06080077r
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CITY OF CUPERTINOt3<;re
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BUILDING DIVISION PERNIIT
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GREENHOUSES ETC
BUILDING ADDRESS:
Pmoin-NO.06080077
21725 CO LLINGSWORTH ST
'.R'S NAME:
IT
PERMISSUE DATE
MUHLSTEIN LADO JR AND ELE
OR1532 S DE
ONE:
SANITARY NO. CONTROL NO.
(408)446-1224
ARCHITECf/ENGINEER:BUILDING
PERMIT INFO
'BLDG PLUMB MECH
E9t�
LICENSED CONTRACTOR'S DECLARATION
Job Description
p
1 hereby affirm W01 am licenud under Provides. of Chapter 9 (emmcncing
with Section 70f1U) of Division 7 of she Business and Propositions Code. and my Iiceve is
in fall foucm andeSttt
INSTALL BAY WINDOWS.IN TWO BEDROOMS
License Class Lw. M
Dew Contractor
ARCHITECPS DECLARATION
1 imbread my life. Mall W used as public recarda
/ Q
Licensed Professional
OWNER -BUILDER DECLARATION
�� /�!
.(lease Not 1 excmpr from Nr Contractors Law for the
ceftexiAny
I hme
-
Coo : c
a 1. Business and Ro(ualom Ca de: Any city or county
following mean.
O
re conmeet alar. Improve, dersolh or repair any structure$2500
Which erail construct.
Which a
Permit t
its esu e.ai requires theapplicantfon xhpermitmfileasignedtulemem
priorwsltensed
Sq. Ft. Floor Area
cation
p m
(c reme kicenudpunuent7000)ofDivisioofthe inclinatsUccnuLaw(CMpter9
(commoncin{ with Section 7000) of Division 7 of the inclinational Profrsiam Code) or
that he Is exmpt therefrom and the bull for the alleged exmption. Any violadan of
M &ar
Occupancy Type
Section 7031.5 by cry apPlinnt for a permit subjecle, the applicants 70 a civil penalty of
not more then five hundred dollen (5500).
❑ 1, as mvmer of the property, or my employees with saga as thein sere compensation,
Required Inspections
will do the work. ted the mucwre a ma intended or offered far We (Sec. 7044, Business
and Profesdau Code: The Cataract License Law dom not apply w m owner of
q p
property, who build, or improves thenen, and who does such work himself or through his
awn unplayeu, provided that each Improvements am act inundate oranered foraaln U,
however, Ne buildingor Improvement is veld wiNiera a yeti or completion. the a.,.
builder will have the burden of proving Wt he did at build or improae far purpose of
saw.).
I, as owner of the property, as exclusively contracting with licensed m 1oxxwa in
Cnow the project (Sec. 7044, Butinm and Profusion code:) The Conwcm's U.
«vat Law does not apply w m owner of property win Wilds or improves duccon, ad,
who contracts for seek projects with a contrxwr(q Beene cid Pursuant w the Committers
Liceme law.
❑lama mptu Stt. ,B&PCfar Nh mason
�0
D•O
0 OM 5 N DECI.ARATIO
1 hereby elilnn under penalty of perjury ane of drat following dttlerWou:
❑ l a w and will mainuin aCenificte of Canxntw self -Inert (or Workers Canpen-
sa cat, ore provided for by Sxtion 7700 of the Labor Code, for the performance of the
work for which this Permit is issued.
❑ I haw ad will mainuim Workers Compensation frustrated. n required by Senior,
3700 of the Labor Code, far Ne performmce of the work far which the Permit is Issued.
'
My workers Compewuan Insurance career W Policy number ate:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(foe action need a,W completed Ilthe permit Is forene hundred defeat (11100)
or kiss.)
I certify Nat In the performance of the work for which this permit is issued, 1 Mall ata
,
employ any pc o m m pcywo me ub)ttth, he Workere'Compcuaden
n
Laws o(Ca1Rp®a!eu.,,.s�
P CANE. If, after making this u of ExcmerCod you
NOome
ushoZ
Cade, yeti mull
subject most
subject 70 the worh Compensation provision or the
vise
mem
foMwiN comply with such provisions or this permit shall ne damrA mveked,
forthwith pro
CONSfRUC ION LENDING AGENCY
I hereby 4MM Nat Nene is a conatmetinn lending Rl for the postmortems, of
the work for which this permit a head (See. 3097, Civ. C.)
Leaders Name
Laadeh Address
I cutify the I haw road the application and Lute thu the aeon Information is
'
correct. I agree in comply with all city and county eminences and sum laws relaung to
Wilding construction, and hereby amhmdrc repmsenuaiva of this city in cnwr upnn the
above-menuuned property for inspection purposes.
(We) agree to saw, indemal fy and keep hnnalae NC City Of GYpeNne against
liabilities, judgmems. eons and expenses which may In my way acme ageim0 acid City
in consequence of the gatnOng of this permit
APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S A
Re -roofs
Sign a of r pnmxwr we
HAZARDOUS MA ALS DISCLOSURE
Type Of Roof
Will the applicant or Nture Wilting eecupent stem rehandle heamaus material
de0rud by the Cupenma Municipal Cab, Chapter 9.12. and the Health sae Safety
Section 2553x,)7
❑Yoa �i No
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 Ne applicent orf building eceupant rex equipment m device which
emit hmardnus air conumimmus x de0md by dw Bay Area Air Quality Management
all new materials for inspection.
Dimict7
❑Yes bkNo
I have mel the Wordarsmauriala requircmmus un icrChapu:r6.95afthe Califor.
rte Health BSafet,Sadoa25505,25533aad25534.1undcnundthuifNc building
does t cum) h a team, that It'll my responsibility ue madly the occupmt of the
onmk met dor is mrwateero, " /
Signature of Applicant Date
�Q �6
All roof coverings to be Class "B" or better
wmrmanNari,<d Beal te