00080127 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AUIIRISS: • PERMITNO.
- RB Groll
'OWNER'SNA FESTIVAL — — APPLTCATIO U — ,
PHONE: UKEEN HUbLN _ 00 AIRPORT - SANITARY6 C O.
n ce O ARCHITECT/ENGINEER . —3 - BUILDING PERNIF INFO
a C •I {HIDO HLECIPLUMB MECH
,z da L=1' LJ LJ LJ
LICENSED CONTRACTORS DECLARATION
Z 5 N'' I n n Coon don I a,r d 1 - ' Job Description '
OZ_G v n fh ro 9( tib p t7.do wlh5 1 Earn and
feet. t3nf the Hu tlInamorata,CWc,and myfire nxc
ge 6is in
Licansel Class and effete. Lie.W " r
Dam Contractor WATER HEATER
W a a N ARCHITECT'S DECLARATION
O a I understand my plans shall be used as public mord, ,
ord
a 6 p 0 Licensed Poric,sienal t
OWNER-BUILDP.R DECLARATION
w 'n 1 hereby allinn that 1 am exempt&on,the Contractor's License Law for the
F Z 4 follnwing renron.(Section 70.31.5,Baslnms and Professions Code:Any city or county -
4 2 C which requires a permit to consumer,ulcer Improve,demolish,or repair any structure
3m priormits issuance,also rectifies 0mapplieaut mrsuch permit to Bob,o signed statement
that he is licensed purtampt to the pmvi.slonsofthe Contractors License Law(Chap,,,9 S Ft. FloorArea Valuation
(commencing call,Section 7000)of Division 3 of ore Business and Pmrcxsions Cost q'
'a thin tie is sceptic Damon.and the basis for the alleged exemption.--Any viomden
of Section 7031.5 by any applicum for a femme.subjects We applicant to a civilpenulty
of cal more than fi.<htadied dollar,(S500).. - - APN Number - Occup, e
1111,as ox oornf the progen,army nntployms with wages ax,hair vwc compensation,
will do th,work,onad the oduratim is net Intended ff d for sal (See.7040 1
Bu n: d1 F Cad Th C t t L L of 1plyto as ''� " Ulred Inspections
utwnpte I p 1 ty Who boards
' p :ch W h dh k himself
throughb': a py pen p.....mentr are notinteor
offered f til f a ngor p t' ole within yearof
nnplvno,thenon, lderxuf have the humor prtving that e amhailtlor
502 — FINAL PLUMBING _ENERGY
„vv e,rp„rpoamf,aan) 506 — GAS TEST
,
°I,as owner.retemo,co ,amexcluxmelyeemmedngwithlicensed contractors to 507 — FINAL P'LUMB'ING
construct the project(Sec.7044,Business and Professions CcdE:)'H,c Cut v '
License Law does not apply to an owner of property who build,of improves Ihcraon,
and who m,mracly for such-projects with a eormortor(s)licensed pursuma m the
Common s License Law,
°I rim eceanpc under Sec. B&P C fur this reason -
Own Dare - -
WORKER'S COMPENSATION DECLARATION - -
1 hereby affirm tinder penalty oC perjury one or the following declamtinne
71has, iJ oill maintain a Cif- ttif3Carver, IfWoks
a n i provided l by Section 9700 tf ' f the Labor Code, f the
peu d r(he cookI 1 1 ih'o procil d '
❑I h 'll d W k 'C p i 1 n a. rc4 . n
I by Se i
El f theI h code 1 he pprA f the k far which this prropiris
isiancLMyW rcar p .too lbounine,romerandPolicy arriale,.a. -
C,inner. Policy Na.: • _
CERTIFICA'T'ION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - -
(This saloon need not be completed if the permit is for one hundred dollar -
($100)or lcw) -
I certlly Ihul in the porlbrm,nce of the work for which this penmtsis rosined,I
shall rine employ any person In any manner so as to become subject to the Workers - -
Compensation Laws of Culifomin.Date
Applicant
NOUCE TO APPLICAN'G IC,uliesnaking thiv Cenifichm of Cxempllnn.you should
become tubjed m the Worker'v Compensation provisions of the Labor Cade,you must
Q O fonbwieh comply with such previsions or this permit shall be deemed revoked.
F ^ CONST RUCTION LENDING AGENCY
a T InAby affirm that there is a remwction lending agency for the performance _
of the work for which this permit Is issued(Seo,3097,Civ.C.)
Q Lender's Name
z Lender's Address -
UfOrr OF 1td0.applicationand h information
correct 1 agreetoco ply with tl county ordinancesand: t tang
Ctsebuilding consurportion and by rdhrize representatives of this city to t op ,
W the those-ifectioned property
tin
-
p Y POP fi6:46A+x
14 S )'y e d 'pJkeepk i thesly c peragainstkW ��� LO-0
V z yl tw, f lng Impairs, tand,expenses
which may
In any accrue ae ago tit said
ChPenn,,.
g i of perm,.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. _ Issued by: Date
Signature of Applicum/Concmmor Date Re-roofs "
HAZARDOUS MA'I'ERTALS DISCLOSURE I
Will the applicant or future building oecupane store or handle hazunloas mmerial 'type of Roof • '
r,defined by the Cnpanlm,Municiryd Code,Choose er9.12,and the Health and Safety
Coda.Section 25572(,)7
El Yet, - 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or mturc For ng occupant use equipment or devices which If a roof is installed without first obtaining an inspection; I agree to remove
-,nil kazoo centres hones os defined by the Bay Area Air Qual icy Management P g
intricU - all new materials for inspection. Applicant understands and will comply with
°Yc` Cl No all non-point source regulations.
1 have read ate halmolous mnterialc repmbr mint ander Chapter 695 of the '
California Health&Safety Code.Sections 2r5505,25539..to 25534.1 ,aderunnd diet
if the building does not currently have a cement,that it is my responsibility to notify the
occupant of the requirements which must be mel prior to issaance of o Controverter of
omtipancy. Signature of Applicant _ Date
Owner in ithmizeda,,at - Dale All roof coverings to be Class feB" or better