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02070116 CITY OF CUPERTINO -- ' BUILDING DIVISION PERMITCONTRACTOR-INFORMATION: ' BUILDING ADDRESS: PERMIT N 10781 GASCOIGNE KNOLL SYSTEM CORP `02070116 Owg� I NAKHIMOUSKY 5375 CLAYTON RD APPLICATIGNgItf§Y2OO2 NONE: (925) 787-5626 SANITARY NO, CONTROL NO. E o ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 6.2 2 LICENSED CONTRACTOR'S DECLARATION Job Description z:qqq 1 hereby.M m that 1 am licensed under provisions of Chapter 9(commencing ADD A/C (3 TON) w 1_ixis in Section 0000)of Divisive J o(Ihe Business and Pmfessi ns Code.end my liccnu 4 is in tali forces eRe 1. ec x< Linnu Cl s Lic.trContr_ O Y I u. Oam �� SDEC ti - ARCHITECT'S DECLARATION 0 g I undemmnd my plans shall be used¢s puhlie«cords 001 Licensed Professional 6OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the $2000 C?< following reason.(Section 70313.Business aid Profession Code:Any cityar county E F G which requires a permit to construct alter,improve,demolish.or repair any structure 3� _pnwl as issuance,elso«q the ar,plicam forsuch pennnmfilea signed statement- thai n'.sIcimcd pdisuen,Idiot,po l ios of Ne Contractors License Law chapter!) 3 B'(],BIB&AYOI (commencing with Secain'1000)ofD ion 3 arm Business and Professions Code) �'',plv^s I' t,: S. �_ . .Y..a i'.+P {.I, Valuation or mal he is exemptthertfmm and the basis for the tiNt rd exemption,Any violation ' ' -of Section'9031'S by any applicant for o permit subjects the applicant to^civil Penalty OCCllpancy I�rpC rot not more m.n Bat Hera«d amlars(gsoot 3 0 CPN ; r;�,l;' est C1 I.as owner of the limitary.-1 my employees with wages as their sole mmpensation, 303 - ROUGH MECHANICAL will di'woik:lad the a,met.R-is-not imcided'or"offered-for sole'(Sec:0044, _ , f° ow .r,.- Business and Pro(esxions Cedc:The Contractor's License Lew does not apply to an 5 01 - F I NAL I�ISERGY ncro(propery,Who builds or improves thereon,and who does such work himself al Ihrou n his own employees.provided that such improvements are not intended or -ofereC __.__. .--- .... ;, o7ule:IL�owever.lnenuildingorin;pmvememia+mtlwdnmaneyearar __. .. 502_-_- FINA.L...PLUMBING-'"ENERGY'--- --- --- completion,the ownenbuilder will have the burden of proving that he did not build or t� rq•.',"401.�u improve ter pnryote af+ate.). 503 - FINAL MECHANICAL ENERGY . ------505 ------F-INAL- _ c ❑Laawnerofthe Property,am Business ad Prof..gwimlie)no art....o -- -,t--�_,.,li,-.1-i------_._.__ mnawntheaw project(Sec.T044.Business and Professions Code)no Comhereon 507 - FINAL PLUMBING z License lawdosenot foapply I^ouowner thprogenywho buildsor simprovesthereon, i 5. -and who.commcts fw.such.projec¢.with.a.mntraclor(s)IicensW.punuant.Io she _._.,___..._S.O B...,...FINAL_.MECIiANI L a CAL_._.__-....:._..__...5e'e. Commctor sLicensela ❑tem exempla c � �;8&PCfonhts mason �,('ti (,k:',•,Nrl,- t Ovine Ci R Die .A FINALeo 'll WORKER S COMPENSATION DECLARATION '1 hereby effinn underpenalty of perjury one of the Following declinations;-' d ❑ 1 heve'tInd'will meinuin e'6ABbaie of Consent to uIfinsure far Worker's AUG 0 7 2002 Comparmumi:u;Provided (arby Section 3700 of thc-labor Code. for the pe (his permit is issued. rfo n f Ne work f h h h end will tndlma Workers Co(nNotatio 1 sumnce as egoired by section BUILDING ,mer y FICA- OF EXEMPTION FROM work hi h this permLL is Policyom berare s00 of the Labor Code f r the performance of ha' o ed M Workers Codpens ion l sure ce carter and' u (� G E Aran N �a933 v'�I t CERT( cY WORKERS 1 ( s l ~t �ll; t l't . -ss COMPENSATION, INSURANCE- 1. »vr,,-:. __._._. _.._._ _...-__'._- _ _ __,;.----------- ; ___ - .- __-_,_.,..- ._-,_ . .. — --._.. - -_s.�. 'rt�I s (TTu se;Ion need not h tom IeieA if the -, _-' -_.. p permit is for ane hundred dollars f, i\:. L.':.1 I:": `•• (. •.I L, ;tiil'! rc1C (SI00)mhon.).1 .i ..._.... ...i:_n - i .,..�.,--:.. .,'•o.. c . work W:..oir r .,.� ....... certify(not in thephamcebf me o k(r which th s permit ii named.I ;lm l sem to en, crIbame s bJeo Com nmu , Cedomia.Dain -- , .,.._.-._- - ppinant' 'NOTICE TOANT If. this Cast ion,you -- - ). emin z bcoothe WorkepCompensation Per monst.f you Forthwith comply un s eh provisions or this Permit shell he deemed ranked. 'I CONSTRUCDONLENDING AGENCY " "' a 1 F f 4 hertb which this the l e c n t n o Ind' enc for the a formance` ,^ a '' Y . . g 6 Y P tl" t"f A r fate woione"r'which this Permit issued C. ) ,r ;_.- s..._. Addtt Z Lcnd r it. -'. , . . ... sti 1::xr';"11' 1. V15 c I emfy mat I he a reed this appliceoon andu+m Nat the about mformm an n ' 9w.. iormna,egme Io comply with ellmy and county ordinances and stem I..relating Oc�7 to building constrdetian,and herebynuthodze rcpmient+0ves of this city to enter upon r W the eb mentioned,property for inspection purpose y,-lyt mdemmpesesk which tanywa ofc al ie"stsaid LU Fq liabilities,judgments,seq costs and expenses wh ch may m anyway w y cane age nst said U Cryy n co sequence or the grenudg of this pe a H; AppL7CANT UNDERSTRND -LL COMP KITH ALLN POs`JT souacE REGuunGNs 7 Issued by: Date t SignemR of ApplicoptrContn tort ' > Dae Re-roofs t e�H oaY3sy {�I«�N^ attupm�S913anddihe�'alth°:�a same Y ''�TYPe of Roof'.;,: .k-! _ ... All.roofs.shall.be inspected.prior_to.any,roofing material being.installed........ ....._._ ry 1;n WII the applicnm o tutu a budding gi'cupant use equip t ,geneg1 wgWb If a roof is installedg P without first obtaining an'ins ection's'I'ag i'ee'to'iemove ri all new mate emit haiutlws ser contammenti ss defined by the Hay Area Air Qaaluy MelieQemenl - ' Dteldat+ , als for ins ection. Applicant understands and will comply with �Ycs P �" , ,all non-point souice iegulado`ns.,,, .r•r.' :t ,r"rlf' 1 h mreeA'Ihe hazNdous materials rcqu rcmmts.urAer Chapier h 93'of the C+lifomu Halm'&Beteg Code.Sections 3]305,33533 end 3SSJa Punden.ad that f the bulltl ng does ria rte dy h ve i-ilenl theist i my .p nstb lay ton u(y the - " . - - .. ..I "' -- oepup m of th rcqu icm Hist h ch m r m i p or to I seance of a critic to of / Occup oy sus' t_ ) 7�9�•L Signature of Applicant Date o ne Mr-, e,sent "Oln - aD Ie All roof coverings to be Class "B 'or better ' - --OFFICE-'-_. e