05010178 CITY OF CUPERTINO m� sY�'
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION
euILDING ADDRESS: EUROPENAN AUTO PERFORMANCE PERMITN05010178
rrn rip. AN7A 1311m
ERS NAME: PERMIT ISSUE DATE
EUROPENAN AUTO PERFORMANCE 711 2819nng
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
(�
Lop LICENSED CONTRACTOR'S DECLARATION
UI hereby mf"
m that 1 em licensed under provisions Of chapter 9(commencing Job Description
with Section 701111)of Division 3 of the Business and Professions Code,and my license is
o' iFull fnrtaanderr«t.
License ClassLic. REVISION--IN HOUSE USE ONLY
j M
,e,ro Dam Coronets, NO NEW PERMIT ISSUED ORIG. #04090049
ARCHITECTS DECLARATION -
'� I understand my plans shell Mused as public mcords
DyU
3 0 LkcnSed Professional
3 OWNER-BUILDER DECLARATION
y I hereby affirm that I am exempt from the Contractor's License Law for the
O O following mason.(Section 703 1.3,Business and Pmfessiom Cade:Any city or county
y$ which requires•permit it,construct.ober,improve.deur ish,or repair any mmc me
Fi< prior to its issuance.also require the applicant for such Permit to file a signed stammer
that he IS licensed Forstmann to the proviSIOM Of She COnpacmra Liceme Law(Chapter 9 Sq. Ft. Floor Area Valuation $0
SFO (commencing with Section 70M)a Division]of the Business and Pmfessipu Codc)ser
Wthat M is exempt therefrom and the baso for the alleged exemption.My violation of
Section 7011.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than fin hundred MIMS(5500).
❑I,uowwroffMpmpmy.mmyemployeeswimwagaaaats,e wlecmnpensadon, 36938002 . 00
will do the work and the Structure is not intended oroRend for sok(Sec.70W,Business
and Pmfecs ims Code:The Commemes License Law does not apply in an owner of Required Inspections
property who builds orimproves themon,and who dmssuch work himself or through his
own employees,provided that such improvements art notimended or offered for sale.It.
however.he building or improvement is sold within one year of completion,the owner.
builder will bare the burden of Moving that he did not build or improve for purpose of
sale1,
❑1,as owner of ct ee.7()W,
Oproperty.,Business allusively contracting Cid:)Theed conuumm to \
cense La it nota ply to i owneofMo Professions ds or i pro Conaacmh Lid (�
.hit law dna not apply m an owner of property who ted p rs improves Comon,and V
who contracts for Such projects with a eonuacmr(s)licensed pursuant o the ConvanoYs
La
aemt dtt Sec. .Bk PC fm this Mason
79; v
Date O_b
WORK S COMPENSATION DECLARATION
I Mreby affirm under penalty of perjury one of the following declarations:
hsve and will maintain a Ce tifcam of Consent to self-hour fw Worlses COmMn-
1[03]7.yl
n,uprovided for by Scctidn]700 of the labor Cade,for the performance of the
for whim this permit is issued.
have and will maintain Workers Compensation Inmva .u required by Section
of the Labor Code,for the performanceOfthe work for which thus permit is issued.
WorkeYs CoroMmation losunna earier and Policy number are:er. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this Section need not hecomplemd if the permit is rot one hundred dollau(SIM)
or las)
I cenify that in the perrom once of the work for which this permit is issued,1 shall not
employ any person in any mannerso as to Mcoma subject to the Worker)Compensation
Laws of California.Dom
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificale of Exemption,you should
Mcmmn$Object to the Worker's Compensation provisions of the Labor Codc,you must
0 z forthwith comply with Such l mvivixn or Nis permit shall he domeod revoked.
Z OCONSTRUCTION LENDING AGENCY
[�� Iherby aMrm Nat ft.is a construction lendingagcncy for Na perfurmana of
13!. tM work for which this pttmit IS Wood(Sec.109'/.Civ,C.)
U] Lerdef.Name
=z lander'.Add.
U C) I cmiry that 1 have mad Nis application and sum that the above information is
LL P Correa 1 agree to comply with all city and county mdinansn and sum laws relating to
0U Wilding construction.and hereby authorise representatives of this city to coir upon the
W above-meodoned popery,for inspection purposes
(We)agree to save.indemnify and keep harmless t City of Cupenino against
t.)Z liabilities.judgments.casts and expenses which may in any way¢o
cc against said City
in consequence of the granting of Nis Permit.
^ APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU QE REGULATIONS.
LLWOo�co_ zc_ ��'aT�
S]`gdat�]re of App i' VCo f Dem Re-roofs
HAZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam car fowo building occupant score or handle huallous material
Med by the Cupaninn Municipal Code.Chapter 9.12,and t Health and Safety
Semon z3s32(a)7 All roofs shall be inspected prior to an roofing material beim
Ayes p p y g being installed.
Will the applicant Or fuwm Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I harallous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
7
0Ya G]Nn—
I have read the haradiws mamrialsmyuiromcnu under CTaPmr6.95Of tM Califor.
nuF ex SafctyCadc.Savau 25505,25511 and 255N.1undcrsmfdfbmiflM Willing
does f currently hews¢non t it u my rtapouihility ts notify that oceupar of the
m which most Mm owissunce nr.ceni0eam pr OcFnly�Cy. Signature of Applicant Date
car ammntiae age "�� I L Dots All roof coverings to be Class"B"or better