08050175CITY OF CUPERTINO:Ns.r�yaa"
BUILDING DIVISION PERMIT
�C�CTORIt�A'O�IV',1�
yCONSTRUCTION
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PUSU 3175
R'S NAME:
PERMIT ISSUE DATE
GPLE INC.
1042 HAMILTON CT
06/09/2008
PHONE:
(650)701-1500
SANTIARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PE RMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
1 becbY IiceesN Chapter 9
•,
lob Description
under pmvivons of
a(fim that 1 am under l (commengna
with Sccwm7O(aBofDlvl 'on 3ofw Busmos;Wd�0rl mMCq awmy Recvei]
T. I .—RENNOVATION OF 2 MEN'S /WOMEN'S RESTROOM, NO
in full forte and cffem "I (/
ueenam cl s Lk.N
RE—ROOF OR STRUCTURAL.'
Dak_L /,-M Cmlrnmr (_nE]$iQ a,C'S't yr'
�T'�H DELLA ION
RATION
11 x use r
1 undcrmanJ my plan] dull W used n public encord
Licensed Pmrassional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the COoruloes License Law for the
following mason. (Secdon 703 1.5, Business and Professions Code: Any city at county
whish enquires a permit las construct. altar, improved, dcmalkh, or repair any structure
prior to its issuance. site requires the applicant for such permit to rile a signed audience,
do Wis licensed Paan, to the Previsions of the Contractor's license Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Busncssand Professor. Code) or
$50000
Nat he it eempa therefrom and the but, for the alleged exemption. Any violadun of
Section 7031.5 by any appliont fee a permit subjects the applicant to a civil penalty of
32633096 Number
Occupancy
Occas
,ml mom than me hundred dollar] ISM
0 1, n owner of the pmpcny, or my employees with wagns n coir sole compensadon,
and da Newark, and w mu Com is unes Lt. IXaw clo forsak (Sec. ]014, Butnm
Nd CanYlemrs Law apply m rt aWMr ar
Required Inspections
property habu builds ode W
ha Wilds improves
inmates uch or
wW desambworkhimuJrar Nmugph.
ovetop
awo employes, provided himpr ve
ingorimprovement k said within one, yeas of eompkdfo, w owner.
Wilder win have w Wrden of purring Nn he did Int builtl w impraa for purpose of
ask.).
0 1. as owner of the property. am exclusively contracting with ]!Caused contractors in
'
construct w Mica (Sec. 7044, Business and Proressiarts Code:) The Contractor's Li-
ve law does am apply to as owner of property who Wilds or improves; wscon, and,
who contract] for such projects with a ronlfYla,(]) licensed PunWal us wr'AnVCmr]
Lkeaue law.
lam exemptuntlersec. ,BBPCferthiseaden
Data
WORKER'S COMPENSATION DECLARATION
1 Wmby aRm under penalty of perjury and of w following declarations:
0 lhsv MllmainWnaCen morConsentmulf-inuumfo Workers Compen-
•• -
udon, n providW fm by Section J70o of IW ISWr Code. farw pedwasm a of t e
week for which this permit is lssmd
0 1 baa and will maintain Workers Compensation LvuranCa, a required by Section
3A c(the labor Cade, for the peRammcc ofw were for which this permit u issued.
'
My Worker's Compemadan Ivurame carticr d Polity n r sen:
Cartier. �1—.0 T IO MI oliry No.: L
FIC
CER�GiE OFOF EXEM ON FROM 1*1_11S'
COMPENSAnO INSURANCE
(Thu xnlon need tat W completed if IW permit is Ind. hundred dome IS IM)
or leu.)
1 cenify that in the pnfomancc of On work for which Nia Permit is issued, l shall not
employ anypcmon in any mannered a to become subject to de Workera compevatim
.
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
become subject to the W sics's Cmnpewtien provisions of the U,, Code, you most
foMwi,h comply with smh include. or Of, permit dull W dcemeA revoked,
CONSTRUCTION LENDING AGENCY
I hereby aRm thal than it. covtructinn lending agemy row the P rrormanee at
the work for which this penis is issued (Sec. 3097, Cih, C.)
Lenders Nmme
'
I<nders Address
1 certify that 1 have read this application and sum that w abone infomatim u
Garrett 1 agree to comply with all city and county Odie. and sum laws relating to
building construction, and hereby sunburns represcnuuves of this city to enia upon w
abw c -mentioned pmpeny for inspection purposes.
(We) agree to sea, indemnify and keep hamleas the City or Cupcnom against
Iiabilidca, judgments, costs and expenses which may in any way time against said City
in co ranee o w [noise[ of Nia pcmlt.
APP I A DERSTANDSA WIL PLY WITHA N N -POINT
Issued by: Date
Re -roofs
Si mprA tic ✓Coronae Data
HAZARDO s ATERIAIS DISCLOSURE
Type of Roof
Win wap'licammrut (ding mcupo anene ortuedle hanrdov matariA
-
ned by the Cupertino Munici I Code. Chapter 9.11. and w HeaIN and Safety
•.surae zss31(,)?
❑Ys Nu
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant mm equipment or dcvicrs which
If a roof is installed without first obtaining an inspection, 1 agree to remove
emh heurdnv air commonaants Is d recd by the Bay Area Air Quality Management
all new materials for inspection.
District?
OYv No
,Ivn nad w hva,dwa materials requienmcros under Chapter 6.95 ofw Caiifer.
n" 1 A c Cotic, Sectors, 15YI5, 25533 and 25534. I urWcmnd that ifthe Wilding
rot l lout a enan4 hoary mipomioilay to notify Lip occupant of the
regain m hm"Ixect in afaCalsixatcP
Zqj0p)
Signature of Applicant Dale
All-
All roof coverings to be Class "Raw or better
con oramha dageo, Dam
G