08050143 CITY OF,CUP,ERTINO
BUILDING DIVISION PERNUT i;JCONTRACTQR INFORMA7,I0N
BUIIDI.(�18N ADDRESS: PERMITNO.
9 DANUBE DR LOGIC BUILD, INC 08050143
7AH1'C'HITECT/ENGTNEER:
ER'S NAME: PERMIT SUE DATE
BRENTARI DOROTHY K 17300 MONTEREY RD STE 200 05/19/2008
NE: SANITARY NO. CONTROL NO.
(408) 778-5200
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C=
u oLICENSED CONTRACTOR'S DECLARATIONIOb DeSCrI VOA
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P Section?OW)of Division 3 of the Business and Professions Cada.and my Berme is RMDL KTCHN(144SQ) &BTHRM(85SQ) NON—STRUCTRL
w w, in full force and effoop
lag License Class LY.♦ _
e -p Dau 5— Comncwr
e 7W ARCHITECTS DECLAMATION
y W< 1 understand my Plans Nall W used u public rerorty
Jy
g ped Licensed Pmfcssional
5
OWNER-BUILDER DECLARATION
COO f I hereby.(Erm Nat I un.munnemBuSim from Ne Contrahora :Any C Law for the
p O which ro reason.(Sectio IID I.S.Business and Professions Cade:Any city m rohoy
i$Pi which requires a permit ro con,the slur,impmsu de Permit
,fi mpsig ed svucturt
�iC Pnhmslcense pursantto ftthd'isiappmeans for suehpemitm file a Cons,,greed statement
ppthat
onernmlilwithursuanttodo,ryovivommtheConuxmhni¢cesUw sion; dc)or Sq.Ft.Floor Area $ Valuation
Y�$ thas Mincingwith Section and of Division S of alleged
pt Professions Cade)h 42500
tha he u cutest M.wfrom and the Geis for the alNged eaemptim.MY violaum of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty ofppN Number Occupancy Type
not mom than It hundred dollars(SM 36951005 :VC1' P y yP
❑Lu owner of the property,or my employees with wags as their tele mmpcvaoon,
Will on the weals,send the$=lure be not Numbed or offered forsa a(Sere.T(aa,Busihc.•
and Professional Code:The Contractors License law does net apply an an owner of Required Inspections
property Cane builds or impmws thvmn,ane who does such work himself or through his
awn employer,provided Wt such improwma ds an,net intended coffered fhsale If.
how...the Wilding or Improsemrat is sold within arc year of rompkdov.the owner-
builder will haw do,Which of proving Nat k did tet Will or improve for purpose of
sale.).
❑I.u vanes of the:prepeny w caudusihely Compcting with licensed ronua.os to
construct the Project(Sec 7Osa,Business and Pmf.siom Code:)The Contractors l;-
cenu law does hot pply m an own.of property who builds or impreses thereon,and,
who tenets for such projects with a¢nuactor(s)licensed pursount to bre Contractors
Liccns law.
❑I un.tempt under See .B R PC for this ream
or
Dau
WORKER'S COMPENSATION DECLARATION
1 hereby a(Rrm under pnWty of perjury are of the following declantihns:
❑1 haw and will msinuin•Cenifiwu of Cometh mself-imurt for Worker's Campen- -
sation.at provided for by Station 3700 of the labor Code,for dm performance of the
work for which this permit is issued.
❑i Ww and will maintain Workers Compensation Insu .as required by Section
3700 of Ne labor,Code.fh Ne performance of the work for which this permit u issued.
My WaAces Compensationinsurance Cartier and Policy number art:
Carrier.5r*—d. F71 0 Policy No.: W 19LY)li•ee7Q'l
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thismim red tet W mmpkmd U use permit is Ica.hundreddown(SIOO)
orkas)
I cenify Nat in the performance of the work for which Nis permit W Wood.l shall not
employ anypemen in any manner m u In Wcomet subject rode Warkcn'Cmnpensalm
Ian of Califomia Dau
Applicant
NOTICE TO APPLICANT.IL after making this Carl of Exemption,you should
become subject In the Workers Compensation provisions of the lalwr Code,you most
.,0o fdl romPIY whin such provisions h Nu Permit sbsll We declined masked. -
CONSTRUCTION LENDING AGENCY
r
[-v I Manby affirm this Wert Ia construction Cagency for the per(oman¢of
C the Cam's fur which Inds u ipermit ssued(Sec.70Y7,f,Cmiv.Ca
0 Lenders Name .
a Z LeadersAddress
V 0 1 certify that I have read this application and sues de,the somm information is
correct.l agree to comply with all city and county chicanas and sale taws relating in
0 CSJ' building Construction.and Wemby anNoda mpmsenutiws of this city m war upon Ne
anewstal d thpcoY for inspection purpnses
6. (We)agrce to sew,indemnify and keep harmless the City of Cupertino against
N liabilities,judgments.cou end espensw which may in anY w+Yamueagunst aid Cly
U z in mnsequonce to bre ranting of this L / C
^ APPLICANT ND A DS N JLL COMPLY WITH ALL NON-POINT Issued by: Date 7 Q�
SOUR E R UL � C s,
Sr ofAppliwnO ohcnaOr Dau Re-roofs —�/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or folnre building decupanumse orhandle hacamous material
u deRncd by the Cupertino Municipal Code.Cbapmr 9.13.and the Health and Safety
41 .Section 25572(a)7
❑Yea IPF, All roofs shall be inspected prior to any roofing material being installed.
Wilt thea scant o future Wilding uccn If a roof is installed without first obtainingan inspection,I agree to remove
PP g pant six cyuipment it Marro whish P ire
J emit huallom air cmuminants u de0md by the Bay Arta A r Quality M nagement all new materials for inspection.
District?
❑res apr�
I haw mad the hxnrdnss materials mWiremems under Chapter6.95 of do,Callies.
nu Hulick SafeyCode.Sass 25305.25533 and 2553/.l undernand that little Winding
!E docs not curtcndY hew a / a Y biliry m ratify the occupant of the
!E
nu wht mot psi f a Cc "a"of u
S°f�"�� Signature of Applicant Date
da ouoauthoriud agent Date All roof coverings to be Class rs'or better .