08050060 CITY OF CUPERTINO € ''a�"�-^. t %•�'r r a�( "� '� `ns * '}� -^
BUILDING DIVISION PERINIIT �Ol �TQR� 'a��
PMMrr ND.
BUa"6LTp8'bREENLEAF 'CT LOT 3 NEXGEN BUILDERS, INC. 08050060
f
ER'S4d�++AME: PERMIT SUE DATE
GfTEENLEAF ASSOC 225 DEMETER ST 05/13/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 322-5800
ARCHMICT/ENGINEEK: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0
30Zp LICENSED CONTRACTOR'S DECLARATION
m 1 hereEm w
y affirm 1 am lsoommd under proviso=of of Chapter 9(commencing Job Description
with Section 7010)aDivism3 a Mae Business and Profession,code,and my license is REVISION-REVISE STRUCTURAL FRAME-TRUSS CALCS
IL:mB forte and defy
p n"�'�'i -ore .co�,gmnar 2g d ORIGINAL #07020040-NO NEW PERMIT.
ARCHITECT'S DECWIAnON to
I undersand my pwu shall w used ss public records
hwt-i Licensed Pmfcasional
5 OWNER-BUILDER DECLARATION
E 1 hereby affirm that I am acmpt from the Conlranors License Law far the
C u O following reason.(Section 703I.S.Business and Professions Code:My city or county
5$ which requires a permit in cmmmnct.slur.improve.demolish,or repair any someone
prior to its Bmamc.alsu requites titeapplicant for such permit to fnaa signed sutement
sse
Man W ca licensed persount to Me pOwisions,of Me Contrachnt,License Law(Chapter 9 Sq.Ft. Floor Area $100 Valuation
F V-O (eommenNng with Section]000)of Divuionl of Ne Business aM Professinur Code)or
59 that W is exempt therefrom and Me basis for the wegeti acception.My vloladm of
Section 707!.5 by any applicant for a permit subjocu Ne applicant to a civil Penalty of N Number Occupancy e
not more than five hundred"tact(SM 32633107! P yTyp
0 1,u owner of the property or my employ=with wages as their sole compunctions.
will da the wort and the stmetu e Y not intended W offered for sale(Sm.IBt1,Business
and Ptacesmm Code:Ter Countesses rs License Law,tions not apply m an owner of Required Inspections
property who wills or improms thereon,and who d=such work himself or through his
own employ=,p=rided that such improwmanu are red intended or offered for sale If. '
knuumcr,Ne building or wpmwment is cold within arc year of completion,the owner.
Wilder will have the burden of Interring that w did Out bdid or improve for Purpose of
ask.).
0 1.as caner of the property am eacluswly contracting with Bansed oxo a nous u
comtrun the project(Sec 1061.Business and Prefessens Cede:)The Cmuacmrs U.
comm Law d=dot apply in an owner of property who wilds or improvca Merton,and
who contracts for such projects with a oontractor(t)licensed pursuant to the Contractoet
License law.
0 l and exempt under Sce ,B&PC for this mound
Data
WORKER'S COMPENSATION DECLARATION
I mreby a=rm under penally of perjury one of de following declaradome
nlhaw Fronded
by Section
37a of Comersr CodensumfmWmrmancempan-
wrim,r which
i thi for mi Smuon 7'!00 of Me labor Cade.for tw perfomanco of Ne
work for Lith this permit is issued.
0 1 haw and will maintain Workers Compensation Irrsurana,as ro,Amd by Section
3700 aMte LaborCade.for Me perlomamc offt work forwhich this Permit u Issued.
My Work ..Ourpym
eal �n,Wa urancanner and Policy number are: -
Camr.�'rrr/GeezyoY Polity No.1/9' e""^0 �
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
('ThlsseNm need not be completed i(Ve Permit Is forme hundred dabou(5100)
orlaa)
I•...:h that in the performance of Me rorle for which Nu permit u issued,I stud!tet
employ any person in any masenerun as to become subject a Me Wintery Compevauon
Laws of Califomia.Date
Applicant
NOME TO APPLICANT:If,after making this ontficaa of ascmption.you should
become subject an the Worker's Cmnpo ssition Provisuu of Me Labor Code•you must
.J O forthwith comply with such pmvis u.or this permit Nall w dm
eeed rewkcd.
Z y CONSTRUCTION LENDING AGENCY
F Ihcrehy.M.that inert is.comwction lendug.poe,for dueperfermacoaf '
the work for which this permit is needed(Sec.7097,Civ.C.)
QLcodcea Name
O z Landers Address
U O 1 awry M.,1 haw mw this application and ma Nat Me show information is
g, t" cmnsL I Agra to complY with W city and cowry ordinances;and state laws totaling in
0 SV' building construction,and hereby mNasm rtpmsenuuws of Nu city to motor open the
W .ww-mcndmed property,for idn',cem purpues
F LSr (We)agree to yw.Indemnify and keep h4mICV the City of Cupertim i, irtlt
(Z5 U fiabiliMa.judgmcots.cowande.X--whicanmagai
hmayinywayacenst,sMi Cil,
ce Z in consequenof Ne granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINISEDed by:
y; Date ..S �'J-fYJ
SO REGUL.ATIONS'. Q�
s0i -gam 13-�� Re-roofs
Sigftumof Appli MCommactor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Mac applicant or forma wilding desupant aim ortandle h mous material
as deltm i by Me Cupenine Municipal Code.Chapter 9.13.arms the Health and Safmy
OW.Section 25512(.)?
❑yca 162Qc All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuwre wilding msuWnt use equipment or devices which an inspection,If a roof is installed without first obtainingiection,I agree to remove
emit
it`nasnm aur ecoumivu nas defined by NM
e Bay a Air Quality Management all new materials for inspection.
0ya fad
1 hent read Ne waartlom materials requirements under Cluparh.95a theCalifor-
nuHulN&Safety Code,Sectiuts 25505.25577 adi 25534.1 understand tharif Ne wilding
does Out currently ham a comma Nat It Y my responsibility m notify Ne maupNt of Ne
dvcmcnts wnaGh do .rte iasuana ar.Ce�Mlearaapamy
Si2= gnature of Applicant � Date
>f 5 - 1%rea- 0�
Owner or authoumd agent Dna All roof coverings to be Class')IF'or better