06040148 CITY OF CUPERTINO
BUILDING DIVISION PERMIT glCONTRACTOR Il ' 3RMA'I?IQN. l:
BUILDING ADDRESS: - FERMA CORPORATION PSEMTNO06040148
585 JOHANSEN DR
iR'S NAME: PERM r[SSUEDATE
DENIS COLIC 1265 MONTECIT9 AVE 07/11/2006
HE: SANITARY NO. CONTROL NO.
(650) 961-2742
ARCHITECDENGINEER: BURRING PERMIT INFO
BD PLUMB
t� L�
i9 j LICENSED CONTRACTOR'S DECLARATION Job DaSCrI UOn
V 1 hereby affirm Nat 1 am thcaused under provisions of Chapter 9(ommrmcing p
! with Stollen 7000)of Division 3 of the Business and Professions Code,met my license is
? m in full farce and cream SFDWL DEMO
s b Z License Chis Lic.0
e p Dam Contractor
7W7WARCHITECTS DECLARATION
1 m U I understand my plans shall he used as public ree"rds
e tar. Licensed Professional
by5 OWNER-BUILDER DECLARATION
i1 herehy affirm Nat 1 am"oh",from the Cantraemra Lice"a Law for Uw
D o fohlowing moon.(Section 1031.5.Business and Prefcaiaa Code:Any city or money
3 3 2 which requires a permit to com est,alter.Improve,demolish.or repair any sencum 1500
Zi prior m ill issuancc.sla requires theapplicae forsuch permit m file a signed+mems"
@�< that he is licensed pursuant m Ne provisions ofthe Contractors Licen¢IAw(Chapter9 Sq.Ft. Floor Area Valuation
with
!� $ (commencing Section 7000)dDivision3"fthe Busbwsand Nalcuum.OxI
i — Nat he is evmpt Nremfrom and Ne bait for the alleged esmnpdon My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of erV u Occupancy Type
rot moat tha Ove hundred dollars(M).
❑1,as owner of the property,m my employee with wins as theb ale compensadon,
will do the work and Ne scuanum is me intended or offered far age(See.70th.Business Required Inspections
and Profcssioa Cade:The Communes Lkmrue Law dead oro apply m an author of q p
property who bulidS Or Improv thmon,and who does such work himself orthrough his
own employe",provided WI such improvements are notintanded moRaed far sale.R.
however,the building at improvement is sold within one year of completion,Ne owner.
builder will have he burden of proving that an did Was build or,improve for purpose of
sale.).
Qf I,as ower of the property am exclusively o dracou g with licensed enmaan in �B
conswm the pmjem(See.7014,Buainea and profesdea Code:)The Comore mes LI- a�
onse Law dao mot apply m an owner of property who builds or improve daemon.ad tI
who canuacts for such projects with a comacmr(s)lloensed puma"m the Contrucmh L9 b
ED
IMy
o Law.
mest Sec. BAPCforths n
—Date o� .141, 9fIn6
ORK 'S COMPENSATION DECLARATION
1 hereby&Ram under penalty of perjury as of dm fallowing decleretioa: �Il ��tI H1TA ss rn „F/�,sv
edforn3700theLaborCode, dusrt`fIY/ilei L1P'I�Jfj�V/}Jr provided far i SeNon 3]00 of the Labor Code,far Ne perfermaece of Ureor which Nu permit u hued.
ave ad will maintain Workers compenaion Insurance,We required by sermon
f Ne labor Cade.far the perearmaoe of the work for which Nis permit ls looked.
orkers Campeaation Intim na carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Deis semlan need not M completed Have permit Is form hundred dollen(1100)
or lest)
I certify That In the performance of the work for which This permit is Issued I shall not
employany any maa
Lawso �eo s me abjam
tdre Worker!Compensation
Lawn of Califamia
Applicant 4/
NOTICE TO A P ANT:IL ager making Nis CcMnnw of Eamption,you should
becane Subject In the Workers Compensation provisions of the Labor Code,You most
O feMwith comply with Such provie roes or Nu Permit shall be domed reversed.
� ► CONSTRUCTION LENDING AGENCY
[.r 1henby.M.Nat Nemlsa construction lending agency far the Performance of
Qi 7 des work for which this permit is Wood(Sec.3097,Civ.C.)
6W. Q Lenders Nam
z lenders Address,
U I ceniey That 1 have mad Ws application and stare that des&hove information is
W r concur 1&gree m comply with all city and county ordinamss and state laws relating To
O U building construction,and hereby authodrz nprescnutiver of this Ci Ly to enter upon the
W above-mentioned property for inspection purposes
LL (We)agao to arc,indemnify ad kap harmless ft of Cupcnino against
cm Ilabilitia,judgmenu.eo s and expenses which may in my way acerae against aid City
in
U sz" APPLr ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU Eoulwno .
�� OG Re-roofs
1 unafApplianVCommetur Data of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or forum building accupamtsmre at handle hazardous;materfet
Recd by dre Cupertino Municipal Code.Chapter 9.12.sod the Health and Safety
0.Section 2553x&)7 t All roofs shall be inspected prior to any roofing material being installed.
0y. &N.
Will the applicant ar future building occupant usu equipment or deviccf which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardnm air comumirunu a de0m•d by ih Bay Asea Air Quality Management all new materials for inspection.
Di ua7
❑Yes 05Nu
I have mad Nehvardrms materials requirements under Chapterei.95 of the Gluon
nisHesW is Safcty Cede.Sections 25505,25733areI25534.I urukmand Nrtifdn building
does we currently haw a mount,Na it is my responsibility m nodfy des occupant of The
m cntaWhich rLwbemeprior missuance ofaCertiOce' 'a dpaSignature of Applicant Date
�7 0�ry
Career er authorized age" N." All roof coverings to be Class"B"or better