00060098 CITY DIVISION
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: Y` PERMITNO.
OWNER'S NAME: APPLICATION SUB DAI'I..
1.8922• FORGE DR 00060098
PHONE: - SANITARY NO. CONTROL NO.
RATIONAL. SOFTWARE 06/15/2000
nQ p ARCHITECTIENGINEER: 'BUILDING PERMIT INIU
K U C BLDG ELECT PLUME MUCH
all F<� IJ 1� 1=1 CI
LICENSED CON TRACT ORN DECLARATION
o i I n b) trfirm Int 1 licensed �ern, a v s orcnapmr 9 mm
ama Job Description
9ng � P .
a,I— alit 5gg ' 7(ql fD' - 3 flheBn II f'ri C de/��a�nd��J7p}%�yl nn.�
W 3µF Dat�V is n till to o r of kCHITECT'S IIF.CL RIS— + " '
ON
at
of landerseradntlideas shall h used a,publicmrordr TEMP PERM EXP 7/.15/00
o,
i5 p O Licensed Priar"Jond
Pm OWNER-BUILDER DECLARATION
=w - 1 hereby affirm that 1 am exempt from ole Cnnlm rd's License Law for the _
following reason.(Sermon 7031.5.Basin...slid Poor...Pns Cada;Any city ar cnumy,
f`O which requires a permit nr construct,alter,Improve,demolish,or repair any sbaehra '
'diI,if,I.. or.IIs..re"yor,th,tur,li,and fo,m,h p nn f f fileadi,al mrtour t _
man he is Focused po t, the maoindwee,.1l Carand,me,License L (Ch nter9S Ft. Floor Area - Valuation
-(commencing with Sect ]0041) f Division 3 of the Business and Profession,Code) q' ,..
or that he is exempt Inerefrom wad the basis b the alleged eamnption.Any violationof -
'0lemion703. vehudreddnlfnrspennitsud)ecsliteapplicam,oucivilp'nulty APNNumber Occupancy Type al-not more than five hundmA dollars($SIX).. ,
❑%dolvade,orlsoprop'rty or my Or with wagesas thi ome,madmia. '
will do the k and the structure is and intended or filleted for sale(Sec.7044.
B Its ad Prefic,sime,Cade The Central License Law deal apoly m,is + Required Inspections
owner of pa openy Who milds or improves thereon,and who does inch work himself '
or through his mama employeesprou;ded that such improvements are not intended or 31.609030. 00 .
offered for sale.If,howevan the building or improvement is sold within one year of
Lcompletion,the owner-builder will have the harden of proving that he did not build or
nprov'forpaPPI afswla')' _ 304 — ROUGH- ELECTRICRL '
❑1,as owner of the property,ani exclusively conducting with licensed earn...Io..In
uI I the project(S 7044 Business d Proccumns Code:)The Customer's
-
License Law does not applyI an turnerofproperty whobuill -droprovesme n '
and who contractsfar such prefaced,with a commuldr(s)licensed pursuant ill the
Contractors
carr L' Law. _ I
CCxempfunderSc ,B San PCfar me,
Owner Pete
WORKER'S COMPENSATION DECLARATION
I hereby etlitm under penalty of perjuh,ane of the following occlwmtlo rv: _
❑ 1 hon and will mainoin.Cenificmc or Cotuent to delf-inwre for Warle,'x
Compensation, as provided for by Section 3700 of the Lmhar Cada, for the r -
,d rformance of the work for wh'mh Iiia permit is issued
❑1 have and will nwintain Worker's Compensation Insurance,as required by Section '
370B of the Lobar Code,for the pedbnnanee of the work for which this permit is -
ixs Myy,�W�ork�e,rs Comp' mal Insurance sor�ri�e�r yofd�Polley nun her ore: I `
mif_r\l yNaWIV Q47(018 =0Z
CERTIPICATIO DEC EMPTION PROM WOkKERS'
COMPENSATION INSURANCE
(This section nail nal be completed if pts permit is far one hundred dollurx - -
(5100),),bo.) '
I certify that in the performance of the work for Is this permit is issued,I
shall door employ any person in any Indoor,so arm hoc series,or the Workers' - + ..
Compensation Laws of Celifomla.Data
Applicant
NOTICE TO APPLICANT If,after making this Celibate,of Hstran on•you should _
hecumc xmanad,o the Workers Compensation provisla k ei the Label Code,you must
fonhwllh comply with such provisions o,this permit xhidl he deemed revnkcd.
z
H 4 - CONSTRUCTION them is.IONLENDING AGENCY
Thereby which this Pu v cannmalo. 097,Ciy.C.) for performance
W Lecher's N farme which this Palmerc,mie i,sucd(See.3119],Civ.CJ -
0
6s Lender's Name
� .Z Lenders Address
� C Icedry that Ir res did,,) licutin a I hatrundolfin,a boost immotedindis
F. correct 1 agree to mand,with oil city and count,kodualry,,and stran It.,reldon, _
[)
Ili building construction.r III family infludio,repsysentatisa,afthis cityI 'thermion
r� Theaalmovicallemildred Property far p Iio p
a (W)agreet d nnfY andk p lardlelllheCtY ofCupertino darnall
= /� �.�.�/
n7. lidhil n pollinators,c t d p s which yin any way magainst slid �../\�
V dIn g a g Ilhisp t I#t/J•i11/l•Cl` ll J I\..JY\..�
�CUGERSTANDS AND WILL COMPLY WITHALL ONPOI
NS. Issued by:cunticoalrunor IInI Is, roofsHAZARDOUS MATERIALS DISCLOSURE '
. .
Will the applied.,.1 mture budding occupant std'or handle homadaux mdm;td Type of Roof
as defined by the Cnpeeino Municipal Code,Chapter 9.12,and file Health and Safety '
Cale,Section 25532(,)" ,
°Y" 0 N All roofs shall be inspected prior to any roofing material being installed. _
Will meappuwut or future building occupant use equipment ordevices'which If a roof is installed without first obtainingan inspection, I agree to remove -
emithazardouscel,cfin
ontumimres as deed by the&ry Area Air Quality Management Pecon,
Diddet' all new materials for inspection. Applicant understands and will comply with
0Y`, ON. - '• _ all non-point source reglations, pP _ P y -
I have road the hammour msocaids regoremcntx Imdur Chapter fi 95 of the ,
California Health&Safety Code,Stations 25505,25533 and 25534.1 and named that - -
ifthehu dncv not currondy buveutenvon.@ut it is my respomsihilifyt no,ify the
cepa t of t requircae whidt mus,ed set odor to rio tee of a nificute oh
Or Ipa y.
�,• - -Signature of Applicant Date _
xmdumodmdagenl Date + All roof coverings to be Class "B"or better