08020155 CITY OF CUPERTINO
BUILDINGDIVISION PERNUT xCONTRAGTQR,INF^URMATIO . .
BUILDING A DRESS: PERMITNO.
18972 FORGE DR TBD — TO BE DETERMINED 08020155
'R'S NAME: PERMIT ISSUE DATE
r'ORGE &. CUPE'RTINO LLC 07/25/2008
HONE: SANITARY NO. CONTROL NO.
ARCHITECTYFNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
U00 LICENSED CONfRAC1OR'S DECLARATION O O O
iu I hereby Nem that I m licensed under Provishr u of Chapter 9(commencing Job Description
uwiwSanionlIXXl)ofDivitlon3ofteBudnessaMProfusionsCode,Wmyl¢enxr R&R EXSTNG ELECT LIGHT TO COMML' BLDG
;i.. in full force And a�cs
p'/a Llunx lav Lle.
cF Dm GOn DELL 1)
eD q ARCHDDECL
ECTS ARATION
e a 1 uMcwnJ my piano shall he used u public records
56
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Z
O UfLDER DECLARATION
-A I hereby.Item tatt I mon am trumps Wm Ne DOnaxxrs License taw f«the
O O following tures&.(Suction 103 cont, Business And see,deaons Coda:Any tiny ale county
$�a which iuu u•Permit ho ui=me tltes tropane,demWLN,«repair any s mmmu .
iy Priormitsissuadpmamquirupmvisilicoff Cnn=winmfleasignedsummenn
ss< Ihatva ncinnsedpurx•nt7")dvisim3te Conuacmrs nue fe o(Ca )or Sq.F[. Floor Area Valuation
f5
(cat mendng wit Satima and the
f r to al a alleged
conamp Profeviou Ction of $7833
Nu io ts campy therefrom red to bur it Ne•Verged exception Any l penalty
of
Satan 7031.3 by arty Applicsnt r«.Permit reek.,the applicant m a a.n peri,lyr ale umberOccupancy
n«matuwanfiwhmdreddollus(gSBo).
31609030 Number 71�Pe
01.uownmoftopmperty,mmymplayccswithwageudcexlceompe m.
will dote wart and to strumae Is not intended at offered f«•ale(Sec.1014.Business
and Professions Cade:The Contractors License Law does not apply m an owner of Required Inspections
property who builds«improves ttejeon,and who docssuch work himself ale trough hr
awompioym,pmNded tat such improvements m not intended«offered f«ale.IL
however,we building arimprovement is cold within one year of cmpletim,to owner-
buildu will haw dte burdm of proving that he did not build«improve far pwpax of
ale.).
. ❑1.as owner of the property,m exclusively contrasting wit Uc n d eamersa on b
c«auuct the project(Sec.70N.Business aed proressiau code:)The Cmtrxmrs u-
aue Law docs not apply on an owner of property who build;or improves tenon,and,
who contracts for tech projects wit a conaacmr(s)licensed pursuant in to Consommes
License law.
Ice exrmptunder Sec. ,BAPCfmdubreaxn
Date
WORKER'S COMPENSATION DECLARATION
I hereby afftrm under penalty of perjury one of to following declaruione
❑I have aM will..feat.a Cenifiutem'Consent to self-ium f«Workers Compen-
sation.as provided for by section 7100 of we Labor Code,for to performance of the
work for which this permit is Issued.
❑1 have had will maintain Workers Compensation Insurance,as memo d by Suction
11000f to Lamar Code,f«we performance of to wort far which thin permit is blued.
My Workers Cmpensatiw ns«a&x coni«and Policy number
Carrier. Polity No.;1aL
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mWanedom needIlan be c«npktera lift permit is f«ouc hundred douana(SI00)
or nus)
I ce tify tat in we parforma«e of we work f«which ver Permit is issued.I shall net
empl%anypcmn in uY manarce as In meant subject to Ih Warkcn'Comperu•dsn
Laws of California.Date
AppOunn
NOTICE TO APPLICANT:If,after mrting tin Certificate of Exemption,you should
baome subject in to Workers Compensation provisions a the Labor Codn you mutt
.J,z fm hwiw comply wiw such provi icas«tin permit shall he darned rooked.
Z O CONSTRUCTION LENDING AGENCY
f< lbeauty-from than tererAconswcdon homm2moacy far we Pe,formanmm'
C the woe far which ver permit Is issued(Sue.3091,Civ.C)
GQ Lender.Name .
z Le imsAddm..
U O 1 catifY Nan 1 have reed tis r,licaumn and lute war to Above rf.ohm,is
ty^. artccL 1 agree m comply with all City std county artmener ad Same laws ml•ting m
O rV^ building construction,and hereby southern representatives aftr city to enter upan to
above-seems ed property for irupectut purpnes
F 4 (We)Agra in save.indemnify and keep h•nalea we City of Cu«rtm against
(• ) IImAlhicid dgumma.costsizvpnucs which may In any way a cmc Apirm said Cit _
U z in consequence after grmyr('(this permit.
ti A ANTU ERS]A S A WILL COMPLY WITH ALL NON-POINT IsSUed by: Date 7'
OUR R TIOONN
Re-roofs
si or pylic.nUCOHAZARaDOUSMATERIALS DISCLOSURE Date
of Roof -
Will the applicant or future building occupant mom m handle haardou maraud
ted by to Cupertino Municipal Cade.Chapter 9.11 and do Hca th and Safety
0.255324)? ux-z All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or future Wilding Sate ant axe ni If a roof is installed without first obtainingan inspection,I agree to remove
PP g e component Qu or Mich
home
air conlminanu u d/e0ned by the Bay Area Air Quality Management all new materials for inspection.
❑Yu Rl N6
I haw mad to harandeumamiain requirco m s under Chapter 6.95 oft c C•lifor-
niaHcullhhSafetYCode. 2550),25533 mul25534.1 undermud dual if to Wilding
does urmntly haw A l wan Itis my re.pmmbilinY m netifY de�upans of do
req me w le ch me 'oftomm um.fa Ccrtliesse cuPa
Signature of Applicant Date
ower or 1hmd.ge n Data All roof coverings to be Class'Af v or better