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05050147 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION 4.`nv p'- BUILDINGAOURESS: o PERMIT NO. 05050147 OWNER'S NAME: PERMIT ISSUE DATE MT(- TF'T T P Wr TNTT��$ NE: SANITARY OL N0. ARCHITECMENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LOz LICENSED CONTRACTOR'S DECLARATION JobDMar oq ® p �® x F I Wreby affirm that I am licenced under provisions of Chapter 9(commencing ©C� �e®111,(/—A�11p� �zw with Secsion]OfYJ)af Division Jof the Business add Professions Code.add mylicetse is in full forte and effect. License Class Lice DEMO PLASTIC POOL Dam Contractor. -� �i�l2005 ARCHITECTS DECLARATION < I undersand my plans shell W Oneidas public me.,& 7yU U.1— LkerseI Professional I OWNER-BUILDER DECLARATION a 0 I hereby,affordSect on I a1..empt from Nro ConuaaCo c;enseAny city o for the xH0 which re mann.(Section R131.S,Business and use,densol Calc:Any city or counre m which requires a permit rat rnnsuun,alter,improve,demolish,m repair any xhumum Fit prior ter is issuance,also m,uitesthe applicant for such permit to rile a signed statement Valuat < Nat W is licensed puuuant to Ne previsions of the Contractor's License Law(Chapmr9 Sq.Ft. Floor Area w�$ (commencing with Section 7")of Division 3of the Business and Professions Count)or .. out he is exempt dumfound and the basis for Um alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicinrto a civil penalty of 3� d. ,er00 Occupancy Type not mom Non five hundred dollars(5500). ❑I.as owner of the property.Or my employees with wag.as their to c urperni will do the work,and the structure is not intended oroffered forsak(See 7044,Business Required Inspections and Profession'Cade:The Conuactoh License Law does not apply to in owner of q P Property who builds or improv.thereon,and who docs such wmk himmlf or through his Own employe.,provided that such improvements art not intended or offered for sale.If. however.Ne building or improvement is cold within one year of completion,the owner- builder will has the burden of proving that W did not Wild m improve for purpose of sok.). ❑1,as owner of the property,am uelusively eo dracting with licensed Contractors to construes the project(See.9044,Business and Profeaions Code:)The Contractors Li. cense Law docs not apply to an owner of property who builds or improves themon,add. who concocts for such projects with a conuactoKs)harmed pursuant o the Canuaaor's License law. I am exempt under C. 814ft B&PCfOrthismason Owncr M WORKER' COMPENSATION DECLARATION 1 hereby&Biirds under penalty of perjury one of Bar following declarations: I have and will maintain aCcnificate of Consent to calf-ion um for Worker's Comper- anon,a provided for by Second 3700 of the Labor Cade,for the pardi emote of nor work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Latin,Code.for Ne yerformance of on,work for which this permit is issmd. My Workers Compensation Insurance Cartier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section recd notbecomplcud if the permit is foronehundsrA Onllars($100) less.) I artily thm u the ierformnote of the work for which this permit is tied stall not cmployany'period 7iI�on in any mannerwa j WVac$ubemtLtNWo rt. 'piddrAhms Laws of California.Oats I/ 111 Applicant iOCA V A U VV I NOTICE TO APPLICANT:If,after making this Certificates of Exemption.you should become subject to the Worker's Compensation provisions of the Labor Code,you muss .,Z forthwith comply with such provisions or this Permit shall W deemed revoked. -. zO CONSTRUCTION LENDING AGENCY 'C+ (hereby aB'om our there is comvuctinn lending agcne,for tW perfuprom.of Cv 7 Ne work for which Nu permit is issued(Sec.3097,Civ.C.) (y Q Under'a Name z 1<nder'3 Address U C) I certify Nat I have read this application and sum that the about information is 14. f^ conduct.1 agree to comply with all city and county ordinances and sum laws relating to 0Ubuilding construction.and hereby authmim representatives of this city to enter upon the r 14 .nova-mentioned limpidly for inspection purposes. F' (We)agree re save,indemnify and keep harmless dm City of Carmine against CL liabilities.judgmenu,costs and Circuses which may in any way acme against said City U in consequence of the granting of this permit. APPLICANT U DE TV✓ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR�4E�,REG r� I / / l t� Yi Azgs�\ Re-roofs Signature of AppliardCantranor HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will the applicant or fu are building Occupant store or handle hazardous material as defined by dm Cupertino Municipal Cade,Chapter 9.12.and the Health and Sales, am.ScctMrr 25532(x)? All roofs shall be inspected prior to any roofing material being installed. �Ycs No Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove cmil hazardous air cotoamina u o defined by the Bay Area Air Quality Management all new materials for inspection. District ❑Yes I haus mad the havaNrma materials requirements under Chapter 695 of the Califor nu Health&SafCyCode.Sections 25505.25533 and 25534.1 undcuund Nat if the Wilding docs not Currently have a mount,that it ismresponsibility ton my the Occupant of the requirem �h, Use tpdnrmii n(a 5C.ofaenpamx Signature of Applicant Date owner m avmgriz.m,sent A D,m All roof coverings to be Class"B" or better �GJCITY OF CUPERTINO DEMO 0 S-Z.)CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# 10 01�ID— Date: 5 I n P I� Building Address: L- I� �3 ( q Pql- dr CLI r ��� r Owner's Name: MI ch q d q- V-P 1h �/-(] Phone #: /OY) q� .3 j3 q Contractor: // 1' �n &tr-0 C IG p License#:lY� �30q J C_.J 2 3 0 Contact: Phone#: 5q s - 4$q s Applicant/Contractor: Building Permit Info: Bldg Elect Plumb Mech Job Description: Residential: 0^0 pIAS* D001 Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: * 0�-000 ® Type of Construction: Occupancy Group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG 2� 7 � Y