Loading...
00060083 CITY OPFjOPERTINO PERMITNO. nut��ll�uvtsgoly PERMIT CONTRACTOR INFORMATION: 'p-/�h /„ !�0 g' BUILDING ADORES$$ s�D od 64-/A� UU VJ V //' SANITARY NO. APPLICATION SUBMITTAL DATI OWNLR' h .r!<� ?5t319rG1���Q/IC/96'l� N/C CONTROL# PHON.^^,: C/V� /lYY -V ✓�///VN///G,; C� 9�4�'i"0 � nRCIIITECI'IIiNGINEIiR - �z/,S / BULIIING PERMIT INTO a'o Oji Y/GJJT( W C I�1-- , LICENSED CONTRACTOR'S DECLARATION ,"3 I hereby aRn t then,1 am licensed under provisions of Chapter 9(commencing Job Description r L L: wilhSettion'1800)ofDaisjsion3oftbelbomenand fuvo Cede.ard m'Ima m" < in full force anal effat r aLicenx Claaa _ Lic.X 3 a H Dam G C 5 AsDECLaw nON 1undeuud mpin,shall Immeed u public rccordr tea% >.o Licensed Pml<wiowl OWNER-BUILDER ON s-i a I hereby are"Ben ut 1 sexempt from m CNee ContrComm ecmh License Law for the ❑ following..(Section 7031.5.Bmircss and Prof ions Code:Any city a aunty F� which rcqume,a permit m cmntruct,aIle,improve,damolieh,err mpon.Y."cove 3_ prior to its i.awna,9.squires the applicant formch permit to Elea.tigrcdmtemat Sq. FL Floor Area Valu tion Nath<is lianud punwnt t.Ne provisions of Bte Canuacore Lianx law(Chapter9 0.oa- oa (commcncingwiNSecdon7")of Division3ofNeBusimusM fasionsCW)or APNumccuane Nber OTYP e Nat he is eumpt Bwefmm W the taxis fa tM allcgN eaempuon.Any vmmtion of P Y Section)031.3 by any applicant for a permit mbjats Bte applicant m a civil pewlry of pt more an rive hundred dollars(5300). NI,aa.wm,nrtep.perry,mmyempayec.wiNw.geanNe'vxlec.mpensui.., Required Inspections will do the work,and Ne structure is.1 lmmuledim.M and for We(Sec.7000,Bminess and professions Code:The Cmumaclor'a License raw does rc1 apply 10 an owner of property wed builds or improves Joao,and who does such work himself or through his own...loyess,provided that such impovemenu are not intended or offered for We.If.howe"L to building.,improvement hold wiNinorc yarofcompletion,the me r-Wilder will have the burden of proving that he did not Wild or improve for pur- you of sale.), / 1,a owner of Ne Seen •.Business ndus and contracting wird l The Ccmarram s i- O construct des not (Sec.7W.an owner andprofessionswho Wilds Cade:)The eadaemon.V- whoclaw coca ton apply m tx owner of progeny who Wilds rs immovm Centro,and who Law.for such projam wird econ"ctm(x)licensed purtuent t.the Contractors 0 License law. ❑1 um exempt ceder Sce. .B&P C for Nis recon Owner Dat WORKER'S COMPENSATION DECLARATION I hereby alarm under permy of perjury one of Ne following dederaioru: ,• ❑Ihavc aM will mainuimaCenifiwtc ofC.nsaOo self-insurefmwoheraCompen- sation,is provided for by Section 3700 of the Labor Cade.for the performance of Ne wok fess,which this permit is issued. ZI will msimain Workefs Compensation Imminence,as rtquired by Sector. 37,1(1 niche labor Code,for Ne performers of the work for which this permit I.issued. My Woh yC quyeBG Fgryn and policy number ucJ,1�C/- Calsyl Y'LeY!/ policy No:�;SYA !J(!/ CERTIFTCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cnis.section need not becomple adn'th,pcmtil is forces hunN.dddlus(SIM) or lna.) I certify Bw in the performaneenf Ne work for which this permit is is.ued,I shall not employ any perxn in any manner x as m become mbjat to Use Workeri C.mpen- m ine Laws of California.Dam Applicant . NOTICE TO APPLICANT:If,after making this Cenirscuc of Esmmptio.,yw mould hanme subject to the Worker'.Compensmion provisions of Ne Labor Code,you mum foMwiN comply wit such provisions or Ni.permit Wall W demand revoked. CONSTRUCTION LENDING AGENCY Q I hersby aR"Nat tem is.const uction lending agency for the pafurmvtee of Z 2 the week for which this permit is issued(See.3197.Civ.C.) Under,Name tenders Addrn:u W I cerllfy coal have mad this application ata sum that the above information is IL ~ correct.I agree t0 comply with all city and county ouvirmces and sum laws relating 10 Z building construction,ata lamby authorize repreunwiven of thus city to enter upon the V C) above-mentioned property,for inspection purposes. Gr. t--i (We)age n m save,indemnify and keep harmless Ne City of Cupertino agginul C) r, liabilmes.judgme.u,costs and wpenxs which may in any way accrue against said City >. W in conxquere of the granting of Ni.pemN. rN Gc APPLICAN'I- �NDRRS'I'ANDSANDWIL,C(IMVLY WITI{ALLNON-PO f z SOURC1 I IONS. GD g o A licardC.n Due HAZARDOUS MATERIALS DISCLOSURE Will Bee applicant or future Wilding occupant store or handle haiud.us material Re-roofs def.cd by the Cupertino Municipal Code.Chapter 9.12,end the HWN ata Safety Code,sectio.255R107 Type of Roof ❑Yes ®Nu Wit the appEcamt or fPuture Wilding occupant we equipme.r m device.which All roofs shall be inspected prior to any roofing material being ,.it hnardour sir contaminants as defined by the Bay Arc.AU Quality Management installed. If a roof is installed without first obtaining an inspection "^ ' Yes I agree to remove all new materials for inspection. Applicant ,�/N. g I here and the herarda mammals m,.immemu miler Chapter 695 of Ne CUb undeArstasand will comply with all non point source regulations. fomes Health&Safety Code,Sections 35505,W33 and 25380.1 uWosuM that if Bee building Jou tcu"oily Mvea mount,Nnit ix my rcsponnibiliry mtwtifY the rcupant (CL V C/(J of Itis h mot W met to issuance of a Cardinx.f ��- zAZ7L1 Si err ofAp 'ca t� Date (70r autonzed agent Delif A roof coverings to be Class"B"or better OFFICE