00060013 CITY OF CUPERTINO
. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IIUILDING D E.:: jUNIPER COURT PERMI'1'N
OWNER'S Will 8 1 API'LICA
VI
PHONE; SANI'IARt'NO. CON'rR01,NO.
lot
❑m GARCIII'1'IiCTENGINEER: 11UILDING PERMIT INTO
00
v�� Itl LI)G LhIiC''� I'Ll1M11l t MfCll
uLIC6NSI;)CONTRACIOR'SDECI.\RATION ��yy��QQes Tption
oz—e I berenr a1Enm mm 1 ant licensed under provision,of chapter 9(commencing iF NO COND I T I'HNS
i✓5Cit with section 7(01))of Divi don 3 or the liminenaand PromF,nro,Coale,anon,license
in hill Imre aml cEeci
2t z a ia,cnsc Cla,., - Lic.a
0 a O Date Cl m oat
5 u G ARCHITECTS DWCLARAr UN
VOn 1 undemmrd my,lam,hall he evi m public all
}
u itp0 Liccmed I'nrle„Iona(
o�y UWNI3K-Ii UILUIiK UECLARAI'IDN
.21 1 hereby Loin,Inn 1 ma exempt Irum the Cnnba,ro,License hew for the
I-•L}afollowing reason.(Section 70315.Husines,and Profe,sinne Ccide:Any city or county O /
Y E 0 which requires a permit a,comuoch alter,improve demolish,oro pan any.structure
i2ei� primm its ineunnce,also requires the upplicam fimutch pc oniuofileasignedewartam
that he is nccn,mpm,randE,the 'It the Contractor',Liam,Law(Chapter 9 Sq. Ft. Floor Area
(comntaming wish Scent E 70(Nq of Division 3 of the 13...ness and Povi slop,Corel
urban he i,oxem,I mcmfnnn ami me bmi,loo the alleged exemption.Any violation
of Section 7031.5 by any applicant for a proud.subjects the applicant m a civil penalty
of nor more man e.<hundred dollars($51a). A Occupu icy Type
C 1.:r ovum unhe property,ter ter em,loyee,wins rages a,mdr,om crtn,emtorm,
will do the work,and me.lmemne i,mol imendual m uttered for,me(sec.7194, 103 — UFE R
Fusions,and Proron.ion.Codi:The Commmo.,License Law,does all apply ,,alt Required Inspections
lwin,rol property Who fit or improve,ma ,ceand who does,ach work himself 104 — .REBAR
or through hi,awn cmtployacn.pmvWcd that such intpmvanems are not intended or
offered fmale.u,however.me building or improvcrttam is sold xitnin one year of 107 — POOL/BONDING
%mn,letilla.me insma-builder will have me ba,om ofpnwmg mat he did art bund Lir
t,nwodopmpo,eof,:oL 301 — ROUGH PLUMBING
❑Lits local(lie pmpemy.mn enclE contracting with licensed contractors to 304 — ROUGH ELECTRICAL
Liomtruct the pmjem(Sec 70,14,Rushes%and Professions Call The Contractor's
censelow does no.a,dy maorwrmofp"o,who build,of improve,dworn. 502 — FINAL PLUMBING ENERGY
and who contracts
for projects a iontoao n pursuant(o me
raaLow503 — FINAL MECHANICAl_ ENERGY
El con call t din rLie c,_ /v�`I &PChot lo,reaw 506 — GAS TEST
owner .�a'm c v/"��
WORK, O. :.SATIONDECLARAnON 510 — FINAL PLANNING
arcnrafnrinLinderpenaltyrfperlaryoneofthefollowingdeclarations: 51. 1 — F.T.NAL POOL
0 1 lace 11111 cal rairlair a Cemfca,of Consent m .elf-ir,nrr for Worker', 516 — F I NAL. BU I LD T NG
Clar,en.mi.... as provided for Is Sierra Phil of the Labor Codefar he
perfmnwnce of(he work lin which this permit i.issued.
01 have and will maintain Worker',Compen,ad on Insurance,as required by Section
lhN)0 Ise Labor Code,tof the perl'unnnnce of the work fur which this permit is
„,ted.My Worker:,Cmnl<mation Imunatme carrier and Policy number Elie. -
Cmricr Polic,Nr.:
CERTIFICATION OF ESEhf PILON FROM WORKERS'
COMPENSATION INSURANCE
{'Ilio sectitin need not he colopk(ed if the per nit in tar one hunded Jallars
($100)ur find
1 ccnify that in the performance of the sod for which this permit is issued.I _
shall not employ any person in any manner so as u,hceomr subject ar the Worked
Cantpenaaton Lawn ol'California.Date
Appllc:ae
NOI'ICI;TO APPLICANT':It,alter nwking Ihi,Crnifcaa ul Exenmtion,you should
Q Ohe,cre, object m the Work,,%Cumpen,mion provision,of the”IN Cole,"m most
forthwith nsmNy With such provision,or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
a I hereby aff int Thal Imre in'a«metme(ion lending agency fnnbe Inrformancc
of Ib0 work lin which 0c,sertnil i,iawcd(See 3097.Clv.C.)
6. ❑ Lcnder's N....c _
z Leader',AJdma
V Q 1 ccnify that I have road this application and cute that the slice informttion is
correct.I agree to comply with all city:Itrd county nrdinanecs and state laws rclmlng
Q V ti hrildingenn,tructinn„nal bercby evil item..,ral lwc,nfthl,city to char upon
y the uMrvememioneJ,rnlxny for inspection puapo,cs.
We)agree tosave.indemnify and let,harmlcwthe City(it Cupertimoagainst
U0 liabilities.judgment,,costs and expense,which may in any x,y aecme against,aid
UZ City in consequence of the granting of this permit. // /� Q
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISSDedb �. Date
SOURCE:REGULATIONS. - y'
Signature of Applicant/Comracmr Date. Re-roofs
iaa. ud� «I.r2L; n�dlWin me appinorrfrais ,ad:� e h:natdru,ma(emil Type of Roof
a,drained ray the Culrcnmo nwnicipal curse.enamor o.13.and me neird and Safety
Code,Section 25532(a)l -
CYes ElNo All roofs shall be inspected prior to any rooting material being installed.
Will the applicant orfinance buildingtccupmme quipmemordeviceswhich If a roof is installed without first obtaining an inspection. I agree to remove
iramNom temm
r come defined q'the Ery Area Air Quality Management
Dki
c it all new materials Ibr inspection. Applicant understands and will comply with
[3 ye, C3 No all non-point Source regulations.
I have reed the ha,adhms materials mquiwrard,undo Chun,,6.95 of the
California Ilealth R Safety Code.Sections 25505.35533 and 25534.1 undcmmrd the
if the building does mat currently have a mould.that it i,any responsibility to notify the
occupant of the requirememn which must be met prior to issuance of u Certificate of
Occupancy. Signature of Applicant Date
owmr or aamod:Td agent Date All roof coverings to be Class "B”or better