05110144CITY OFCUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PACIFIC COMMUNICATIONS
1FRMR"°,05110144
R'S NAME:
PERNET ISSUE DATE
RE
COMPUTERAPPLE
285 SOBRANTE WAY, UNIT F
01/12/2006
PHONE! -
SANITARY NO, CONTROL NO.
(408)830-9550
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BO EO PLO MEOCH
LICENSED CONTRACTOR'S DECLARATION
Job Description
i hereby affirm Nal I am licensed under Provision of Chapter 9 (commencing
with Section 70(10) of DIvIi 3mfthe Bualneuad Precast n Cade and my license is
I.failadenttt iZ (
INSTALL 5110" TALL GRAVITY MOUNT W/2'
License w Lie. g
Data contactor
DIA. ANTENNA & CABLING FOR WIRELESS COMMUNICATI
ARCHITECTS DECDRATION rkowifsg Nazo
j
1 undersand my Pan shall h used u public recons/P_
Licensed Professional
OWNER-BUILDER DECLARATION
1 hcmby affirm that I am exempt from the Conummes License Law for the
following aeon. (Section 703 [.5, Business and Profeaion Cade: My city memory
which requires a Permit to cowact, alar, improve. demolish, or repair any structure
prior m its issuance, also requires The applicant for such Permit to Ole a signed smemem
thatMislicensedpunuantlnNepmvisionsofNeConummor's License Law (Chapter 9
—
Sq. Ft. Floor Area )j - V 0
(commencing with Section IWO) of Division 3 of the Busiand Profession Cam)or
ness
bib`ao
Nat he a exempt merefrom and me boa For the alleged exemption. Any violation of
N—
APN Number
Occu ane
Occupancy
yTy�ot
Section 7031.5 by any appliun, for a permit subjects the applicant to a civil penalty of
more than five hundred doll.(L
31602106.00
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j A vflfP
❑, ,
will do the work and the snet.. a malmended ora@red for We (See. 7044, Business
And Profession Condensates ThCondensates License taw does rot apply Nan awnr of
propertywhm bulldsorimpmws thereon. and whoduessuch work himselformrough his
ewAimprowm notlmmndedmoamed for sale, If.
Ping
'
Required Insp
hown owever. or improvement within theowatof
bundler the building orimprowmving not Par a
Improv far
builder will have Mm bums of proving that he did not Wild m Improve far purpose of
that did
ale.).
p 1, As owner of the property, sat exclusively contracting with limned anuamat to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Lt.
come law data not apply m an owner of pmperty.w'ho builds or improves Memon, and,
who contacla for such projects with a contranora) limned personal to the Contractors
License LAW.
❑ 1 am exempt under Sen. . B At P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penity Of pedury oro of Ne fallowing dedsonsion:
❑ I haw and will amMun. •CeNOnm of Consenum self-imam fw WoaeYaCwnpen-
alion. a provided fm by Section 3700 of use labor Code, rat Me perfewheae of the
,
mods for which this permit is issued
❑ L haw And will maintain Worker's Compensation ince rasa, as required by Section
3700 of Ne labor Code. far an pctf smace of Ne work for which Na permit a issued.
A Warks f 7010¢ exotic al Polity number 059
C7GR• IPaliN
CERTIFICATE OF FROM WORKERS'
FROM
COMPFFdV3AT10N INSURANCE
COMPENSATION
(This section Iced hot be completed ifthe Permit is format hundred collars ($107)
,
or lees.)
I certify that In Me perf xmNCe of the Work for which this permit is laws, I shall am
employ any person to Any Maher W AS An t1m0MC subject 10 The Workerx'L'arommuntion
Laws of Califomia. Dam
'
Applicant
NOTICE TO APPLICANT. If, after making Na CeniOnte of Exemption, you should
become subject to Ne Warrior's Compensation previsions of Nm LAW Code, you must
forthwith comply with such provision or this Permit shall M daemon revoked.
CONSTRUCTION LENDING AGENCY
1 hcmby affirm Nat inert is s crnomardon rending agency for the perfwmanco of
the wort for which Na Permit a issued (Sec. 3097, Co. G
Undoes Name
'
lander'¢ Address
1 ceNfy that 1 hoe read this application and sum Nu Ne am. information is
'
arrect. l agree to comply with all city And county omin meas and sue Tawe Minting to
building conouctian, ad hereby W thorias mPreaenuti,es of this city to enter upon the
moormendooed property for Inspection purposes
(We) agree to saw, indemnify and kecp harmless the City of Cupertino against
Ilabilidea, judgmenu, casco and expenses which may in my my seem &Saint said City
in conegucme of Me granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOW&�_—_ ' /',L/��
l
Re-roofsf1'��
Type of Roof
Signal. of Applicant/Co.mactorr Date
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or fugue building occupant eon or land). huamom muerial
As defined by the Cupertino Municipal Code. Chapter 9.17. and the Health and Safety
❑Yen Seclum 25532M)'Na
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I agree to remove
g
Will the applicant or future building occupant uequipment or devices which
'
malt huudous All conuminanls AS defend by me Bay Arta Air Quality MWg,nnent
all new materials for inspection.
Diauict7 �,s
❑Yes gp Nu
I hew mal the huamnuamacrlals requirements underClupterd.95 of the Califm-
nle Hmalth@SalmtyCoda.Secdmu25505,25533md M534.lundcaund Mutifmc building
dao mol curtcnTly haw a tenatTt.No IT a my billytto notify the occupal or Ne
mgmm awMchmuRbc In Tau ear eniOne or a7,�
�1., `�+
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner tar aulharimd agent Date