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CITY OF CUPERTINO
PERMIT
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NTRACT,0WANk0RNIr1.'TIUN
BUILDING DIVISION
BUILDING ADDRESS:
J. M. O'NEILL, INC
PERMIT"°04030214
1027S DR ANZA TIMM
R'S NAME:
PBRMIT ISSUE DATE
TAN DIVITORIO
5880 W. LAS POSTTAR TiT
PHONE:
S&TARY NO. CONTROL NO.
(925)225-1200
ARCHITECTYENGINEER:
BUILDING PERMIT INFO
BL00 ELECT PLUMB MECH
17-1 t� 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
I Mousy dflrm Nat 1 sm licensed under prowli of Chapter 9 (cmnemeain{C
_
with Section 7000) of Division 3 of dm Businessland Profusions Code.md my license is
to full o= and effem•
TI --OFFICE UPGRADE
License Class Lk."
Data— Contractor
ARCHITECTS DECLARATION
1 undersand my plans "I W used as public record
^
V�
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby .Bind that 1exempt from the Cantmmor, License law for the
following rtawn. (Section 7101.1. 1. Business and Nv(essiuu Cade: My city m county
which requires a pmmii m Construct, alter, improve, demolish, or repair soy strumum
_
prior to its issuance, also requires theapplicant for such permitto file a signed Moment
thatha is licensed pursuant to the provisions of the Commctor'sLccue Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
trout h is exempt therefrom and the Easis for thin alleged cumpdon. Any violation of
3 WK34"erO0
Occupancy Type
Section 7051.5 by M' applicant fm a permlteubjecu the i1pplicanu0 a civil penalty of
mat moa Nen Eve hundred dollars ($500).
0 I, u owner of the pmMny. or my employcu wish wage u thea aria wmpewdm,
Required Inspections
will do the work,snd NeswcuaisnotinkndedoraReM(or We(Sec.70U,Butircv
Contos rLicense Law amto s not apply an Comeof
and Professions Code: lite trac
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property who Wlldsorimproves Neeson, and who doessuch warkhimselforNrough his
own employee, provided that well improvements era act intended oroRered fmule. It,
however. the building or improvement is sold within we year of completion, the owner.
bWlder III have tha burden of pmvinli Net he did not build cr improv for purpose of
tile.
1, as owner of the property, am emluively contracting with licensed contractors to
jea (Sec, 70m. Business and Profusions Cod:) Tha Contractor's U.
not apply to an cower of property who Wilda or improves thereon, and,
r such pmjecu with a Columnogs) licensed pursuant to Ne Contractors
du Sec ,08 PC far NisDaoRKER'SC
"Mmby
MPE TIONmysM
m under penury or perjury oro to lowng declarations:
1 have and will maintain aCenllic to of Consent to self -Insure for WerkeraCooper.
union, as provided for by Section 5700 of the Labor Code, For the perfosmana of the
work for which this permit is issued.
0 1 have end will maintain Workcr'a Compensation Women, as required by Section
3700 of the Labor Code. for the performance of the work for which NU Permit is issued.
My Workers Compemmion Insurance cartiur and Policy number art:
Carrier, Paltry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
(This amorm need not uncompleted IfIM permit Is formic hundred dollars; ($100)
nr less.)
I mnify Net In cite pmfnnwsuce of the work for which this Purnell is issued. l shall not
employ any fiction in try manner an as In become object to Ote Workers' Cmnpewdon
Laws of California. Date
Applium
NOTICE TO APPUCANT. If, afar masking this Certificate of Exemption, you should
become subject m the Workers Compensation provisions of cite labor CDde You mut
foMwith comply with such provisions or Nis permit shall Is, deemed revoked
CONSTRUCTION LENDING AGENCY
I bunchy affirm that Vert is. rouuuctinn lending agency for the rimfurmma of
Lha some fur which this pernit Is issued (Ste. 3097, Civ. C.)
Lenders Name
Leader, Address
I anify that I haw read this application and sum that cite above infoonarlun H
C(ol 1 agree to comply with W city and county ordinances and soon laws misting to
building construction, cad hereby mNOrixe apruen Alive of ulia City m enter upon the
above-mendoned property for inspection purposes.
(we) now, in save, indemnify and kap harmless ft city of Cupertino against
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liabilities, judgments. ensu and expense• which may in MY way accrue Against said City
to conn c of the "noting of this pcmmit.
APPLIC UNDERSTA S NO WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO RCE ULATION
—Re -roofs
Type of Roof
igWs. of App InnUCamacmr e Date
HAZARDOUS MATERIALS DISCLOSU
WIIltheappllemamfuic Wlldingaccupanutommhandlehus usmaterim
deMc l by the Cupertino icipsl Code. Chapter 9,12, and Ne Health oil Safety
de. Se❑ctionn 25532()?
All roofs shall be inspected prior to any roofing material being installed.
ye.Will
a roof is installed without first obtaining an inspection, I agree to remove
Elie applicant or future building occupant ate equipment m devices; which
emit haurdom air contern ts u dell of by the Bay Area Air Quality Mmagement
all new materials for inspection.
District?
0Yu No
uanl sec fialsequi..nMun&,Chapt,6.95.fthe Califon
md2553d.lWnotifndNnupWilding
eWdu..ce.f.cconificateofoccupentacy.
A.wH..IM&.'Y
srtsponsihility to natrfy dr occupant of Nev
Signature of Applicant Date
All roof coverings to be Class "B" or better
Own
authorbed agent Dan