04090089 LCITY OF CUPERTINO + *% ' ' w g'w`'` `" �+ �r� s`�w!i
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION <
RDILDINGADDRESs: TIMBERLINE BUILDERS INC PERMIT No04090089
#NNE:
ER'S NAME: PEIT RMISSUE DATE '
YUVAL S
SANITARY N0. CONTROL N0.
(650) 868-5291
ARCHrtECTrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LOO LICENSED CONTRACTOR'S DECLARATION IOb Description
Fp I thereby Orion Nat 1 am licensed under Pmvitlons of Chapter 9(commencing P
�W with Section 7")of Division 3 ofthe Business and Professions Code,and my license is
"ch infull fClass errtef REVISION--RETAINING WALL
5 q? License Clue hue.A
—c Dam Contractor—
!2t:. NO NEW PERMIT ISSUED ORIG. #02080091
ARCHITECTS DECLARATION
'rya S-6
< 1 understand my plans shall he used u public records
G Ute, Licensed Professional
3 OWNER-BUILDER DECLARATION
I 1 hert6y from Nal 1 ore cxcmpr from the Conhanots License Law for the
O O following reason.(Section 1031.6,Business and Pmfeasions Conic:Any city or county
m(L which.quires a Permit to conn.",aItg.improve,demolish,or repair any structure
prim to is ismanee.alsu R tunas the applicant far such Permit to file a signed satemen,
Nat W is licensed pursuant to the movism.of NC Cmunno 's limn.Iaw(charter 9 Sq.Ft. Floor Area - Valuatic$115
'I-O (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y $
that he u exempt therefrom and the basis fm the alleged exemption.Any violadon of
Section 9031.5 by any applicvttfor a permit subjects Ne applicant.&civil Penalty of APN Number Occupancy Type
rc N
not maan five hundred dollen(5500). P Y YP
❑1,u owner of the pmpeny,or my employcu with wage u Noir role compenuBon. 35624004 . 00
will do the work.and Ne suu"ure Is not intended or offered forage(Sec.7W,Business
and Pmfeegma code:The Contncmrs Limme Law dose not apply to an owner or Required Inspections
property who builds or improves thereon.and who does such work himself or Nmugh his
ownemplayees,provided that such improvements=not intended oroffered forsale.IL
however,the building or improvement is sold within one you orcompletion.the owner-
builder will Iran Ne burden of proving that W did not Wild or improve for pu,gm of
sale).
❑I.u owner of project
Sec.7 am tad ss and Professions
contracting s with licensed mnuaoart i.
more, a the pmnot (Sec.o in Business and Rofcsoou dsCocke)or
The Contractor's Ld ,(�
who law dors not apply to ts owner of property who Wilds rs improm Coning arta. v r
whom.Law.for such projects with a conlracmr(s)liaised pursuant m the Conuador's
L sense law.
❑lam exempt untie See .B&PC for this rearm
mer Date
WORKERS COMPENSATION DECLARATION
1 hereby alma under Nosily of perjury,on:of the fallowing declarations:
I as and will maintain a Cenificam of Consent to sec f-insure for Wedges Compere
section,u pmvidcd for by Sgtion 3700 of the labor Code,for the PeRormanm of Nc
work for which this Permit is issued.
❑I have and will maintain Woulag s Compensation Insurance,as myumed by Section
3000 of the labor Cade,for the Performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carie and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section recd not W completed if the permit is faronc hundreddollm($100)
or lues)
1 certify Net in the perrermance of the work for which this permit is raged,l shall not
employ any person in any manner an u to become aubje"to tW Workers'Compensation
Laws of CaIi!.mnm Date
Applies.,
NOnCETO APPLICANT:IL after making this Cenificam of Exemption,you should
Wcome subject to the Worker's COmPenaallmn provisions of on,Labor Cade,you must
J$ forthwith comply with such provisions or this Permit shall W deemed faked.
'Z O
[-� IhereE affirm that Nem is a construction lending agency
for NC performance ofCONSTRUC ION LENDING AGENCY
thnder's which this Permit is issued(Sec.3(191,Civ.CJ
U)
P. Q Uss
ndch Naga,
z lender's Addre
U 0 1 certify that I have mad this application and stale that the above information is
!3w r correct.I agree to comply with all city,aod county ordinances and sate laws relating to
0 U Wilding co aination,and hereby auNosire representatives of this city to enter upon the
r 4 above-mcmdoned property for inspection purpose.
(We)agree in save.imlermi fy and keep hamless the City of Cupertino again,
Ffq liabilities,judgments.costs and cxpenscs which may in any way amore:against mid City
in
of t1m grantim,of
his Permit.
UZ
APPLICANT eUNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signature of ApplicaH Dao
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the&pPlicam or future Wilding mcupant acre or bootie haaraou material
az defined by dm Cunino Municipal Code.Chapter 9.13,and the Health and Sdcty
❑Yu
wc.Sccdon 25532(pe&)? ON. All roofs shall be inspected prior to any roofing material being installed.
7DiatWill the applicant or future Wilding occupant nue equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ric,?
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes ❑Nu
1 have mad lie haarddres materials requirements under Chapter 6.95 of the Califon Health&SgetyCoe,Section 25X)5,8533 and 25534.1 undersand Ns,ifNe Wilding
s not currently have a tenant,that it is my responsibility m rattly df capent fir the
uimmenu which mug W met prior to agoom of a Cerdress,of Occupancy. Signature of Applicant Date
Owner or authornad agent Date All roof coverings to be Class"B"or better