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CITY Or CUPEWFINo
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BUILDING DIVISION PERMIT
CONTRACTOR INI+O,RMATI,ON :
.:�. .,
BUILDING ADDRESS:
001 N pg ANzA BLVD if ini
ROYAL CONSTRUCTION CORP.
PERMITN005010138
W NEWS NAME:
PERMIT ISSUE DATE
UNITED NATIONAL BANK
11680 GOLORING RD.
01/2S/2005
E:
SANITARY NO. CONTROL NO.
(626)358-6688
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR S DECLARATION
Job Description
lion by
P
70KD)o( ithat vis1amftheBdunderprovisionsofs Coder9(commencing
with Section ]LYM)) of Division 3 of the Business and Professions Code, and my license is
infell Come and effect.
REVISION --IN HOUSE USE ONLY
License ClassLica
Dole Cnmracwr
NO NEW PERMIT ISSUED/ ORIG. #05010120
ARCHITECTS DECLARATION
Ihe
SOFFIT HT TOMATCH (E) /CHG MTL STUD TO 25 GAUGE
understand myplans shall used aspublic records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Conlractoes License Law (or the
following reason. (Section 7031.5, Business and Professions Code: Any city Dor county
which requires a Permit to construct, eller, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such Permit to file a signed Tamment
that hic is licensed pursurint 10 the Provisions Of the Commission's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 701 of Division 3 of flue Busirmai and Professiom Code) or
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that he is exempt therefrom and Ne basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penally of
not more Bob five hundred dollars (5508),
❑ I. as Downerof,he property, or on, employca with wages as their sole compensation.
Required Inspections
will do de work, and des smeture is not intended or offered to, (Sec. 7041. Business
and Professions Code: The Convector's License Law dao not apply Io an owner of
pmKity who builds or improves thereon, and who does such work himself or thmugh his
own employees, provided that such improvements are nut intended oroRercd formic, if,
however, the building or improvement is sold within a¢ year Of Morldefion, the owner -
builder will bars the burden of proving Net he did not build or impmr¢ for purpasc of
sal.,.
❑ I, as owner of
and confessions with licensed contractors to
C
�\
Seopeny, .a. B sines
project
the es not (Sec. ](eno Business Professions Code:) Theves
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themon. std
cane law rims not apply je an owner o(pmpeny who Wilds or improves thereon, and,
sense La property
. �^
whofor such projects with acomncmr(s)licensed pursuant to the ConContractor'scContractor's's
License La w.
La
am
C1 I am exempt under Scc. , B & P C for this rcazon
�-
ismer Date
WORKER'S COMPENSATION DECLARATION
1 Mreby aRmr under penally of perjury ore of the following codafatimm,
a and will cOmmaio a Certificate of Consent to self insure for Worker 'sCumpcn-
n, as provided for by Section 31W of the labor Code, for the rerfmmanu of the
work In, which Nis permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, az required by Section
3700 of the labor Codc, for Inc performance of the work for which Nis Permit is issued.
My Worker's Comptnsalinn Im umnec carrier and Policy number am:
Cromer: Policy No.:
CERTIFICATE OF UEMP TION FROM WORKERS'
COMPENSATION INSURANCE
opme section recd nm beemoplered if the Permit is for one hundred dollars (5100)
to less.)
1 certify Nm in the pcifmmafee of the work for which this permit is iazued. 1 shall not
employ any person in any manner sn m to become subject to the Workers' Compcmafimn
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Cenlficam of Exemption, you should
broom subject to the Worker's Compensation Provisions of the Labor Code, you most
fonhwhh comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby alarm That there is a construction lending agency for the performance of
the work for which this pens it is issued (See. 30117, Cis. C.)
Name
Lender's Addmas -
1 certify that I ban read Nis application and seals Nat Ne above information is
correct.
cuildin 1 agree to comply with all city and county ordinances and curt laws relating m
herehyauthorivsroprescmafivcs of this city to enter upon the
abovengcmnsnuctlon,and
ahovo progeny for im purposes.
an
(We) age indemnifyan the City Cupertino against
(We) agree w save, indemnify and keep
my in ac tar
espouses whichmayinany wayaccrm against said Ciry
in
in consequence of of this
graind
Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
UNDERSTANDS
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of Applicur t Cmntra.for Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Of future building occupant Tree or handle hvaNuut material
az defined by the Coconino Municipal, Code, Chapter 9.11, and the Health and Safety
.otic. scnioo 15532(x)?
All roofs shall be inspected prior to an roofing material beim
P Y
❑res ❑Hat
P g g Installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
m4amous air contaminants az defined by the Bay Arca Air Quality Management
all new materials for inspection.
,it,?
❑Yes 0 N
Ihow real the bavaNims mamrials mquimini under Chapter 6.95 ofthc Califon-
-
nix Health A, Safety Calc, Sem ors 25505.15533 and 25534.1 undcrswnd that if ft building
does not currently have a renant that if is my fictional hil ify In and I No occUPanl Of the
rcquircomms which must the met prior In issuance of. CcNncate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
of authenced agent Date