03020047 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACnTjOR INFORMATION ,
BUILDING ADDRESS: ACME & SONS SANITATION/EL (!TWTING
?1r-72 GRANADA A.17 A
OWNER'S NAME: 3408 HILLCAP AVE APPLICATIO A
Adk MICHAEL S14TM n? /1 1120(11
NE: (408) 295-2263 SANITARY NO, CONTROL NO.
AR CHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT— PLUMB MECH
AAO LICENSED CONTRACTOR'S DECLARATION O O O
w❑ 1 herchy nm Net 1 em licensed under provisions or Chapter 9(commencing Job Description
<W with Section )of Divimion)af theBnsiness end Professions Code.and mylicca¢is
in in
fire and r t. IOU ' TEMP POWER (TOILET) FINALS93
Lice las; Conlr
Canlr EC
— ARCHITECTS DECLAR ON
n< I undersand my plana shall W used as Public records F E B 1 8 2003
V
301 LicenxdPmfcssimnal
S OWNER-BUILDER DECLARATION
Comment's
.�<Y 1 naso affirm on 1 am exempt s an the Conlns Co License Law for the BUILDING
2O following ores a(Section]031$Rosiness and Professions Calc:Any tiny orimunly
i�$ which requires a Permit re construct,alar.improve.demolish, file
repair any someone
prioraits issuance.also requires the of for such FCrtni'mfilessigned Chaps em
that me cing wit pmction7 the provisions of the Cumnaur'a LiwnxLaw(Choder9 Sq. F[. Floor Area -1Hafjon
C G
(commencing with Section 700o)of Division 3 o the Rosiness and Prufcvians Code)or VTJ
e, Nat he u exempt therefrom and the basis for the alleged ascription.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of 3 net BTaT Ai®�Lr,f 0 0 Occupancy Type
not more than five hundred dollars(5500). AVIIV Ir p y yp
I,uowncr of Ne properly,or my employers with wagesuthcir ole comPenmuon,
will do be work,and the structure is not intended or offend for sale(Sm.]04q Business103
and Professions Code:The Communes License Law does not apply to an owner or - FER Required Inspections
property who builds or improves thereon,and who does such work himself or through his 304 — ROUGH ELECTRICAL
own emplowa,provided thati uch improvements are not intended oroffered for sale.It,
however.the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or Improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with Recommit contractors no
construct the project(Sec.]004.Business and Professions Code:)Tho Conuacmra Li
cense Law docs not apply to in owner of property who Wilds or imponves Hereon,and
who conte for such projects with a contraceT(s)licensed pursuant a be Contractor's
License Law.
❑I am exempt under Sec. ,B&P C for this reason
Ow r Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pc jury one of the fallowing declarations:
1 haat and will maintain a CeniOcne of Consent self-insure far Worker's Compen-
s idem,as provided for by Section 3]00 of the Labor Code,for be Performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of be work for which this permit is issued.
Workers Com,croL�aationrinsurantt icr and Policy num_berim, J
Car
rier: Y�tn✓15' Policy NO:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection need not W completed if be Permit is formic hundred dollars($100)
or loss.)
I cenifY Nat in the Performance of be work fm which this permit is issued,10.11 not --- --- — — -- - - --— --- --- -- '—
employ any peron in any manner an as to become subject o the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificae or Escrepnion,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.JO forthwith comply with such Provisions or this From it shall W deemed revoked.
E7) CONSTRUCTION LENDING AGENCY
(~ l hereby affirm that them is a construction lending agency for the urforammed of
C' the work for which this Permit is issued(Sec.3097,Civ.C.)
4t7 q Lendcr's Namc
Z Lender's Address
V 0 1 certify that 1 have read this application and ser¢Nal the above information is
IL F conch.I agree to comply with all city and county ordinances and sure laws elating in
0 V building construction,and hereby audNnme representatives of this city to enter upon the
Lkl ahnvcmentioned property for inspection purposes.
„LL (We)agree no aave,indemnify and keep harmless the City of Calamine,against
h liabilities.judgments,costs and expeusm which may in any way accrue against mid City L ^
Uz In' ccof tbe got 'of this p[rnir. �S
'—' APPL UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date o/ 5 �5
SD CER U ONS. /
Re-roofs
turc . ppncimucimracnur Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant store or handle hazardous maerlal
as defined by the Caroni.Municipal Code.Chapter 9.12,and the Health and Safety
CoJc,Sccdon 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑You ON.
Will the applicant or future building occupant use
cquipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rsittharardove air conuminanu as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes 107
❑No
Ih reaJ Ne hosmErau maetialsequirtmcnu under Cbaptcr695 ofIM alit..
iia Hca &SarctYCWd,. donsZM5.25533and25530.1unJcnwdth®if NCWilding
does rely have a Nnanr,but in is my respori ihiliny m mbfytbe imapanl of the
menta men muubemet pdmnm issuaom ora CcniRcam oJpcc pan F Signature of Applicant Date
0
D cror uthonredagent Data All roof coverings to be Class "B" or better