08060122 CITY OF CUPERTINO 3'✓ - �agsr ?ri +" = } '
BUILDING DIVISION PERMIT `CONTRACTOR INFQRMA I4N'
BUILDING ADDRESS: PERMIT NO.
1.0431. N DE ANZA BLVD EOUTH BAY CONSTRUCTION CO 8060122
R'S NAME: PERMIT ISSUE DATE
APPLE 70 KNOWLES DR 7/10/2008
NE: - SANITARY NO, CONTROL NO.
408) 379-5500
ARCHRECnENGINEM BUILDING PERMIT INFO
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300 LICENSED CONIRACTOWS DECLARATION Ib Description
m 1 Wroby aa.Mut 1 am licensed under proviionssof Chaper 9(rommO
erming
wiMSceMm7(lk))ofDon7efdbBLLL ..dPof.i..Cad..apemy�icuva OMML TI INTER PROJJ4THFLR RMDL SPACEpNEWWLS,
^❑w NfYll(aero and cRecL Y EILINGS, FLRING,DRS, HVAC, ELECTRCL&PLMBING(18993SQ)
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ARCNITECI'S DECLARATI N
< l u nJ my plans shall W used as Public records
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t o Lieehhsed Hvfrasloml
OWNER-BUILDER DECLARATION
s� y 1 hereby aRm that I am exempt from the contractor's Leone Law for Me
C e following mason.(Section 7011.5,BYalmss aM Profemfons Code:My city or county a
Which requires a permit to construct,after.improve,demolish,m repair any structure
iy prior to its issuance.also requires ttr applicant farsuch permit to Bk a signed smemem
< that he is licensed pennant to the pmvisiom of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y3 (commencing with Section 10110)ofDivision 1orMeBusiness and Professions Crum)or $16000 00
`t Nat M le esmnpt Mord ore and Me Incas for Me alleged eseraptimt.My violation of
Sermon 7011.5 by any applicator for a permit subjects the applicant M•civil penalty oFN Number Occupancy
mreamManB5110)
wWarneddoll.(5 . 2633114 . 0TYPe
❑1,m wmer o(the pmputy,.my moploym wit ngn u Ue'v sole compewUm,
will do Me work,and Me,tnmtum h not intended or offered for sale(See.1014.Businm
and Pmfctions Cade:The Comraco/a Liana law does cot apply o an Warr of Required Inspections
property who Wilds or impmves Marren,and who doesauch work hirromfor Waugh his
own employees,provided that such improvements are not inMnded contacted formic.if.
howevor.Me building or Improvemem is sold within one year cdcompletion,Me War.
Wilder will have the Wrdcn of proving Mar M did not Wild or improv for purpose of
use.).
O 1,as avec of the property.aro corm"ely contra°int wit licensed conuacrau as
construct Ne project(Sec.7064.Business and Professions Code:)The Commeam's U.
room Law does not apply to an owner of property who Wilda or improves Memos,and,
who contracts formeh projects with a eommea r(s)licensed ..at to Me Contracture
License Law.
Iemuemptunder5ee ,BAPcforthtsmsann
Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Me following declarations:
I have and w01 maintain a Carubou ofConum M self-insure for Waters Camper.
nation,u provided for by Section 1700 of Me Labor Code,for to performance of Me
wart for which this permit is inued.
❑1 hate and will maintain Worlmes Compensation Irma rma.u required by Section
3RD of Me Labor Code,for the performance of Me were ferwhm,ccs permit is imued.
My Warkef CWurana oma and Policy number am:
Carrier: mpensmi.i Policy No.:L"LGJYtl c(Q
FlGTE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Otis sect.¢ed not be cmhpked lithe permit Is fora.hurhMml deems(SIM)
or less)
1 certify Met in Me perfurmarce of the work for which this permit is issued,I shall am
employ any person in try moaner so as M become subject to Me Wodmaa'Compensadon
Laws of California.Data
ApPEnnM
NOME TO APPLICANT:If,aMr.,king this Cer iOrme of Exemption,you should
become subject to the Wencer's Compemiuon provisions of Me labor Cade you muse
.J,z fanbwiM comply with such provitom or Mu pewit shall W deemed mated
Z O CONMUCTIONLENDINGAGFNCY -
(~ ? IWrehy annue,MUM tem is a conaluctim leading sgency for the performance of
FC Me work for which des permit is issued(Sec.7097,Civ,C)
U.]Q Landers Name
z lenders Address '
V C) 1 certify that 1 have omd this application and sue Mar Me shote information is
I,!! cemeav I mgrs to comply with all city and county o tinanas and stale Ian Haling to
O S`'J Wilding construction,and hereby mmo its rtpmmuUw of this city to upon Me
,.bilitics udgm property far exXo en purymes
F y (We)agree o save,indemnify and kecp harmless Me Coy of Cam,num against
fA Ilebilites.udgmcnts.coN udexpenses which may in any way against acid City
V z in y a of the granting of permih
► RE ULA ON A CA DS DWIyWITHAL NONPOINT Issued by: Date
I° °� Re-roofs
Si ort App scanVC nmatter I Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ue apPlient or(alum Wilding o cammos ore or i andle inecodam maoris
fined by Me Cupertino Mu icileal Code.Chapter 9.11.and Me Health and Safety
.section us17(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ys No
will Mea applicant dr ture Wilding excu nt use a ui If a roof is installed without first obtaining an inspection,I agree to remove
PP L W q it Qu or deviaa which g
ieict? m ser c.tamimnts u definN by the Bay Area Air Quality Management all new materials for inspection.
District?
P
[3 Y. o
I have read Me hat=meed regmremems under Chaper G95 of the Califor.
nuHWMkSafmYCade,Sceu 21511arld1S514.imidemand MnifMe Wilding
does note yyqrr a y haw a¢non t o my mihility m notary M aaupane of Me
regmremyhta wU icnmost here nt of a cmufeae cf(k�ihV. Signature of Applicant Date
Owner or auNarivcd aimm ban,— All roof coverings to be Class'RW'or better f