04060087 CITY OF CUPERTINO t h'."' •'wvaz^e x^ .t f "`v w " "'` '
BUILDING DIVISION PERMIT: �CONTRA.CTOR INFURIVIATIO
BUILDING ADDRESS: PERMff NO.
CUPERTINO CONSTRUCTION INC 04060087
R'S NAME: R2rNEFAF BR
PERMIT ISSUE DATE
.*E; SANITARY. OL NO.
I (498) 29; 9000
ARCHITELT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
,uoo LICENSED CONTRACTOR'S DECLARATION Job Description
F 1 Mreby affirm that 1 am licensed under provisions of Chapter Y(commencing
with Section 70011)of Division 3 of the Busircss And Profession Code,and ic is
n<
AV
s in full Tome and cffttt.
zt'q= Lianw class Lm.a SFDWL-2 STORY/3 , 277 " LIVINGbacen
D' TEcr°sDECLARATION GARAGE 463 SQ. FT.
2,W I understand my plans shall he used as public mmrds
2, 6
3 A.
10t LiccnuJrey onel
OWNER-BUILDER DECLARATION
I heerebby a1Em o n 1 em exempts an the Contractors sins, am License Law for the
p O following reason,($assn](131.5,Business and sae dentin Code:Any city or county
as$ whichits ism ate.is nConstruct.
resthealmaimprove,dcermitt ore a.,.I,Anyawcwm
n—m
prior to is issuance.also rrquiles the applicant for Loch r,wiuo fleasigned xummem ..
that he IS licensed purwant in the provisions Of the comoscon's UCRY'Law(Chapter 9 Sq.Ft. Floor Area _ top
�H$ (commencing with Section 7")of Division 3 of the Business and Profession Coal of * b80o0
5 that M is exempt theefrom and Ne basis for the alleged exemption.Any violation of /
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number —0bEtip Cyjype
AM mom Nan fw hundred dollars($500). V
r]1,as owner of the'Mprsty,ar my employmwith wages as their wm rea meson, 32608031 . 00 � Qat
will do Nn wont.and the,umnse is nmimmnded croRcmd forsale(Sec.7 W.Business _
And Profession Code:The Connutors License law tine,nut apply in aA owner of Required Inspections
property who builds or improves doemon,and who doessuch work himself or through his
Own anonyms.provided that wch improvements are notinmMed or ORerW for We.If,
however Or building or imprMannm is mid within ox ycex of mmplaumi.Ne owner.
builder will have the burden of proving that he did not build or improve for purpose of
salt.).
I.as owner of the propony,am exclusively conharting with lianed commuters to
convect the pnjcct(Sec.70A6,Business and Pref Woos Code:)The ConOacw's U.
retic Law does not apply in an Owner of pnperty,who IWilda or improvrx Contra.and
who contacts for such projects with a conaCtor(s)liconed pursuant in the Convectors -
License Law.
am escmpt Anda Sec .B&P C for Nis reason
cr Dan
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e
WORKER'S COMPENSATION DECLARATION
(hand aline Antler Penalty of perjury ore ofthofollowing dttlaer,Co
1 have and will maintain Section
37 m of the Lab mso Code.
for WmtrhCOmpcm
worn, r provided for by Section 3]00 of the labor Code,for the pedmmance of the
work for which this permit is issued.
haw and will maimain Workers Compensation I...As required by Secure
N700 of Netabm Co ,fm Ncpcdormu,cenf Newo forwhich NisMmilisinued.
My Worker`s Co Pon Lion mu m Ace artier and Policy mance, a + -
CarsieT. 3, Policy No.:
C In TE OF EXEMPTION FROM WORM
COMPENSATION INSURANCE -
CrIns section need not he completed Bob rcrmit is forms,hundmddollw(5100)
nr Icss.)
1 cattily that in Ne perfwmanee Of the work for which this permit is issued,1 shall not
employ any person in any manner sus u to become subject o the Workeft Compensation
Laws mf C;thromia.Dam
Applieum
NOTICE TO APPLICANT.If,after making Nu Ccnificam of Eacmption,you sIOMW
become,subject to the Worker's Compensation provisions of the Labor Code,you must
.J Z forthwith comply with such previsions or this Permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
'e+ k for
rwhichihi that Nertusued(Sm.
S .309ending Agency for the perfurmanrc of
".� Nc work fur which his hatmit s issued mmum97.Civ,CJ
W A Londces Name
U Lender's Address
:D Q I certify Net 1 have cad this application and sum unit use about infomatiun is
U. come,.1 agree in comply with all city and county ominwecs and state laws relating to
OU building construction.and hereby wCmlrerepresentatiMa Of this City to enter upon me
,r W ahovc-menioned propcny for inspection purposes. tt
(We)agree m Cove,Lod CxKM and keep harmless the City of Ii,anins against 1� A
F nog inconse,uhne of the Costs Lord es tens a which may in Any way urnm againuvd City
U z APP,.CANTeUNDERSTANDS Athis
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
J�Will
CE RE ATION . _O
Re-roofs
go.
of ApplicantlCon tot Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Ne applicant or future building acupmt store or handle hmardous material
ned by the Cupertino Municipal Code.Chapter 9.12,and Ne Hcahh and Safety
!g,n25533(A)T All roofs shall be inspected prior to any roofing material being installed.
�yWy�;roII NearplicamOr fuwrc building acupant esu cyuiPmem or d<vices whichIf a roof is installed without first obtaining an inspection,I agree to remove
avamous air contaminants As dcfncd by the Bay Area Air Quality Management all new materials for inspection.
Uisv¢tT; /y
Yo, ''DIu
1 have mal Ne hanNnus mamrials equimmens undo Chapmr6.95 of the Califor-
nu HcaIN&SmctyCode.Sauous25505.25533 and]5536.1 un icrsund Natlrthe building
does not currently have a Leman..that it is my nespanihility to Amory dm occupant of Nc
mmwboth muxl mclp9nirm
rwissuanm Ofaccniucw`Ccuporn" Signature of Applicant Date
Owner orauthmmnds em `""-" D"- All roof coverings to be Class "B"or better C/