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00060119 CITY OF CUPERTINOPERMIT NO. BUILDING DIVIstON PERMIT CONTRACTOR INFORMATION: B.DInLDING ADDRESH: /9 D p - 9 �se.�s- /1, / •/t, C � L.gw rylTAil(_J�-v-I_—�,v-r7 SANITARY N000dOpLICIT10N.5UBMITTAL DATE ., o M a s� Q r,. it./1`' �T�I`k�l.. J 1�F..<�.7��/� Fran 1J LD �) I_A AY 06//111L95PL%,66 wont.: U �- ma- o tCHITECf/F;NCINr:ERIIIJ ��� S�)9tS7 �9Z LDfNO PERMITINF �(DO Ute az Mau F i LICENSED CONTRACTORS DECLARATION Z O,'�— 1 heaby affirm that 1 am licensee under provisions of Chapter 9 commencin o--v pt ( e Job Description F:Cw withllto grad. ec Division3of theBusimss std Rummies Cade.and my Gave is �� yg�p f� �f p�pyE Licanfmce seal eReet. a erl-1/VL .s�a.a t�',.,g.,�.k /Imy • ///- _ �s• f� / , e'7 3 N Duemn,e Cl. Cuo nor 347 •� ��}'�t ".d(_J/A Q�D/ If+L(`/IseA•'F•s/i9'1�P�AC/ L_ys/q"°/sl'/•g")s„ij ntend ARCHITECTS DECLARATION /es c�)OQ coup, 1 undemy plans shbe used u records public eds v kw i�O lacmsed Rofeumovl OWNER-BUB,DER DECLARATION ' C?< I lumby,eMm that I am exempt from Ne ContracmM1 License law for me e E O following maser.(Section 7031.5.Business and Profmiov Code:My city a county u 3 which requtre,a permit to construct,alseg improve,demolish,or repair any structure S F[. Floor Area prim to its issuance.also requimz the applicant for such permit to Elea signedmsetmnt ©D q•, I YaIU [toned that he is licenxd putauat to the provisions of the Contractors License Lew(Chipset 9 CU (mmmencing with Semion 70DO)of Divisim 3 of the Businus mrd Profusions Code)m that he is exempt theterrom end the basis for the alleged exemption.Any violation ofis Dumber ccup ncy YPe Section 7031.5 by any applicant for a permit subjects the appli.nt to a civil penalty of d .. not mus mo Eve hundred dollen(3500). 0 Lasownerofthe prosany,ormyemploy"s with Wargo meirsolc compewdms, - "s InspeCt10DS will domewok.cd" x,Cohn.License Law dofa cede(Sec.]0x4.Budin. and Prty who Cnde:The oyes tacmr'a Lndria Law den nm apply to if ower W 305 — FRAME property who builds primped thereon,end who does such intk tided.o ereal is Own employees.n,ptovidnd mat sono improves sold w art ria year N o plfeRe for olearAgdIwevicellhave building of rment I.itons he istaomymo( prove for pue- 307. — INSULATION ptea u ande).der will have the burden of proving mit see eitl not build or improve for pa- posenfan). 601 — ROOF TEAR OFF • 01,.owner of the property.arcxcluslvely contracting with licented cmtncton to 602 — ROOF -PLYWOOD NAIL construct the project(Sec.]Mde: 4,Butures,and professions Co )The Consensus's U. cemn law dues not apply to an owar of pmpnty who Wilda or impmvo tnetean.w 603 — ROOF BATTENS who contracts fa such pmjmm with a centtacmr(p licensed pursuant m the Contracturs Li"nselaw. 604 — ROOF IN—PROGRESS 0 l am cxemm underSec. 3 6:P C fa this mason Owner Dem WORKER'S COMPENSATION DECLARAIDON I heteby edfor under penalty of pe jury one or me following erformtiore: 13100.(the tion,o provided for mi Salon 3]00 of the lab,r Cade,fa me petformence of dmork fa which ills permit is issued. 1 have W will mainuin Wooer's Compen.tlon Ivraae,u rtquved by Section labor Code,fa me perform."ofdrc week fa wltich riapumitisiawnd. y W.&Z5h Cotgpc.tion Insurance cam"end Poliy num ramcr:Ls�= / M seta policy Na: CERTII FICAIE OF EXEMPION FROM WORKERS' COMPENSATION INSURANCE - (Thi,satinnrealms he mmPletM Ifthe Permit in foronehurdeed dolleta HIM) w It..) I catty that in the performance of the work for which this permit is Issued,I shall ria employ any p ount I.any most so o m became subject.the Woranti Compan- Wmn laws of Cdiromia.Date Applicant NOTICE TO APPLICANT:If,aft"nuking this Cenificate of Exemption,you should ,agmae gubjen to the Worse,Compensation povidone of the Labor Code,you man foMwim comply with such provisions or this permit gull Ise deemed revoked CONSIRUCITON LENDING AGENCY Q 0 I hereby uffirm that mere is a construction loadingagency fame perfontw¢e of z ry me work for which ria permit is issued(Sea,3097,Ci,C.) F. 4 Londe/s Name �i Lenders Addrc,x . LI certify toes I have read thus,application and ata s that me above information is z correct.I agree to comply with all city W county mdoun"s stations,laws relaid m building construction.and hereby authorise reprc,cnmtives of this city to enter upon the V: above-mbntioned promny for itnpec0on pueposm, (We)agree so sn".indemnify and kap hatmlm the City of Cupertino armed V luhilitin,judgmers.cmts and rxpense which may in any wey acc.s.,mst said City " �t W Inc onsegaae of me,renting of this permit r ILI APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT V Z SOURCE REGULATIONS. �I ." 1A/1 X Q-Q 1 @.YYvJ Ci Sir...ofApplicaMCWmwmr Data HAZARDOUS MATERIALS DISCLOSURE Will than applicant«future building acupent some a handle hasWout material Re-roofs v defined by the Cupertino Municipal Craig,Chapter 9.11,and the Health and Safety Coda.Section 25532d' Type of Roof El Yet [3 No Will the eDPlicantor future building occupant use equipment or devices which All roofs shall be inspected prior to any roofing material being mlNctha, aGcontaminantsodefinedbyde,BayArcaAn Quality Management installed. If a roof is installed without first obtaining an inspection ❑Yrs ❑Nn I agree to remove all new materials for inspection. Applicant I have rad the hazardous tm,"id, per 6.45 of the Cel.. understands-and will comply with all non point source regulations. co n 533 and 2353Gha P Y P g fade Helm&Safety lly S snvau 1.do,i 25511 end 25534.1 tmhntend that if the building ao"rwtcarrtich neve.mnentmuh is my Crritrmnairrmeacupmt of the rtyuiremenm Which must be nen pdono isaueae of a Ccnificom of t]"upeay. , Owmroreuthonacd agent Dart Signature of Applicant Date All roof coverings to be Class"B"or better OFFICE