08090170 CITY OF CUPERTWO �a'�3 , a•.-tea `;3'r�.�- r`"� ' '-.-+.
BUILDING DIVISION PERMIT
CUNTRACTORINF.ORMAION
x. , seas � 4 .....
BUII.�ING pDRESS: PERMIT NO.
1O�N0 N DE ANZA BLVD TBD - TO BE DETERMINED 08090170
NER'S NAME: PERMIT ISSUE DATE
JOHN M SOBRATO 09/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHrrEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTORS DECLARATION - lob Description
1 WmpY affirm that 1 we licen B under provisions fof Chapter 9(commencings P
_�� with5cetim7IXp)ofDivialon3o(theBudnmandProfesdomCode.admylicenseis HANGING TAKE OUT SIGN 8-3/8" X 36"
- m in full force and eff G - G`
,qz uanmpazt ` Lie.. e � NOTE:CALIFORNIA SIGNS INSTALLATION PD FOR BUS LIC
toDam Y-7e�rr canvacm �r /ti .
7W ARCHRECTS DECLARATION 9/25/8
I undoem nd my plans dull be used u public records
54u
0I Liceucd Pmfcssi.nal
i3 - OWNER-BUILDER DECLARATIONeComemet
s I hereby aRrm that I am exempt form 1W Cosham o License Law for to
is
no following mason.(Section 11nnawc umar. and ms.dcrone Cade:Any oily m county
5_ which regdres a permit to construct dun nt reforms.dcch ermit t or repair ad structure
_Z<
pow miuissud purse tut toires ithpr isionam for Contractor
ofile asignedsummcm
ho beisuamedpmanaat aumpm.ida� afineeanBa mrsuarml,w(Chapmr9 Sq.Ft Floor Area Valuation
r�s (commeming with 5ation 7D00)of Division Sof the Budneurd Pmfeuior CaM)ar $2100
�5-. that M is exempt therefrom and use buds for the alleged esempion.Any violation of
Section 7031.5 by any applicant for.permit subjects Bic applicant m a civil penalty ofNumber Occupancy
not more soB
n K hundred dollars(S5013). 316 02104 .W Pane Y Type
I,uownes of um Proprny.ormy wpl%cis with wagesudmvsolc compcusation,
will do the work,and the somatise u not intended oraffered Ammic(SIL.7014,Business
and Professions Code:the Contracmes License law does not apply on an moor or Required Inspections
property who builds mutation.Nvmn.and wbo docs such work himself err through his
awn employee,provided that such impmsemru are not intendW oraRemd formic.It.
however.Ne building or impmwmenr is sold within one yev of completion,the owner.
Wilder will have use buNam of proving dist he did an,build w soprano for purpose of
sale.).
0 1,as owner of the Property,w amhuku'l,co ansamg with licensed canmacm a in
cuawet the project(Sec.Toa,Business and Profession Code)the Conmacmri Li-
ccmea law does not apply to an owner of property who Wilds or improws theman.and
who comrmta for such pmjttu with.conmanoH.)Iiceused pursuant or the Cmdunu me,
Lk-.law.
❑IameaemptummaSee ,BBPCfmthisreuon
nu Dose
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following daclanuau:
❑(have and will maintain a Cerifiamof Commentmself.insureforwormssCompen-
sadon.u provided for by Sado.3700 of the Labor Code,far the performance of the
work for which this permit is issued
❑I have and will maintain Worker's Compensation Insurance,as outputted by Section
370)uf the labor Code,for the performance ofthe wort for which this Permit is issued.
My WorkMs 1Compeuuion Imutance amu and Poli%number tie:
rti
Caerl4�:11C L(y[ilP Policy N9.:_7;�—')—DUU3;j3-
CERTIFICATE OF EKEMMON FROM WORKERS
COMPENSATION INSURANCE
Mus session need act bacomplesed IHbe Permit is Imam,honewdoolbas(SI00)
or Ica)
1 wtifv Nat in the paformume of the work for which this permit is issued.l shall nm
empi%anypenon in any manner an u b become mbjmt to the Worker'Compenaauw
Laws of Cdifomia.Dam
Applicant
NOTICE TO APPLICANT:IL after making Nis Cer iriam of Eacmption,you should
become subject to the Worker's Corexas tion provisions of the Lapse Code,you most
.J Q forthwith comply with such provisions or this permit shall he dcemed rewired. -
Zpct coNsmuc ION LENDING AGENCY
[—m I hereby alarm that Nem is•coesmmtinn landing aIn%for the perfermmce of
a the woo for which this permit is issued(Sec,3(197,Civ,C-I
QLender's Name
cl,.7. z lender's Add.
U 0 1 artily that I have mad this application W sum that one shove infomadon is
un F Carmel.I agree In Comply with all city and county Ordinances and ream laws mlating On
OU Wilding construction,and hereby wNmim uprvenuldw,of Nu city on cams upon the
abowtmenuonedprpemy for inspection F 4 (We)agree to mat.indemnify and keep harmless the City of Cupertino agaiest
fI3 inconseque consequence
or th.,esu Lid eapenseawhich may in any way amrcagaiud said City
U 2 APLICA nee of D RSTAN of this permit. 2 C-I,J
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
SOU�gCE 0.EGUI.ATI0NS.
/�nivat �/lzC-n7tcc (2 �/ Zs Re-roofs
Sigwure of Applian✓Conuactor Dam /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Yic applianr orrutam Wilding accvpantmre mountain hanesdom mamrid
as defined by the Cu,mum,Municipal Code.Chapter 9.12,and the Health and Safety
tae.section 255324)? All roofs shall be inspected nor to an roofing material beim
❑Yes .H�, P P Y 8 g installed.
W311 thea applicant or future Wildi. ons. If a roof is installed without first obtaining an inspection,I agree to remove
PrP E Pant use es Air ut err devices which 8 P g
cDistrihaurdnus air conumiwu u defined by the Bay Ara Air Quality Management all new materials for inspection.
❑yo
I have read the huaNaus mamrialsrequiremenu underchaFmrti.95 Of the Califon.
nu HWthaSafmYCode,Sraiau 25505.25533,nd25534.1 wdcruand Natifdm building
does rot'...fly have.serve Out it u my respe nobility m notify the mcupmt of the
requi c hkhmuvbeca M..'mirmanccohCerufmama( _�P y Signature of Applicant Date
� �,�4�'e'_ a �� e6 All roof coverings to be Class'%¢"
Uunor or mthon>ed,gond Dam- or better