08050125CITY OF CUPERTINO
CONTRACTOR Ii�ik'ORMATIONN:
BUILDING DIVISION PERMIT
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BUILo�Y�2�FshUCILLE AVE
TBD — TO BE DETERMINED
P0805 .
08050125
•I'S NAME:
PERMTT ISSUE DATE .
DB RE CALIFORNIA RESIDL 1 LLC
05/14/2008
PHONE:
SANITARY NO. CENTRE N0.
ARCHTIECDENGINEER:
BUILDING PERMIT INFO
BLDG EIPC7 PLUMB MECN
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LICENSED CONTRACTOR'S DECLARATION
Chapter
Job Description
1 M.rtby "m that 1 an Beamed under provisions of 9 (Commenting
with Section 7").f Division 3o1'de Bu,in. ad PrefCdom Code, aha my limme is
REPLC OLD MNMNT SIGN W/NEW MNMT SIGN, RPLC WALL
in roll tame aha crane,. 74.,-00
Licenm , a Lle.g
LTRNG W'/NEW LETTRNG. NEW DIRECTIONS SIGN SERVICE
Da./Y—M�rlf V�Cowmw I OA1
ARCHTIECrSDECLARATION KtUN P6
PD BUS LIC 5/14/8
1 undersand my plans Audi W used a public record,
Licensed Pmfeaional
OW NER-BUILDER DECLARATION
I Wmby aUirm that I.. Camp, from me Conumtors Ucewe Law for the
rellowing mason. (Section RD 1.5. Budnw.s and Pmressiam Cam: Any city or county
which winter a Permit to cowrace alar, improve. damuluh, a minor my ,aactum
! mor Was mss... da requires me appliciut far Such permit to file a signal aummmt
that W u Recanted Pmmmt to the povisiow of dent Contractor, Lon¢ Ixw(C6apm 9
Sq. Ft. Floor Area
Valuation
I (Commencing with SeNan]D(Ky)ofDivbion3offlan, But. andPrerwsiawCode)m
$7400
that ha is attempt therefrom ad the buffs for me alleged eaemption. My violation of
'ber
31602094Ap`AG
Occupancy Type
oehatfiwheaadea,mRmbjearen applicmtmacvB penalty of
on Fmtrohmdmdella,
0 L u nacre of the Property, or my employees with wages u leu role compenwlan,
will do the work and the asmmum is not imMed oronered far tele (Sec. 7044. Business
ad Pmreedona Cade The Cmumrafs Licence Law does ret apply to m ovmu of
Required Inspections
pmpcnY who buiMaorimprmeadcreon.roti who doaachwortli mteVm am igh hu
ownnmploycom. pravMed thatioch improaemants we Out intended worcmvd reale IL
a ner-
however. the Wilding or impmvemmt is mid within arc year o(completion. the Cannot.
Wilder will have tha burden of proving met he did Out Wild or improve for purpose of
Wilder
-
ale.).
0 1. u owner of the property am conclusively connecting with licare ad Cannanore in
_
construct the project (Sec. 7064. Business ad Professions Cade:) The CoanaetwY U.
.
areae Law doer at apply to m owner of property who Wilds or impru. thereon, ad.
who contacts fmauch projects with a contramr(s) ncemend porwnt in me Contractor,
Lieewe Law.
acmm under See. ,B&PC fourthis moon
Dao
WORKER'S COMPENSATION DECLARATION
1 hereby affirm ander peachy of perjury one .[ft felmwing dmlanniow:
❑ I haw and will maintain a Certificate of Consent to sill-IwurtfaWohcr,Compon-
sodw. u provided fn by Sedan 3700 of me Labm Code. fm the performance of the
wwo It far which this Permit is Caw&
L,fI NVe and will maimaln Worker, ('OmpewYio. I... Y RgdRd by Sccdoa
...
3700 of me Labor Code, far the pcdomante of the work for which this permit is issued.
'
MY Workers Compewatian Imuran¢ artier ad Polley, numbbVintV -zap
S7*7X Al" Ire/ %
Ca mr. policy No.:
.
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu secure rand mtbecompleed if me perch u fmow hunNedmBu, (5100)
or leu)
1 cmtify Wt th the pmfomente of the woh fw which mi, permim u ivued. l sled I ata
employanypormnInmymwffljub ytbJalbtie Wortrn'Compewatim
Law, of Califomry' Data f Y //��11 X
Appllan v.,Tpeel /
NOTICE TO APPLICANT: If. Ata making this Ccrrifiwe of Exemption, you Amid
become aublmt On the Worker, Compensation previsions of the Lam Code, you muss
forthwith comply with each favyiA w or this Permit shall W rimmed revoked.
I
CONSTRUCTION LENDING AGENCY
I hereby afreme that mem it. contraction lending away, for the paformmce of
the weak far which this wrmlt is lewd (sec. 3097, Civ. C.)
Lenders Name
Lenmr, Address
1 cortin &a' 1 have rad ria application ad am this me aWve infomatim la
const I agree M comply with dl city ad county mdinms and ,u c Inn .[.do, b
Wilding cooamnion. and hereby mthada rtpnsenauvets of this city in cant upon the
aWvatimjunwd property row iwpeNon puryosea
(We) agree to ave, indemnify ad kcp harmless the City of Cupcnim agaimt
cannoneer which may in mal way aCave against aid Coy
aceaman
into Of th.Sonatand
m ofineRSTAN ofA
APPLICANT AND
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURcy REGU
Issued by: Date
TITINS.
1'i1Y108
Re -roofs
Sigmure of ApliCDab
HAZA1tDOUS MATERIALS DISCLOSURE
Type of ROOF -
Will ftfMuni Wildinge.
aedle health
amalarial
Cuantnd
and Chaotvee2,
the Cupertino Municipal code. Clnpur 9.1; roti he Health roti safety
io
. section 25532(a)7
❑Yes 040
All roofs shall be inspected prior to any roofing material being installed.
Will de epplicam of comm Wading ocou,a, um amiip era or mriru which
'If a roof is installed without first obtaining an inspection, I agree to remove
call hnaNaw air comoma�na d by the Bay Area Air Quality Management
all new materials for inspection.
�a �date
CYw 4;1
I have rtvl the hnaNrma maserlalsrtquiremenuunmr Cheparb.95 of IM Califon
sin HClth&Salley Com, Secdwu 155f)5,]5533md 25534. Intolerant thatiflhe Wilding
does not currently ham a anmC mel it is my r apowibility OF nobly the mcupmr of the
reyuirtmyu whp he mnpriar lermanatee of a ccn""";; yep 14
/�
Signature of Applicant Date
I All roof coverings to be Class 'A" or better
Owner or witthhori ad agent Dara