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05020071 CITY OF CUPERTINOtrsrxa "=# a= BUILDING DIVISION PERMIT CONTRACTOR-INFORMATION ' a_, ra.�n_ riN as , c.„wyS f.P:P BUIL DING ADDRESS: WEST HOME AIR PE ""'05020071 44c; ('TJPRRTTM0 PF) ' ER'S NAME: PERMIT ISSUE DATE S V9801 qANT TFRFqA PT un ONE: SANITARY N0. CONTROL NO. (408) 202 96 ARCHMIC(ENGINEER: BUILDING PERMIT INFO PE, ELECT PLUMB MECH 01 y O Zp LICENSED CONTRACTOR'S DECLARATION U� 1 herby affirm Nal I am licremwd under provisions of Chapter 9(commencing Job Description p SMwish Section 7(th of Division 3 of the Business and Professions mCut,and my license is '! F mfail to.and effect.License,Class Lk.N REPLACEMENT COOLING TOWER 44? Zf� Done-C.."scoo DELL As Oat] use DECLARATION ¢vC 1 undersunJ my plans shall Ise used as public records �� 1)o✓ ,y0 ea Liccnud Pmfarsiovil OWNER-BUILDER DECLARATION vN 1 hereby offirm Nal 1 am exempt from the Contractors License Law for the ,© m O following r,.on.(Sccuun 703 L5,Business and Profcadum Code:Any city or county m which mquires a permit in construct,alter improve,demolish,or repair any stmmum prior w its issuance.also requires the applicant forsuch Permit o file a signN satemem tivc Our heislicensed pursuant totcproviaronsofdue Contractnrauaare Law(Chipor9 Sq.Ft. Floor Area Valuation ra (commencing wi in Section]000)of Division 3 of to B uvincas and Profusions Code)or y _ that he is exempt therefmm and to basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicanuo a civil rabidly of 3 24&TMd1r(be10 0 Occupancy Type not mom man five hundred dollars($500). P Y YP O I,as owner of the property,in my employees wit wages as Neff Nle compeocatur will do dre work and Nasrmetute u not intended or offered for sale(Sec.7014,Busircss and Professions Code:The Consracwrs Lures,Law door not apply to in owner of Required Inspections p uNny who builds or improves thereon,and who doessuch work himself or through his Own employees,provided mot such improvements are at!pleaded oroffcred for sale.If. - howcvcr.Or building or improvement is sold within one year of completion,the owner. builder wall have the burden of proving Nat he did not Wild or improve for puryore of s ile I. O 1,as owner of the impor y,am exclusively contacting with licensed contractor to comi Or pmjcct(Sec.7044,Business and Professions Code)The Conuactari Li ccore law d t apply to an owner of property who builds or improves tenon,and who cantos- is ch mjecawilh a eontncmt(r)licensed pursuant to On Conuanafs License law. lam eaem un ec. .Bh PCfor0 at Date 1 ORK PENSATION DECLARATION 1 hereby amtm under penalty of perjury one of the following kelantians: I have and will maintain a Cenificam of Corton to self-imum for Warkcr's Compen- sation.as provided for by Sation 37W of the labor Code.for the perfomunce of Or work for which tis permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as mqumcd by Section 371 of the labor Code,for dte petformancc of the work for which tis permit is issued. My Workers Campemsauon Insurance cafficr and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cl section need not be cwplcwd if rbc pemit is form=hundred dollars($101)) . or less.) I roily this in the performance of Oc work for which tis permit is issued,I shall not employ any person in any manner so as m become subject o the Worker!Compensation Laws of California.Dat Applicant NOTICE TO APPLICANT:If,afor making Nis Certificate of Exemption,you should become subject in me Warkeh Compewdon provisions of the labor Codc,you muss .Jz Outwit comply with such provisions or this Permit shall be doemd!revoked. zCONSTRUCTION LENDING AGENCY P: I hereby affirm mat tore is a construction lending agency for the Performance of CL to work for which this permit is issued(Sec.3097,Civ.C.) Landers Name z Lander!Address U O 1 anify d u I have read this ii,iienion and sate that the above information is ly H correct.1 agme to comply wit all city and county ordinances and sum laws sedating to O U building construction,and hereby autcria,mpmsenutives of this city to offer upon Oc C[1 above-mentioned property for impccu0n purposes. (~ C (We).,me to save,indemnify and keep humle.to City of Cupertino against N liabilities.judgment,costs and expenses which may in any way accrue against said City t.1 z in conugneb of the Bunting of tis permit APPLICA ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCETZ. 1QS. c}-`lp Z'i Re-roofs Signature of ApplicanU ontractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant store Or handle haus our material as ectirmd by the Cupertino Municipal Code.Chapter 9.13.and the Hcalth and Safety ,jokile,Sccuon 25532(ap All roofs shall be inspected nor to an roofing material beim ❑Yes Bpm P P Y g g installed. Will the applicant or future building aaupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove I(hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. District' ❑Yes ip No Ilia •lihehazMmsmawrialsmquimmcnuundcr Chapmr6.950ftheCalifor- niaHeal S ty Coda,Sccuoas35.Ns5,25533md25534.lundomaadtulfthc Wilding docs not urtc have a an4 that is 6 my responsihilitY w notify the Occupant of tc mquim I at, ihmus mctpriorwissuanccofa Ccnificamof Occupancy. Signature of Applicant Date r�Jl -0 All roof coverings to be Class"B" or better Owner ofaut orizcd a6 est Date