05020141 CITY OF CUPERTINO "1^^'
BUILDING DIVISION PERMIT �i T,,RACT Ok�INF,ORMATION
BUILDING ADDRESS: PERMIT NO.
SOUTH BAY CONSTRUCTION CO INC 05020141
LAZANRO DR
OWNER'S NAME: PERMIT ISSUE DATE
E:
SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION Job Description
W❑ I Mrfi
mby atm Nat I am licensed short proio
visns of Chapter 9(commencing
iW with Section 70Ml).fDivision Sof NC Business and Paressimm Code.and mylicres".
fall roma and effaC `� 1
LitemeClw�Lk.. TI--RECONFIGURE COMPUTER RM/HVAC
—c Dao W� Coinracmr ELECT. DISTRIBUTION/RACKS/STRUC. SUPPORT
�i¢�t ARCHITECTS DECLARATION
< I understand my plans shall W rued u public meet&
dryV
o G Licensed Professional
g OWNER-BUILDER DECLARATION .
I hereby affirm th.s I am exempt from the Conmacmrs License Law twine
_p0 following reason.(Section fll31.5,Business and Professions Code:Any city or county
K m which requires a permit to Construct,alter,improve,demolish,or repair any amucam
u �+ prior Or its issuance,also"or=she applicant for such permit to file a signed su¢mem
t?'< tbarheislicensedpursuammshepmvisionsofth,CoM.1.1.Lic...Law(chapter9 Sq. Ft. Floor Area V*-aat n000
,?n (commencing with Section 7")of Division 3 of the B tidiness and Professions Cole)or
y $
that he is exempt therefrom and de btu for the alleged exemption,Any violation of
Section 7031.5 by try applicant far•pc.it subjects the applicant to.civil penalty of APN Number Occupancy Type
not more than five hundrcd dollars(5500). _
❑1.as owner of tae property,or my amploycu with wagei a their sole compensation, n\ 3.2 6 3 3 0 9 6"0 0
willdo thowork,and lheslruqureis nmimendedorartered mrs.1.(See.1004.Business - /� Required Inspections
azo Professimu Code:The Cmummu is License Law does nut apply to an owner of - - q P
property who Wilds orimprosv thereon,and who dwssuch work himeellar through his —s
own employats,provided that such improwneents are notimended or offered for sales If. f/ h n
however,the building or improvement is sold within one year orcompledon.the owner- g} 7 Iti rj
builder will hers the burden of proving that he did not Wild or improve for purpose of f J
sale.). `
❑1,as Owner of the property,am exclusively contacting with licensed contractors to 1 1
comsmct the projoet(Sec.7044.Business and Professiom Codc:)The Contractors Li-
cans law does not apply to an owner of property who Wilds or improves thereon.and .. . o
who contracts for such projects with a eortraemr(s)licensed pursuant to the Committers
License Law.
❑I am exempt under Sep .B&P C for this mason
Owner Data
1307MWORKERS COMPENSATION OECLARATION
1 hereby affirm under penalty of perjury one of the following dechrations:
bare and will maintain a Certificate or Content to aelf-mano for Warkera Compen-
n,as provided fm by Section 3100 Of the Labor Code.for the performance of the
for which this permit is issued.
buss and will maintain Worker s Compcmation Imrsnce,as required by Section mf the labor Code,for the performance of Ne work for which this permit is issued.
Wmrkines.Compensatio Insurance canier and Policy numMrraam:
ier. /s ���..-TKSwitwc.poliry No.: Q 11
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE '
(This seChion teed not W camplctod if tie permit Is fmonc hundred dollars(11110)
m Isis.)
1 certify thin in the performance of Out work far which this permit u issued.)shell not
employ any person in any manner an as in warm subject to the Workers Compensation
Laws of California.Dote
Applicant
NOTICE TO APPLICANT:IL after making this Certifseatc of Exemption.you should
become subject in the Worker'a Compensation provisions or the Labor Code,you must
0Z forthwith comply with such priarmom or this pmmiuhall W cleaned newkad.
ZO CONSTRUCTION LENDING AGENCY
t-w I hereby affirm that there is a construction lending Monty far the Performance of
> the work for which this permit is issued(Sec.309'1,Civ.C.)
W Q Lender's Name
D. Lender's Address
V O 1 totally Net 1 have reit this application and cam that Nc mere information is
ly F" careen.1 agree to comply with all city and county ordinances and sum laws relating to
QU building tonswnian.and hereby authorimrepresCradws or this city to enter upon the
W shove-mentioned proparty for inspection purposes.
G (We)agree to save,indcmni ry and keep harmless the City of Cupertino against
N
liabilities.judgments,costs and expenses which may in any way actmc against Mid City
U in consequence or the graining of this permit.
�AyyPLI�ANT UNDERSTANDS ANS WILL COMPLY WITH ALL NON-POINT Issued by: Date
S/JUI!/jE REG /J // t f/�/
s sP' t� a Re-roofs
St azure of ApDlicaHAZARDO Oeste
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicantar( ubuildingoccupant seamor handle amommatetlal
as defined by dM
e Cupertino Municipal
cipal Code.Chapter 9.11,and the Health and Safety
Code,Section 15531(x)?
Ys Nu
All roofs shall be inspected prior to'any roofing material being installed.
❑ R1
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
I aemm rdnair Contaminants as dcfmcd by the Bay Arta Air Quality Managcmcin all new materials for inspection.
¢vin?
J ❑Yes
1 hoc mad the hvaNtws materials mquiretucnu under Clupterri.95 of the Caliroa
.is Heolth&SarctyCodc.Sadmu 25505.25533 and25534.1 undcrsatm tam ifthe Wilding �/(j�y./�- ✓ azar a
Josttmmly M1avc a¢nook that it is m rcaptmibit y m notify d¢apan
cut fir Nc '�+�'�✓� > l
re immts hichmu licactprinrm1a aMemr.c�rateorp�/panCy/ Signature of Applicant Date
ownartr,tmori�<dagent � Date All roof coverings to be Class "B" or better