me following declaration:
haw and will maintain a Certificate of Conant to self-insure for Worker's Compere
satia0,a provided for by Section 3700 of d¢tabor Code,for me performance of the - - -
We"for which this permit is issued.
0,
have and will maintain Workers Compensation Insurance,as required by Section
3PW of the Labor Code.for the performance of the work for which this permit is issued.
My Worker's Compensation huxurance artier and Polity number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu rection need not W completed if the permit ire forout hundred dollars nti00)
or less.)
i cenifv Not in me fnrmance of me Or r this omit is issued.I shall nut
e rpmy any per a3 to net the Wmkerf Comrensuhm
Lawfof Califomi Date
Applin t
I xo APPLp this CcNficam th Exemption,aon,you should
Wco Alco to the}}��''a'' cr ration prevision of Ne Labor Cnde,you must
.JO roan th comply_111 Aran sarthispermluhell Wdcemed revoked.
Z .; CONSDIUCTION LENDING AGENCY
[- I homey affirm that there is a construction lending agency for the perform sof
!Y the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
Z Lender's Address
U 0 I certify that 1 have read this application and sum mat me above information is
W F' comeL 1 agree to comply with all city and county ordinances and state laws relating to
0U building construction.and hereby aumome reposenmivas of this city to cram upon the
r W above-mentioned pmperty for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City o(Cuperlino against
Uziiabilities,judgmenu.costs and expenses which may in any way acerae against said City
^' PPLI ceNTeUWa' s
t. COMPLY WITH ALL NON-POI Issued by: Date 1. -
S URC R U
Re-roofs
sr'nater f AZA OUS MATERIALS DISCLOSURE Da Type of Roof
ill the,app hunt or for=Wilding oceapanamre or handle haardom material
as deEned by tre Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cade.Section 255320P - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o ff lum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
a hazardous air contaminants a dcfmcd by me Bay Arta Air Quality Managcmcmt eW malCCl I for inspection.
uric"
Ycs /�kv-
I have real me hall ndus materials virtmcnn under Chapmrli.YSafineCalifor-
niaHcalm&Safety Cale.Scedo 35 3and 15534.1 understood!Nazi!dr Wilding D
does not IY have that i y responihility m notify the acts t of the -
munimm uwh m t n p' r uanccofa Ccrufca¢of anon SI cant Date
neral ¢mod senDa All roof coverings to be Class "B"or better
CITY OF CUPERTINO '�:�s /;a�° ' —
BUILDINGDIVISION PERM $ CONTRAC�TORMORM, .
BUILDING ADDRESS: MOCELIN CONSTRUCTION PERMIT""04100015
OWNER'S NAME: PERMIT ISSUE DATE
YOSSI & AWA
E:
SANITARY NO. CONTROL NO.
(408) 732-66139
7. D
ITECfIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
1 hereby affirm that l am licensed under previsions of Chapter 9(commencingpiection 70XI)o(Division Softhe Buslnasan rofessinm Code,andmyliccnxisIo 4ndcfltt 5q � �!O REVISION--FL PLAN TO NEW ADDITION- -
�� in NO NEW PERMIT ISSUED/ ORIG. $,04090001
Co.,.RCHTIELTS DECLARATI
�y < IundcrsunJ my plans shall W use as'.Alia n s '
DyU
o(n
Licensed Pmfcssianal - -- -
4y
OW NEBUILDER DECLARATION 0 1 Wrtey ammo Nat 1exempt from the Contractors License Law for the
`
00 following reason.(Section 7031.5.mt, he'. and Profession Cole:Any city or county
K m to which us isa n e.also re care atmee epee improve,derenfilh Permit t in.,.it til mmnuaa
yii poor to issuance.also requires the applicant for such Termite"talc asigncdnsmmem
that W is liccnxdrursuaest m the provisions of the Contrmur's License Law(Charmr9 Sq. F[.Floor Area Valuation 0
yes (commencing with Section 7")of Division 3 of me B usineu and Pmfeuions Code)or
'y $
that he u exempt therefrom and the basis for the alleged cxemptiou Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant or a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(SSW). '
01.as owner of the proprty,or my employees with wages as their sole compensation, 36921082 . 00
will do the work end menterma is not intended or o11crW forma,(Sec.7014,Business
and Pmfemma"Cade:TOO Chalmette.Larissa Law does not apply m an wner of Required Inspections ._. _
pmpeny who builds orimproses thereon,and who doessuchworkhimxl(or through his
own employees,provided that such improvements are not intended oroRered forsole.If.
however.the building or improvement is sold within one year ofcomplction,the owner. "' -
builder will have the burden of proving that he did not build or improve for purpose of `
talc.). ow
0 I,as wner of the properly am exclusively contracting with licensed contractors m
construct the pmjeci(Sec.7044.Business and Profession Code:)The Contractor's Li.
cane Law does not apply to an owner of plurally who Wilds or improver mereon,and.
m
who memos for such projects with a cortractor(s)licensed pursuant mine m
Canmers
ac o" _ .
Iexempt enempt under Sec. B&P C for Nas
is reon
, Or Date
WORKER'S COMPENSATION DECLARATION
1 hereby afEm under pclexty of perjury can of me following declaration:
haw and will maintain a Certificate of Conant to self-insure for Worker's Compere
satia0,a provided for by Section 3700 of d¢tabor Code,for me performance of the - - -
We"for which this permit is issued.
0,
have and will maintain Workers Compensation Insurance,as required by Section
3PW of the Labor Code.for the performance of the work for which this permit is issued.
My Worker's Compensation huxurance artier and Polity number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu rection need not W completed if the permit ire forout hundred dollars nti00)
or less.)
i cenifv Not in me fnrmance of me Or r this omit is issued.I shall nut
e rpmy any per a3 to net the Wmkerf Comrensuhm
Lawfof Califomi Date
Applin t
I xo APPLp this CcNficam th Exemption,aon,you should
Wco Alco to the}}��''a'' cr ration prevision of Ne Labor Cnde,you must
.JO roan th comply_111 Aran sarthispermluhell Wdcemed revoked.
Z .; CONSDIUCTION LENDING AGENCY
[- I homey affirm that there is a construction lending agency for the perform sof
!Y the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
Z Lender's Address
U 0 I certify that 1 have read this application and sum mat me above information is
W F' comeL 1 agree to comply with all city and county ordinances and state laws relating to
0U building construction.and hereby aumome reposenmivas of this city to cram upon the
r W above-mentioned pmperty for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City o(Cuperlino against
Uziiabilities,judgmenu.costs and expenses which may in any way acerae against said City
^' PPLI ceNTeUWa' s
t. COMPLY WITH ALL NON-POI Issued by: Date 1. -
S URC R U
Re-roofs
sr'nater f AZA OUS MATERIALS DISCLOSURE Da Type of Roof
ill the,app hunt or for=Wilding oceapanamre or handle haardom material
as deEned by tre Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cade.Section 255320P - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o ff lum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
a hazardous air contaminants a dcfmcd by me Bay Arta Air Quality Managcmcmt eW malCCl I for inspection.
uric"
Ycs /�kv-
I have real me hall ndus materials virtmcnn under Chapmrli.YSafineCalifor-
niaHcalm&Safety Cale.Scedo 35 3and 15534.1 understood!Nazi!dr Wilding D
does not IY have that i y responihility m notify the acts t of the -
munimm uwh m t n p' r uanccofa Ccrufca¢of anon SI cant Date
neral ¢mod senDa All roof coverings to be Class "B"or better