03060053 CITY OF CUPERTINO ' ��`.' '^ *° '� ( �f ^"` '"°
BUILDING DIVISION AT
PERNIIT 0 �� zOR�dglw ,,, a- &asq+
BUILDING ADDRESS: PERMIT NO.
GREG FAROTTE CONSTRUCTION NC 03060053
AM FERMIT(SSUEDATE
8545 MONTEREY STREET 06/06/2003
P999 GF SAX TGSE SANITARY NO. CONTROL N0.
(408) 848-9993
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDOO ELECT PLUMB MECH
O
3o0 LICENSED CONTRACTORS DECLARATION JobDescri tion
La 1 hereby a(f ow that 1 am licensed under provisions of Chapter 9 wammencing p
wins Sued.7003)of Division 3 of the Business new Formal.Code,and my license is
in full to.and effect.
LlccmwClw Lic.N RELOCATE WATER & GASPIPES
p Dau Connxlm
1]00 ARCHYIECI'S DECLARATION
Q I understand my plans shall W used As public records
y O
5 3 Licensed Professional
OWNER-BUILDER DECLARATION
;f I Mrthy aRrm last I am eaampt from the Canon clans License Law for the
EE
CODDO
$� following mason.(Section Eonstru Business and Pe.doro pe Cada:Any oily m aunty
which requires issuance.also to construct.slur,imprnvu.demolish or repair ed structure
_Z�e poor aiuensedauantto rue lertaionof far achpermit to Blemiaw(humenl
< that bannow llcepedpuwanitotheofDiorousofthe eBuacesrWanse mlanC Code)
Sq.FL Floor Area c X tion
zC� (cam a is exe with Section]and law basis
7 tof he Al Business and Profusions Code)tar '+'1 D"��
a..
that io is 31.5 b any a li and ae aper it de alleged ascription.in Any it penaoladlty
of
Section 7WIs ser hundred Ion.permit abiecla see applicant n,M.n pealtr or 31T'N'8�eRl 0 Occupancy Type
not mart than Bro hundred dollen(SSW). i
❑1,as awoa of the papery,m mY emplayepe with wgu pe seer ser compewdon,
and datheworl.aodc: he cturerrclsLiceneLaw do forst apply roan.Bner of 202 - UNDERF$a@RC @1$3d�G
and property
whlons Code:The Canuactort.License who law dose not apply lf an owner of
propuly whotanaorimpra.e.aerean..nd wnodoesarch Werk mm,<uminmagh his 301 — ROUGH PLUMBING
awnemployessprodAthaiachimprme UmnMmmwedmolrmed(wW.It 502 - FINAL PLUMBING ENERGY
howeror,nsqWildlot or impravpnent r said within one year of compldon.aeowner
-
builder wllf haw the burden of proving wt he did nm Wlld or Improve(orpurpose of 506 - GAS TEST
nas owrcr of the property.am eaclusiroly contracting with Banned contractors to 507 - FINAL PLUMBING
construct the project(Sec.7044.Businea and prurepeape Cade)The Camnetor's Li-
cepee law das nal apply as an owner of property,who Wilds ar Imp.thereon.ad,
who emm wo,for and prejam,wins a amncmr(s)licensed pursuant on the Contractors
0 1 a Law.
P "
p Ian exemptuMa Sec .B&PCfar this Monaco
J
caner Dalt
WORKERS COMPENSATION DECLARATION
LJ
I hereby ellirm under penalty of p:rjury orc of she following deelandou
I tor.act will WOW..CeNOau ofooment to self-Wore for Workers Compn
-lion,u pmvMd for by Section 7700 of see labor Code,for the perform arce of Ult
work(m which ser permit is wood. '-`�-
❑I have and will maintain Workers Compensation Imuran,a required by Section .
3700of thc labor Code,for the performance of see Wolk far wb(ch this Amon is iuued.
My Worker's Compensation Insummx carrier and Policy number tae:
carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
(Thr sealm reed rat he ampleted E Ue permit Is i.e.hundred dollars(SIM)
Or less)
I certify that In the performance of the walk for which dris permit 1s issued.)short nM
employ any person lgCnY aersqumhecmtlj aft, Wcomirenadon
Lave of California.WR
Applicant
NOTICE't'Q APFUCANT:IL ter making ser Lamiluu of Exemption•you should
Wromq ecl to the Workers Compensation pmvioruns or the Mbar Came.you mum
.,O forthwith comply with such provisions or this pcolut shall ba dccmcd mated.
Z CONSTRUCTION LENDING AGENCY
(-r4 work
which
shot there lu construction 30 len ding agency for the performance or
y'ti the work fm which this permit Is Need(Sec.7097.Civ.CJ
a Q
Leader Name
7 Z IedeeaAdarea
()01 cedfy as I Mare read this,application and now that the-baro information r
cancer.l agree to comply with all city and county earthworms and salt laws mrling a
0 building construction,and hereby announce mprtacramivus or this city to enter upon rM
W .hove-mandorcd prop;ny fm Inspection pugasea
(We)agree to ave,indemnify and keep barmlpes see City of CupeNrc against
yIlebilidn.Judgmenu.cusu adexpenape which maymanyvnyaccmcagalalaaid City
V 7 in consequence of the gnnang of this perm IL
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINf Issued by: Dat
SOU EGULATI NS. fir
6 03 Re-roofs
Sm arAppOanvCanuasa °ite of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
III lite applicant or run=building occupant am orlandlc Innen us materia
pe de0md by Ue Cupardw Munmp Code.Chapter 9.13,And Ute Iblth and Safely
code,salon 2x532(.)? All roofs shall be inspected prior to any roofing material being installed.
0Ype No
WIII the applicant or future Wilding aaupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air conannnanu pe d Road by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya No
I have red the haadousmaterrls requimmenu underCMp erli.95af du C,lifor.
aiAH.I •SaWycWt,Soct.15505.25533 and25534.1 undcruuid as ifthe building
does not currently ham a rental,seat 1r is my reapm nidi ty to notify see accuptal or the
not mens ni mumWmetpnora(aa,nrallcaniflaaooeapan . Signature of Applicant Date
r a3
owner or authri agent nth All roof coverings to be Class"B"Or better