08050142 CITY OF CUPERTINO at . �' '
BUILDING DIVISION PERIVIIT CO,I�I,"QV' orf I1VFORMATI®N.
PERMR NO.
Boll,pld+5A�DI�REE50HNSON AVE SUNTREK INDUSTRIES 08050142
WNER'S NAME: J PERMTTISUEDA71E
STACY TONG 5 HOLLAND 06/09/2008
HONE: SANTfARY NO. CONTROL NO.
(949) 348-9276
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Bopp LICENSED CONTRACTOR'S DECLARATION Job Description
e V 1 hmeby am.WI 1 vm licensed ands,provisions of chip.9(mmmcncirg P
e vdiSeelw.7M)ofDiviaion3afw
drcBusinandProlssiardCadM
e,smylicense is INSTL 14-175 LIGHT PANELS ON ROOF. SUNTREK
n'�a in full force and effcc� Y 6
U clan Lle.0 INDUSTRIES PD RNEWL BSL #28410
contractor
W7 ARCH17EC1'S DECLARATION
U I understand my plans shall be used u public records
Baty Lic.med Professional
OWNER-BUILDER DECLARATION
COC I hcrohy.(Sero that 1 1. excmpl from the Conuano Cade:lucense law ear tit
p rOy which in6 masa&. ermit t ]581.5,Busi ot. imi e.de nm h.oAny cisy of county
COC
p
which rots bes isms a cJill m construct.applicant
himine.h Permit ale e 2 Sig ed structure
prior iu its licensed
aro mqo the the applicant for such permit m file ae Land statement
(halm isscing wit Pursuant to the Of Division
ivisoof Ne Conwness Lwemclaw(C odc)or Sq.F[. Floor Area Valuation
y�s (cot he is exempt Section 7030)Ofivis far aftweged Business and Prof ions Code)of $22000
try — that io is exempt any applicant
and or aver it 30)subjects
the csmnant in Any violation o!
Section 7031.3by nhuneppliollroeapemtil eabjecu Ne epplicanlmacivil penalty of Number OGCU araC Type
nm more Nan few hundred dollars(g5W4 37531053 .E P Y �YP
I,u owner of the property,in my employees with wages as their sole eompeuadon,
will do thoOme,and tW mthemea r not intended or o@red forsale(Sec.703,Business
and Psofessiou Cade:The Cannanoreilx o Lia, Law duan,apply m anw
owner of Required Inspections
propeny who buildsorimpmws throon.and whodoes.such workhimmlfor through his
awe employee,provided that such imp,memenu art not intendnd mattered forsa,U.
however,the Wilding or improvement is sold within one year ofcompledon,the owten .-
Wilder will have the burden of proving that M did not Wild in improve for purpose of
sale.).
❑1.as owner of the pmpmy,am exelusinly contracting with licensed contractors to
comtmct the project(Sec.70".Business;and Prorossions Code:)The Commus's V-
sena Law does out appy m an owlmr of property who Wilda o,improves demon,and.
whoconweu forsuch projsett wIN a eonvanmr(s)licensed pursuant in the Cunuan in',
License Law.
O l am cannot under See .B@PC for this reason
wrier Dau
WORKER'S COMPENSATION DECLARATION
I bemby affirm under penalty of perjury one of the following decimation ,
I haw and will msinuin a CmiBau of Consent m mlf-insure fa WorteYSCompen-
smion,u provided ism by Section 37M of the labor Code.for the performance of me
work for which this permit is issued.
❑I have and will maintain Workels Compensation luuran¢,ss tsyuimd by Section
3700 of the labor Code.for the performance ofthe work for which this permit is issued. '
My WerkeYs Compen»uu lnwnno ulnaand Policy num rg�{
X
Cartier.JTCgT� Policy ZZ D0tQ 97/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
O'homcdo t reed ml W complemd if 30)permit is forms hundred dollars(5100)
or lest)
I cenifv Out in the performance of the wart far which this ps,mit is raved.1 shall not
employ any pence in any m.,so u to become subject in the Wmken'Cmapcuati m
Laws i f Califamia.Dam
Applicant
NOTICE TO APPLICANT:IL after making this CeniEcate of Excerption.you should
become subject to the Wohm's Cempcuition provisions of the tahm Cade,you muss
.J z forthwith comply with each Provisions or this permit shall w dcemcd revoked.
z 0 cONSritucrhoNLENDINGAGENCY
the[-� I hemhy aRrm 11us Vert is a
C!Yyi Q dark for which the Permit is iveed(Sec.ti30911e,nCdiinv.g C.)
LcntleYs
ler the perlurmana of
Name
a z Lenders Address
UQ 1 cntify,that I Mn next Sunen Ian s applissund and same dawn infornauon r
&U coma 1 agree in comply with all city and county ordinances and sun laws mlaung to
0 building construction,and hereby wthorime mpmxntalives of this city to color unto use
r LU aabilidajuanedproperty
us.c costs
icor inspection expenses
puryamt
f-t W (We)agree to son,indemnify and trop harmless the City of Cupertino agaiut
h Iia,mosequeuxanu,cuuandexne-.-.which may in any way acceae agsiuusid City
U z in cansequeace of aro BranunB of Nr permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Cz;Fy
SOU REGU TIONS.
G 7—q, Re-roofs
Signaum afApplionVConuamor Data
HAZARDOUS MATERIA DISCLOSURE Type of Roof
Will the opplicam or future Wilding ocapantstou or candle hmardou reateril
as defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety,
.Semon 255324)?
dr
❑Yo All roofs shall be inspected prior to any roofing material being installed.
(g� o
Will Ian applicant or future Wilding occupant um equipment m,devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havudnu air canumiunu a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑yo art]lu
I have road the hvardOas a unarrequiumenu undsrChapur&93 of the Califor.
nu Hul"Sa(nyCade,Sections 25505,=3and 25534.Iumfnaand theifthe Wilding
does not Lmmn11Y have a Bram,Nu i,r my mscomihlli,y b notify the occupant of 30)
reyuirtmonu which moth mel pnorw Wuastec afv Ccnifiute o(Oc Suture of Applicant Date
orareathan.dagenl Dow�r All roof coverings to be Class'1{a'or better .