05040164 CITY OFCUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: NELSON GONZALES CONSTRUCT 'ITND'05040164
18685 HANNA DRIVE
.R'S NAME: PERMIT ISSUE DATE
UZSH HIRIYANNAIAH 2235 STORY
PHONE: SANITARY NO. CONTROL NO.
(408) 390-5659
ARCHMICTIENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB NECH
0
j o s LICENSED CONTRACTOR'S under DECLARATION job
I nearby )M'-f as 1 3 B¢nB caroler provisions us cedo. 9(commcaing {`■}`+—t+ n
£Z� wia SOcson 7IXIU)afDivW alafdm Bar=an Profa,iwu Cade.am mYlicenmm LES
Contractor
+< k full forte and ellen. ADD GARAGE (480 ' )
> z (64
laama cl It.,
a Dam I underwnJ my Pim„MTI arc TSSrrECam public recoNl
APR P4 ?OOd
Y
+a Licemcd Pmfessionm
yy OWNER-BUILDER m die CoATION ���
aZ 1 hereby aRrm mm I am sumps from ao ContnnaYa Licence law for the
O O fallowing rmmn.(Section 7071.5,Business as Pmfeecone Cale:My city ar county
9 which mquhes a permit on Common,ohne harrows.demolish,or repair my sm.tum
iy pdor m its in.,amu requires me applicant for such permit m 0k a signed matemat
c that he is licensedpumWm
uanthetheprovaoftieContractor'sma
cclaw(Chapter9 Sq.Ft. Floor Area aluation
(commencing with SeNanIWO)ofDivision l or the Business and Rofaniam 3 Cade)or $55564
Nat he is exempt drmfrvm and the bails for the alleged uempJ..My Aolallon of
Section 7071.5 by any appllcam fm a permit abjecu the applicant to a civil penally of APN Number Occupancy Type
tat mom than five hundred dolbma(SM
❑1,u commercials,property,army employees with wages u dmb,oleeompemadon.
and do la woes ands,he Contmrotrefereed,Law new
Imam(Sec.7 me Builness '
and Prolamines
cmc:77th Conuamr',Liana Lew does oat apply a an awrcm of Required Inspections
prop elywho build,Or improaem eermn,and who doesa.h work himeelforWaugh his
awnemployrem,Provided that much Improvements art nminmmed oroRered fmaale.If.
howaver,the building or Improvement tsald within am year ofcompkti.,ass comer.
builder will hoe the hordes of proving dot M did.1 holm or Mmaw for purpose of
ale.).
Q 1.as owner of th Property.am,elusively contracting with demand convanon to
consumer the project(Sec.70,4,Business and Profadons Cade)Miss C.tsatof,Li-
cera law am not apply a an Owner of propmywho build,or improwa dmreon,and,
who com sea far such panic=with a eonu eter(O lmenad p'muan+m the COnumnor's
License Law.
❑Ipmesemptundu See .B&PCfarthuma.
40 e Dam
WORKER'S COMPENSATION DECLARATION
I hereby anbm under penmty or pedury one or the following delsrssame: -
❑I have mm will maintain a CerdOcale orComent to elf-Insure forWadmf,Compen. '
motion.u provided for by Sedan 7700 of W labor Codefor the palmookae of the
wart for which Wa permit is issued.
0 1 haw and will maintain Wortrf,Compensation ImpWtanca,as squirm by Section
7700 of the labor Cme.for the Performance of the work far which this Farrell is loved. '
Myrler. Campemad Insurmcc canner am Policy number soc
Cartkr. �L Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thts mass.need notbecmnpleted U um permit Is farms handmdmBan($100) ,
or teem)
1 cerefY the,In the performance of the work for which thio permit is issued.I shall not
employmy Peron in my as' row mbemnnmbjectadm Wortrn'Campemad.
Laws of California.Dam
Applicam
NOTICE TO APPLICANT:If,after making this Cemfcac of Exemption,you should
bxome abjece he the Work is Compensation provisions of the tabu Cody.yen sun
.JO forthwith comply with much provisions or this permit shall be daemm rewked.
ti CONSTRUCTION LENDING AGENCY
I heathy affirm mat dam is a Cameroonian leading agency the the performance of
fY.> the work for which this permit is immune(Sac.7097,Civ.C.)
�W Lender's Name ,
Z Leser',Aeaav
U O 1 cerdry,that 1 haw read IN,application as saw that the above information is
0.^ comtt 1 agme be comply with all City and County Ordinances am sum I,M relating m
rU^ building commander.and hembymaodse rtpramudws of this city to now open ass
[i7 ,yaw-menaa.d property far impaction purposes
LL (We)agme to ave,indemnify and keep armless the City of Cupertino moms
IA liabilities,judgments,costs and expenses which may In my my seems allsaid Cry
U Z in consequence of the gnnung of au permit.
„•' APPLICANT UNDE ANDS AND OMPLY WITH ALL N77,rO OINT Issued by: Date d, -0 �-
SOURCB 0.EGULA S. /
c4 Re-roofs
Signature OfApplfnmO on am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ass appliance or future building oceupml sem or hawk hanNam mamds
as deRned by the Cupertino Municipal Cmc.Chapter 9.12.sod ass Health and Safety
vies Section 73373(0)?
� cop/^ All roofs shall be inspected prior to any roofing material being installed.
� V
Will the applicant or future building accurate em equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haamna air conuminanu u defend by the Bay Arca Air Quality Management all new materials for inspection.
District? �✓
0y. lis'^” .
T haw read the naramms^•„^dabrequimmew uncia CMmpmrd.95 orthe Califor.
.is HW h&SafetyCods.Sachem;25505,75577 em25534.1 undersand autism building
data.s cthendy havea au it s my mapmutMliry a totally ft occupant of W
rtgaremn ph'm mum be prior tamumaora Certificateaf mtpmcr. Signature of Applicant Date ,
Owner at wthari d Dace' - All roof coverings to be Class"B”or better .