03020007 CITY OF CUPERTINO- e.a., , sou• ',is„>J .,'?
BUILDING DIVISION PERMI GQNTRACIORINEORMAT
BUILDING ADDRESS: SIGNS OF CLAIFORNIA PERMITNO.
10051 DE ANZA BLVD 0102onn7
OWNER'S NAME: 48 GOLF RD. APPLICATION SUB DATE
BEST FINANCIAL 02/04/2003
IM HONE:
(925) 484-4733 SANITARY NO, CONTROL NO.
RCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Ogg LICENSED CONTRACTOR'S DECLARATION O O O O
1 krchy arum that 1 em licensed under provisions of Chapter 9(commencing Job Description
with Section 770p0�0)O(Division 3 ofthe Business and Professions Code, unimylicenscis r� r�(1 [�
o8gb Licenlse cl.J-T�'•l T Lie.« J"-.I f'S ser 4'tii SIGN !!—DTIV a�I�
Data Contra
So RCHI bu.se DELL ION
li undenuM my Nall he uxd u puhllc records O Q �QO3
�o lona sb JUL U
OWNER-BUILDER DECLARATION
as F i hereby affirm that 1 em exempt from the Contractors License Law for the BUILDING p 0 following mason.(Sccuon 7031.5,Business and ProfessNVGions Code:Any city or county
$ wRcM1 Iryuire•permit m cogoal.r.improve,dron l'uh,or mpair any sm,so.
�5^ pdrrkjui
That he is licensed ensed P,also requires the applicant forsuch permit 1.file a signed mkment
G ursuenu0 the provisions of the Comracmr.License Law(Chepter 9 Sq.Ft.Floor Area 2)§E"tion
$ (commnuing with Sutton 7000)of Division 3 of the Business and Professions Code)or
_
thus he At exempt dertfrom and the basis for the alleged exemption.Any violation of
vection 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of ¢ Occupancy Type
not more than fie hundred dollars(5500).
❑I,asrwnuofthepmpeny,ormyemployenwiNweguuthelrwleWmpeuauon,
willdo the work,and the nretu s isnot intended monernd forsale(Sec.7044,BusinessFOM
and Professions Code:The Contractors License taw dm not apply in an owner of 10 3 — UFER egUlred Inspections
properly who builds or improve thereon,and who does such work himself or through his
own employ=.provided that such improvements are not intended trollied for Ads,If, 104 — REBAR
however,the building or Improvement is old within ON year of completion,the owner,
Wilder MR have the When of proving Ow k did not Wad or improve for purpose of 105 — ANCHOR BOLTS
aste.). 304 - ROUGH ELECTRICAL
Lusownerm(ukproperty,Am.Business exclusively
contacting with)Thlicensed comncrors to 505 - FINAL ELECTRICAL
cauuuu.the project(Sec.]Old,Baser of aM Professions Code:)The.dot et.Lit
corselawdrer such Pon rojects with
ith Aofpropeny who sed pursuant to
andt 514 - FINAL PUBLIC WORKS
whocontractsLa for each projects with a canuumr(s)licensed punuam m Be Contractors'
Licence Law.
❑Iame�xemptun�derSue�. � ,B&pCfmthbrearn
Owntr4Pr—a.2sv�\ \ -+� DateOPP /G
K'�LLK��SCO�.I PBN ATI�ON DECLAR
1 hereby a1Rrm under penalty of perjury ON of Ne foil Ing decluNonc
[]I ban and will maintain.Certificate of Cmssem to self inure far WndimesCompen-
aation,As provided for by Sutton 37M of the labor Code,for the performance of On,
work for which this permit Is fussed.
❑T ban and will maintain Wortrrs Compensation Insurance,As required by Section
3700 of the laWrCode,for the perfe of ormancthe work for which this Permit is issued.
My Worker.Compensation luurance em."Am I PoI umkrare:
Cartier Poll No//p
CERTIFICATE OF EXEMPTIOESQ ORKERs'
COMPENSATION I
rlhis section need not k completed if the permit Is form.hundred dollars($100)
or leas.)
I Crtify Nat in the"Iformance OIps rk,for which this permit is issued,l shall not
employ any plesonWon era1/u btor!%,so the Worken'Compenution
Laws OTC lif rnp,gT}`a(
APPI'qI t5_
NOTICtt'7.b AP C if1110eni0c of Exemption,youshould
1,701, subjmt m the Workers Compensation pmvisions of the Ua r Code,you masa
70O mMwiN comply with such provisions or this permit hall W deemed revoked.
q y CONSTRUCTION LENDING AGENCY
[—� l hereby affirm that them is a construction lending agency for he performance of
pC > the work for which this permit is issued(Sec.3097,Ci¢C.)
6Wi Q Ener INunc
Z lenders Address
U Q 1 certify that 1 ban read this application and sum that IN above information is
0 cortttc I gree to comply with all city and county ordinancese,iof and sank laver upon t e
L) U wildingconstruction,end hereby inspection
representatives of this city roenter upon the
W ahovemenudned gmproperty for inspection which r.
g� (We)IS.toasn,indemnify and keep harmless the City of Cupertino against .
fq liabilinconses.quenc of Wecwuand expenses which may in any way attroe Against said City
U 7 in consequence of Ne tontine of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL ryONPOINT Issued by: Date
S0,URCEGULA TONT $,
Re-roofs
tpeltHAZARDQUS.MATEIUALS DISCLOSURE Data Type of Roof
Will the applicant of future Wilding occupant store or handle hazardous material
u&ffoed by the Cupertino MuniciplWOric.Chapter 9.13.and tie Health and Safety
Code,Becton 33533(a)7 All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes �Wildimp.n..-'
Will the applicant or futures equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hauNous air contanno nu asrta Air Quality Management all new materials for inspection.
DinrkR
❑Yes
1 have mad the barardrug mawfalsequimmenu under Chapter6.95ofue Califon
ni.H lth&Safety Cr ,S 625N15.25533wW 5M.1 umkmandthatifthe Wild' g
ducrotcur ntlyhaveaknam.thntitiamy.sponsibility.nodlytkucu ant the
require uwhichmugWme riormlssuanceof.Certificate upmcJrt.- Signature of Applicant Date
gars D, D All roof coverings to be Class"B"or better
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