05060070 CITY OF CUPERTINO r� -raw „ezd r--
BUILDING DIVISION PERMIT .,CONTRACTMANFORMATION.`1
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BUILDING ADDRESS: TEMACA ENTERPRISES P""`N005060070
10536 N FOOTHILL BLVD # A
OWNERS NAME: PERMIT MUE DATE
THE HALLMARK GROUP 7135 GEORGE AVE 06Z'10/2005
E: SANITARY NO. CONTROL NO.
(510) 714-7727
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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�Co LICENSED CONTRACTOR'S DECLARATION
with SeJob Description
E 1 hereby affrm n NI am licensed under provisions of Chapter 9(commencing
Section 7")of Division 3 of the Business Professions Code,and my license is
o' infull force amdc a o J / REVISION--WOOD TRELLIS
>q 2 Liccnsc Clan �( , Lt..Y ��L`b
Dmeort f,n(aQ_ � ��soecuRAro �a — NO NEW PERMIT ISSUED/ORIG. #05020135
�i i I understand my plans shall be used u public records
JyU
o Licensed Profusional
3 OWNER-BUILDER DECLARATION
<I I hereby affirm Not I am exempt form ilm Contractors License law for the V
02 rollowing reason.(Section 7031.5,Business and Professions Code:Any city m county
5$ which.,.it.a permit m cmourt t,alter,improve,dcmoloi or repair any structure
prior m its issuance.also teu
qircs the applicant for such permit to file a signed statement
i< that heia0eensedpmaon,I. cporvisionsofds.CommcmrsLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation $0
Is n (commencing with Section 7")of Division 3 of one Business and Professions Core)or
i $ that he is exempt therefrom and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
act m..Nan five hundred dollars($500). 32613069 . 00 P y YP
. ❑Lu ,work.they mien is
cmployded orNvngesur affured for ale(Se. 04,1,8 utipn,
will dothcwons Code:
The Cumisnoti Livenstended Lawd=notl apply 7U a0,OwnerLof RequiredI
and Profusions Codr:The m ttncmri License taw dos not apply m an owner of
Own enyw,meaho ,pdaorimprovulhimprovand who doessuch us
mself.r through his a.
own ver,th ccs,p building
or i ponmatsuch rat is improvements not ear o cd moffempIcti nd for come
L c
however,the Cntiebrien ofementishat le,id one you of completion,Ne owrcr.
Wilder will hoax the burden of proving Nu he did mil build or improve for puryose of
sale.). `-
❑1,u owner of the propeny,am exclusively contracting with licensed contractors to
constntet the project(gee.7004,Business and Profession;Cade:)The Contractors U.
cense law dos not apply to an owner of propenysvha builds or improve ft...and.
who contracts for such projects with a canlnctor(s)licensed pursuant in the Contractors
License law,
❑l ons exempt under See. ,B&PC for this mason
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby aRmn under Penalty of perjury on of the following declarations:
I have and will maimain a Certificate of Consent o self-inure for Worker's Compen-
sation,u provided for by Section 3700 of die labor Code,for the porromuna of ft
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for the pesorronec of the work for which this Permit is issued.
My Workers Compensation Insurance prier and Policy number art:
Cartier. Policy No.: _
CERTIFICATE OF FM MON FROM WORKERS'
COMPENSATION INSURANCE
(thin section need not WcompleRd irthe Permit is foronc hundred dollars(SIpB
or less.)
1 cemry that in the performance mf the work for which this Permit is issued,l shall rad
employ any person in any manner so u to become Subject o NC Workers Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Worker's Com wnamiom provisions of dm labra Cade,you muv
.,O foMwi N comply with such provisions or this permit hall be deemedevoked.
Z ^' CONSTRUCTION LENDING AGENCY
'r~+4 I hereby affrtm that dtem is a construction lending agency for ft Performance of
C'7 the work for which this permit is issued(Sec.3097,Civ.C.)
LQ A lenders Name
z Lendcri Addicas
U C) 1 certify that I have read this application and smic that the above information is
ey P correct.I agree to comply with all city and county ordinances and some laws tainting to
0 V Wilding construction,and hereby authorize representatives of this city to color upon Ne
above mentioned property for inspection purposes.
FQ. (We)ai to save,indemnify and keep harmless Ne City of Cupertino against
,r, liabilities,judgments,costs and expenses which may in any way meeptc against said City
V z inconsequence of the granting of this Permit.
A NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S�ULAT19y$/
ginmmeofA croormccooerC W Date Re-roofs
is
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(.tort building occupant atort m hale hanrdous material
as dcMed by tM Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
,doliCod,Section 2553$x)? All roofs shall be inspected prior to an roofing material beim
❑Yea P P Y 8 g installed.
Will Ne applicant or future Wilding occupant use equipment Ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
.it hazardous air contaminants as dcfrcd by dm Bay Arta Air Quality Management all new materials for Inspection.
Do
`
Yes y u
1 have mad the hmardons materials requiremcns under Chap cr 6.95of thc Calier.
riaHealth&Safety Code.Seciisu15505.15533 arv1Z534.1undersund Nm if Nc Wilding
currently has. ¢nand that it is my rupomihib y m notify Nc eccomm or Ne
awh I or toionomicemfamofOccup Signature of Applicant Date
Owner m...norI, :gent aro All roof coverings to be Class"B"or better