05060160 CITY OF CUPERTINO ,+:xra�+,
BUILDING DIVISION PERMIT CONTRACTOR�INVOO MATION ,,,
BUILDING ADDRESS: MURPHY TRAN 1111105060160
OWNER'S NAME: PERMIT ISSUE DATE
MURPHY TRAN 18861 LOREE AVE OR/95/9005
E: SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH 0
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�oz LICENSED CONTRACTOR'S DECLARATION Ib Description
r� I hereby af0rm that 1 am Immtawm
d roger provisions of Clu nor 9(mamanclOesCnP
n{
wireSccdon70W)ofDiAsion3ofhc Busfw "Pro ins liccnwis
kmnmme,adercea (sJS � ADD 1105 ' (L1V. ) & REMODEL &
��? License Cl Ck.M
F D,se Contramr
understandGARAGE—aI 2 3 '
TI
used
N
y�a+cy7 1 understand my pow shall
tll he be uwJ u public menrtls
=t� Licensed Pmfcstianal
OWNER-BUILDER DECLARATION
m I hereby afffem that I am exempt from me Commute,License Law for the
S:00 repeated moan.(Sadun 7031.5,Business and Profealow Code:Any city or county
n 9 1! which mqulaf a permit to eonalrum,alter,Improve.demnllsh.or repair any atwewre
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prior to its issuance.also requires the applicant for such permit us rile a signed statement
Ilgg�< Nat he la licensed prominentprominent to the provisions of the Comma r s License law(Chapter 9 Sq. Ft. Floor Area Val$"AOOO
$ (commencing with Section 7000)of Division 3 of the Buslnas and Profusion Crate)or
Nat he 4 exempt therefrom and the basis for me alleged exemption.Any vio4ton of
Section 7031.3 by atty appliant for a permit ubjects me applicant in a civil penalty of APN Number Occas ane
tat mom than five hundred dollars(M), P y TyPe
01,u owner of the property,or my cmployca with wags as debark compensation, 37513026 .00
will do the wok,and theafeuctum Is notinanded oraRead fonah(Sm.7044.Bwiwa
and Prerea4ow Code:The Cora en't Limme,Law does not apply in an owner of Required Inspections
Property who Wildsorimpoasmerman.and who dos such wok himsedfecthowth his
own employees,provided that such Improvements art not Intended oraRered(orale.If,
however,the building or improvement it veld within taw year of completion,the owner.
builder will hero the human of proving that he did not Wild w Improve for purpose of
ale.).
❑1.to owner of the so.7 ,.Bexclusivelysineand confession maim Bowed manfeamws w
Construct d Project(Sec.n an Business end rrofadaw Cade:)Theves mason. fid
cense law dos notch pro m an owner of property who Wilds or improv Quarantines and.
who contacts Law.for such projects maim econfeacwr(q licensed pwewnt b me ConvatoYa
0 I slaw.
❑lam aem�p�t7under Sea ,BkPCfa Ilia n � Aq
Own" ,�?m" �� Dam T Zf � /
WORKERS COMPENSATION DECLARATION
Ihend will miun@r pwltyafperjement of me elf-imure following declaratiWorker's Co
I h,as end will maintain eCe n 3700 of Consent wCode.farm for performance
a cempn- /
worn,r provided for mi Section 3700 0(the Labor Code.far the pcdormena of me 1"l�
wok for which rose Permit is issued.
❑I haw and will maintain Waltzes Compewadon Insurance,as required by Section
37Wof me labor Code,for the performance of me woa for which this permit is Issued.
My Workmes Compensation human artier and Policy number me: d^p
Carder. svhff C dMe Policy No.: I7
CERTIFICATE OF EXEMPTION FROM WORKERS' T ��
COMPENSATION INSURANCE T
(Thisseetlmt aed not W completed ifthe permit Isfwane hundred dollars($I00)
or lens)
1 cenify Not in the emptor ear of de,work for which the pemtit 4 issued.l shall am
employ any person In nay manner an as in baome subject in me workers Compensation
Laws of Califomis.Das _
Appliant
NOTICE TO APPLICANT:If,after making this Cminam of Exemption.you should
become subject in the Worker's Computation provisions of the Later Cade.you must
.JO Forthwith comply with tach provisions or Lots permit shall shall Wdamal revoked.
Z� CONSTRUCTION LENDING AGENCY
'�+ I hereby affirm that mart is s mnwation lending agency,for the perfarmwa of
tai .�
the work for which this permit 4 imposed(Sec.3097.Civ.C.)
0GQ Undoes Name
Z LendersAddress
UR I cenify that I haves read this application and sate that the&how information is
la burmct.l agree m comply with all city and county rain mof and role lawsupthe
(] Wilding construction,me,incomply
heathy wmodw county
onli mesmis sumity laws
totaling upon to
W he
above-mentioned Property(w Inspection Purposes
�"f•L (We)agree to on,indemnify and keep hmmleas the City of Cupcnino against s
tan Tri IlabilWa,judgments,corm and expenses which may in any my accuse against aid City
V`L
Inc he of me y of mis pemtir,
�'^ APPLICANT UN NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2
SOURCE
Dam
Re-roofs
Signature or ApplicanVCon
HAZARDOUS
Des
US MATERIALS DISCLOSURE Type of Roof
Will the applicant w future building ,Cupantataa bre amouf material
a defined by the Cupertino Municipal Cotle.Cheper and t H
9.17.roti the ulth and Safety
Cade.Section 25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
le ❑Yen ❑No
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mh havamous air cone emu as defined by the Bay Aaa Air Quality Management all new materials for inspection.
China?
❑Yes ❑Nu
1 have mad the hoard.,materials requimmenu under Chapter 6.95 of the Califar.
n4 Health&SarctyCade,Secdaw 25505,35533 and 25534.1 unde,und that tribe Wilding
Joel not comedy ham a tenant,that it is my map.sibil4y,in nobly the occupant of use
mquimrnen metpmetpiarwLuummofa Ccninamat0ce LSA Signature of Applicant Date
c itJ
Owner or atharircd agent r5me All roof coverings to be Class"B"or better