04090049 CITY OF CUPERTINO -� "
BUILDING DIVISION PERMIT CONNTRACTOR4NFORMATION - - —
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BNLDINGADDRESS: GEORGE GERA 1E11ITN004090049
vER'S NAME: PERMIT ISSUE DATE
GEORGE GERA
E:
SANITARY NO. Q CONTROL NO.
ARCHiTECfIENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION lob Description
u F I hereby affirm that I sur licensed under previsions of Chapter 9(commencing
'ujwith Sectim.700B of Division 3 011ie Business and Profusions Code.and my license is
^Z,us Iafail farm mdeRea. REMOVE PART OF CANOPY
s ne License ClassLic.I
4Fo Dae Contractor TRASH ENCLOSURE
W2QQ ARCHITECTS DECLARATION
I in dersmnd my plans shall W used as public¢Cards
3-U
3 o G Licmec0 Professional
OWNER-BUILDER DECLARATION
xF I M1erchy affirm Thu 1 am exempt from the Contractors License Law for the
o o following reason.(Section 703 1.5,Business and Pmfusiom Code:Any city nr County
K g E� which mtluius a permit to construct,ilmr,imprnve,demolish,or repair any structure
m—'^ prior to its issuance.also requires the applicantfor such permit to file a signed surround
That he is licensed pursuant to the provisions of the Commeans License law(Chaper 9 Sq. Ft.Floor Area Valua,d To 00
as (commencing with Section 71100)of Division 3 M she Business and Professions Code)or 4
y that M is exempt therefrom and the bus for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjceu the applicant to a civil penalty of APN Number Occupancy Type
not more than Ove hundred dollars(1500).
369'38002 ' 00
E3 1,ss mvnerofdte property,ormyemployeu with"gum
Cale comperrsadon,
andPhfiewok.ands: he Con isnot&Lica tl Law ddfm salt(Sec.to aa.water of
and erty who bu Cade:The Comoman, rad ata[Law dao or apply ff rt owner of Required Inspections
.we
enywhab,provied door mehemomandwha ements and act ctende or
rthr san.ugh If. {�S� fV pI g5 ��®
howemployus,ping or ithevementpm said
within
intendeddmoneretl for owner- IIYr`— I'11I1��\Ialf(///C/tJt�
however,the building or improvement is salt within ane year of completion,the owe of
builds will have the burden of proving Nu k did not build or improv for purpose of
sale.).
❑1,re owner of Ne property,am exclusively contracting with licensed conmCtors to FEB L 2005
construct the project(Sec.7044.Business and Probta ions Cade:)The Contractor's Li.
seem Taw docs not apply to an owner of property who builds or impmves thereon,and
who tonnes for such prajecu with a canvactor(s)licensed purswnt to the Conuacmra
License law. BUILDING
Y aver as m voter Se[. .B L:P C far Nis season
r Dae —/0—by
R P 10 DECLARA`'nBy'
hereby afro un r pe ty of rjusy oro of the following dedamoss:
leve and will meinuina CenI he of Consent in for Worters Compdm
as provided for by Section 3]W of the Labor Cade,for the pdrromance of the
work for which this permit is issued.
❑I he.and will maintain Warkmrs Comyeuation Insurance,.required by Section
37M of the Latour Code,for tic piddommce of the work far which this permit is issued.
My Worker's Com mmution lumen,Cartier and policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ma xecdon need not hd completed irrhe permit is forom hundred dollars(SIM)
or lus.)
1 certify that in the Peformen�kc of the work for which this permit is issued.I shall nut
copl-Irle0pp¢�n�rn any m6uCsad EldWrsruAl yrpjccr ro dm WOrken'[ompewuon
Laws ofnCaECtrah.Da¢ __//''JJ.A4..II AAP
�/V .snlO
CE"A ICA If,afro i this Cdnifieate of Exemption,you should
come su jce the We is Cc Notation previsions of the Tabor CMC,you must
.J2, farthwith comply with such provisions or this permit shall W dedmet revoked.
Z O CONSTRUCTION LENDING AGENCY
P: thereby affirm that there is a construction lending agency lot the purrommm of
C 7 the work fur which this permit is issued(Sec.3097,Civ.C.)
W n Lender's Name
D. Lender's Address
C.)O 1 minify Nat I have mad this application and area,Nat the above infoaremim is
"H roma I agree to comply with all city and county eminences and sure laws relating to
0(J building construction.and hereby authorise mpremmitivrs of this city to cnmr upon the
4[I moovc-ricrumod propeny for iuspceuan purposes.
(WO)agree to save,indemnify and keep humiess the City of Cupertino agairtst
Fliabilidu.judgments,costs and expenses which may in my way accrue against Mid City
V z APPL A are UNDEor the RSTANDS Amating of rsDmILL COMPLY WITH ALL NON-POINT Issued by: Date
S ULATIONS.
—out Re-roofs
um fApplic on Dae
ARD S MATERIAL$DISCLO]� Type of Roof
AAkWe acam ser forum building occupant sroe or handle hasardous material
refinillthed by Ne Cupp1ipertino Municipal Code.Chapter 9.12s and the Health add Safety
ale. dCuOn25s321417 All roofs shall be inspected prior to any roofing material being installed.
� pr Q�Ho
Will Nc applicant or(drum building occupant use equipment or dc,ims which If a roof is installed without first obtaining an inspection,I agree to remove
i haaardnus air conromimass as d[rined by the Bay Arca Air Quality Management all new materials for inspection.
tries]
❑Yds QNo
1 have read the haaamtes materials requirements under ChmarT6.95 of the Califor-
niaHcalth&Safety Code.Sections 25505,255]3 and 25534.1 unticrsimd theifthd Wilding
dos of Candy have a renil t, r it is my responsibility to nodty me Occupant of the
ms which must bd ter ortoirsdance.f.C[rdero 'fa crb Signature Of Applicant Date
author as `e'L� Date All roof coverings to be Class"B"or better