04090082 CITY OF CUPERTINOr'a+Y 'A'N'S"+�'-s,� 3''F zs
BUILDING DIVISION PERMIT 4C3ONTRACTORINVRMATION _
BUILDING ADDRESS: ABCO CONST ""N'04
ERMrr ND04090082
OWNER'S NAME: PERMIT ISSUE DATE
HEN
E:
SANITARY0. CONTROL NO.
ARCHITEC rENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOo LmdamIDCONTRdmotorSDECLARATION hap JobDescri [i e4LE®
0 C 1 M¢by afLIC Nal I sero CONTRACTOR'S
TOR provisions of Chapter Y(commencing P
b with seema'0(IB)of Division 3 of on Business and Profrssium Code.and my[im=is
n in full force andenea DEMO
M? License Class Lic.0
li" Dam ConuacNr
qtl ARCHITECTS DECLARATION SEP 23 2004
>?g< I undcr.and my plans shall he used u public norm ds
9yU
o Li¢nuI hereby
BUILDING
OWNER-BUILDER DECLARATION
F.00 I hereby.(Sero on 11. exempt from the Tessio noon Code:Amy c law for the
F.00 which requires
permit
it)
710 sr Business and profession orAny city smaunty
ture
K$ which requires ti invitation.also re lir construct.alcor,improve,demolish.m repair ed .mcwm
FZ<
poorhe its nsedprocessor
10 ml ran for mill itteil replica Low( hapten
Nal Acis licensed pSesuao mu.of Division
of the the
Lhcnselaons Cook)or Sq.F[.Floor Area Valua[Ion
�H� t(commencingais; xempt Scnfan 711n d ft basis for of me Alleged
mss ond Profeson.Any
CMc)or
Nut he la exempt therefrom and Ilse baso for the ellcged cxcmpuan.Any violation of
Section 7071.5 by any applicant for a permit subjects be epplicanuo a civil penally of 3-AFNUtZ*vr0 0 Occupancy Type
not more Nan Bn hundred dollars(ML
1,u owner of the property,Or my employees with wages u,Mir sole eompensatlOn,
will do the work.and theawcmre is notintended mortared crumb,(Sec.70,14,Business Required Inspections
and Pmfaasiom Code The Contractor's Lir•-law docs net apply m an owner of q P
property,who builds Or improves diereammul whodoessuch work himself.enough his
own employ.,provided Ihatsuch impmnmenu art not intended aro@rW fmsaie.If,
however.Ne building or improvement Is sold within one year of completion,Ne owner-
Witter will have the burden of moving Net he did not build or improve for impel of
sale.).
1,as owner of the progeny.am exclusively contracting with licensed contractors m
ren Ne pmject(Sec 706,1.Business and Professions Code:)The Contractor's Li.
me law dors not apply man comer of property who builds or Imprisons Ihemon,Md.
who contracts for such projects with eco slaetor(s)licensed mmsuao As she Conuu,o's
License Law.
❑Iem exempt. der Sec. ,B&PC In
this on
ODam
K C PE SATION DECLARATIO
I hereby aRmn un nilly of perjury m¢of me f in dxl tions:
haw and will maintain CeniEnleof Comenuoself-imure or Woetels Compre
e
cation,As provided for by Section 3700 of rte Labor Code,for me XKOrmamc of the
work for which his permit is issued.
p 1 ban and will maintain Worker's Compensation Insurance,as required by Section
3700of Ne Labor COM,for the performance of the ooh for which this permit is issued.
My Wmkcrb Compcm lion Wuran¢artier,rend Policy number am:
Cartier. policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITIS section need not M completed ifft permit is for one hundred dollars($100)
or Mss)
1 certify Nm in me perfnmmnce of Ne work for which this peon,is issued,l shall not
employ any person in any manrmr so as to become subjcn to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making his Ccrtifcmc of Excmpticn,you should
become subject m the Worker's Compensation provisions of the Labor Code,you must
0 Z, fOMwith comply with such provisions or Nis permit shall to,deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
�-. 1 hereby aBum that them is a consmnorlon lending agency for Ne performance of
!>:> be work for which this permit is issued(Sec.3097,Civ.C.)
W 1<ndors Name
6. Lender's Address
U 0 I certify that I ban mad his application and sum Nat the above informe,iun is
U. P correct.1 age m comply win all city and county mil...Mod sum laws relining to
0 V building construction,and hereby someone mpreunutins of nu city on cnmr upon lM
W above-mentioned pmpeny for inspection purposes.
6i (We)agree to sen,indemnify and keep Woolens the City of Cupertino&gains,
N lobiliuu.judgments,cots and expenses which May in any way accmc against said City
V z I....quimille of me granuag of Nis permit.
CA UNDERSTAND NO WILL COMPLY WITH A NON-POINT Issued by: Date
OUR ULATIONS. .
Re-roofs
Sign. a Or Awcams'
IM&d.,
N AR OUSMAT RIALSDISCLO$URE Type of Roof
Will theappli' ser fuwrt bu0 gmcupanI stem2 Ind" smamrial
as cler. by tfr Cu 'no Mun'np GOM.Clupmr 9.13,and the Halm and Safety
Code,Section 353]3( 7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will me applicant or tutu-buil ng orcupa.,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haramme it conurem.is u Are by ire Bay Area Air Quality Managemcm all new materials for inspection.
rsuict7
Yes
1 haw read the harerGlms materials requirements under C'hspier 6.95 of do Califor-
maHCalm&Safety use.Sc-a"3530 JJ and JSSJa.l unMhoomm.if no Wilding
docs mol cumcndy n e mnanL mot it s y osponsihility m notily Nc«cupant of Nc
mirememuwk met tss coftCeniOcareofcup e. Signature of Applicant Date
are All roof coverings to be Class"B"or better
owns .r- p r<aagam