08020117 CITY OF CUPERTINOa�=z* .r+ .=-,
BUILDING DI VISION PERMIT ,�xCONTRAC'-"TQR, NFORI�4ATION"`
- .
PERMIT NO.
BQagtTOTEAALE PL THD @ HOME SERVICES 08020117
HER'S NAME: PERMIT ISSUE DAIS
CATI MYER 3200 COBB GALLERIA PKWY STE 02/19/2008
HONE: 7 n n SANITARY N0, CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
R&R 16 WNBDWS, 2 CUT DOWN sO ELECT
PLUM o
3 o a LICENSED CONTRACTOR'S DECLARATION r
rd u I hemby af0rm dot 1 am IlWnscd under provisions of Chapter 9(commencing Job Description
Z� with Section 7")of Division]of the Business and Professiad Codo,and my liceosois
i^_n in full force and effect 12 '�
9 Dau Conan'."
ARCHITECTS DECLARATION
p u I understand min plans shall be used a public rmo is
Y
ya
Licensed Pmfrsuoal
a OWNER-BUILDER DE CLARATION
0I I hereby.(Ones that 11. exempt from the Contractor's Co :A License Law for site -
zO o which ng ones a croll t 703 1.5.Buainus and ver dem ns Calc:Any city of county
Z which mqus u a e.alst to cnnswct plot improve,dcmdish,or repair any W statement_ZSn prior its issuanco.aisu mquims site opplicanlfar inch permit uicese signeddsutemcnt
< Ilw he is licensed pumona to sin:provisions of the Cormier'.lJmme law(Chapter Sq.Ft.Floor Area Valuation
x�9 (commencing with Section 7000)of Division 7 of ft Business and Professines L-ole)Or
Q - thin h is exempt dcmfrom and de basis for site ailegcd...mption.An,violation of
Section 703t.5 by any applicant fora permit Wbjee s site applicant W o civil penalty of APN Number Occupancy Type
on,mart dun five hundred dollars LSM
❑Lasmocroftheprepcmy,of my employees with wages utheirselecompeoution,
will do the waw.and site mWcmm h.mutended oroffs,ed(anal.(See.7016.Btdvas
and Professions Cade:The Conmcm's Lim"Law does not apply Or an awns,of Required Inspections
propeny who buildaorimproves ths,con,and whodaeaouch work Mmselfm Wough his
own employees,praNded thanteh irepmvems,ns..in inm u ed W aRs,eed for ala IL
hawewr,the building Or Imp o.t is sold world.ons you of completion.the owmr-
builder will have the boded of proving dol W did not build Or Improve far purines,of
tale.). '
1,m Owner of the property.am uchadvely,contracting with licensed contractors in
smwmm the project(Sec.7064.Business and Profmdmu Code)The Coouacusr's U.
Unions law does not apply in an owns,of pmpcmy,who builds or Improves daemon.and
who contracts for such prejecu with a conuanor(s)licensed person,in the Commodes
Limn®law.
0 lameacmprundasee ,BAPCfeethismsso.
OU
Dom
WORKER'S COMPENSATION DECLARATION
I hereby alErm under penally of perjury one of the following dvlentions:
❑1 hove and will maintain•CedRmte of Conten,W nslf-iesum los Wowera Compen-
sation,a provided for by Section 7700 of the Labor Code,for the performans of the
work fm which this permit is issued.
Mw and will maintain Worker's ComPematlon Imuranm,as equimd by Sermon
77W.f Ne Labor Cotler for Ne pcif...of the waw fo vdiich this permit is Issued '
My Worker Comperam Inns wrier and Policy nyy{{nmher ons:
Cartier. xz rz(-a.-t Pnliry No.;,W9Z/ rj
CERTIFICATE OF EXE1vFnON FROM WORKERS'
COMPENSATION INSURANCE
(This sevim nerd ani M completed if de permit Is for one hundred do0asa(5100)
or less.) ,
I Wnify that In the Performance of Ne work for which this Permit is Wood,I shall not
employ any person in any mannered m to becoma subject to de Worhni Compensation
Laws of California.Date
Appli ant
NOTICE TO APPLICANT.IL after making this CeniOnm of Eacmption.You dhould
become subject in the Wooer's Compeuotion provisions of on,labor Code.you muss
.J O forthwith comply with such provisions w Nm
this Permit all be deemed revmkcd.
,'Zy7 CONSTRUCTION LENDING AGENCY
[-tom 1b.mby.111.dust them isocoiuuuctinn lending agency for the perfunumen.r
Cri i the work for which this Permit is issued(Sec.3197.Civ.C.)
W lander.Name
Z) Z landeh Address
U O[ 1 certify that I Mw news this application and sumis de thshow ikamadun 6
Liv E comm.I aim to comply with all city ad county odbunma and mute laws,¢toting In
.C7 building consrumion,and hereby Wthosre mpmecaudws or this city in enter upon the
W show-mention"property far inspection purposes
LL (We)agree to saw.indemnify and hep harmless the City of Cupertino against
Ilobilides.judgmcnu,costs and opemes which may u any way.cart against said City
U Z in consequence of the grading of this pvmh.
�-' APPLIJJl!11RRffff UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:34"t�zw Date
SOU C EQUL2NS.
X11/ n�.l[[ 6ZI4 Pn. g� 'r`Or /moi
Slgnatum of ApplionuRcntW
imr Date Re-[GOES
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or rut=Wilding accupanmmm or handle haodous material
as de0ned by the Cupertino Munt Code,Chapter 9.11,tad de Health and Safety
.Sectio.15551(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the oppliem,or future Wilding Occupant use,equipment Of devices which If a roof is installed without first obtaining an inspection,,I agree to remove
emit havard^o air U marrinanu as defined by the Bay Am.Air Quality M...gcmc., all new materials for inspection.
DisuiclT aaaa�����
❑Yea u
I hew mad the hvidousmamriW me iiremems oder Chap U6.9S.fdte Calirm-
nu HolN&Safety Code.Scnimu15505,155)]ee115534.l undUrund distrust,building
dam am curently haw a tenant this It u min mapoosildlitY m anti(Y the ocupan,of taeAU
mtenuwhithm Wine 'Or in issumus of.Cerukam of Uccupa^Ly. Signature of Applicant. Date
Owner or amhorvedI Dau All roof coverings to be Class"B"or better
' '