Loading...
00020149 CITY OF CUPERTINO - PERMITNO. BUILDING DIVISION ' E PERMIT CONTRACTOR INFORMATION: 00 2. © r BUILDING ADDRESS: los 5' M DRONXo, 3-2 C� Sfl�s 'IAC. NO. APPI.ICATIONSUBMiWAL DATE OWNER'nS NAME: f�Op ��I/• l/ / ' ,p f IC.# !_e /' GI �I q /•-N Z NIC CONTROL# ARCHITECT/ENGINEERp All BOLDING PERMIT INFO / kU� LICENSED CONTRACTOR'S DECLARATION - oZ=p '1 hereby athreadui 1 am handed#mer pmvisions of Chapter 9(enmmeming Job Description , F=Cor with S«tion 7000)df DivieionJoftu Business and Pmfeuiom Came,am my,lianait - a,o 52 sat eoxmrt fl.ae « 3 u n Dem Contra d✓ 1 eyN� t t g 01 ARCHI'1'ELT'S DECLARATION W�, 1 undemam my plans uhail be user ea public mec«ds - u�61 y5y O O IdcvuM Pmftesioral _ .. a OWNER-BUILDER DECLARATION qqqq ?e thereby#Man that 1 am exempt from me ConuactoYr Liana Law for the. c fz- following mason.(Section 7031.3,Business Bud Professions Code:Any city or county mWinch reopmes a ll to n,alcor,impmm se,deollah,or repair my,.a 3. armcamm primseimill...se.Mr."pimv lliiappliant far such permit tc file.aigrudaammem. Sq. FI. Floor Are Valuation Nat he is licensed Pursuant to Na e piesim ,of the Connecters License Law(Chapter 9 _ (commencing with5«don7lM)07 of Division3o(the Buriou and Profeuiom Code)or ' that Mix exempt therefrom am the basis for the alleged exemption.Any violation of A P Occupancy Type Sectob7031.3 by any applicant for a Nems subjects the applicant to a civil penalty of not mole than f ve hundred dollars(1500). ❑T.as owner ofdm progeny,or my employees with wages as their vole compematlm, 'TM&fed Inspections will tlo the work.endtheamcwrcienm imemedorortertdfo...In(S«.7014,Banums ^� W Professions Code:The Contractor i Liame L o W dm not apply to an comer of .VYe Porosity who builds or ianprovo thereon,atd who dog such work himself or through his own employees,provider that such improvements ate not intended or ortered for- sale.If,however,the building or impmvc om,build within ore ymr of ismplenon the co serbuildor will have the Wada of proving that he did net build or improve(a par. ' you of sale.). .. [1 1,as ower of the pro".am e.tImimly convecting WIN Incomes]c.re to - conrvuct the project(sec.7044,Businessland Profeai.Code:)The Contractus',Li. - ' cense law d«.not apply to an owner of property who Wilds or improves thereon,and, who contracts for each pmjecu with a conmcbm/0 licensed pursuanno Ne Comm am" - License law. , ❑I a an exempt under Sec. ,B&PC far Nis won v� Owner Dam I `'9 WGRIOiR'SCOMPENSATIONDECLARATION - i hereby affirm um«peachy of perjury oma of Ne following d«laaiiora: ❑I base am will maintain a Certificate of Cmaenuo only insum for Workers Compere nation,as pmvided fm by Section 3700 of the Lebo,Core,fm the petfomunoe of the `. work for which into .it is issued. - ✓ n.�l.. - . Elarid1 have awill maintain Wo lives Compensation Immance,u rtquucd by 5«tion _ 37U1afthe Lot.,Came far the perfamatee film kf h.ch th..p...... iso ed MY Weak,^rlC�orype Inverar{�cam dP I'Ynumbs Y (The section, CneeAh compleEerMiPfDNeOpNcaFnRO,is foWr orOoRKhauF!RdSrtd dollars(SIM) NCE D Be Jr...) I mr ify Wt in the pertovnaoe Mthe work for which this Boom is issued,Isiah ^' nee employ any person in any manor so as m becuane suhjav on the Workers'Campen. sation Laws of California.Dere s Applicant =CE'FO APPLICANT:IL ohm making this Cenificate of Exemption,you should ^ becoto subject to one Weathers Compematon provisions or the Lubar Code,you muse forthwith comply with such provisions or this permit shall c deemed amused CONSTRUCDON LENDING AGENCY .0 " IhercbY ulprm tat them ieaeonemNon laming agency for the perfumwce of` • ' z the workfor which this permit is nand(Sec.3097,Civ.C.) , F Lamers Name t• ..� > Lender',Address .. - . W E I malty that 1 have dad this.1hation and cora tut the above information is CLmarml.I agree to comply with ell city and county ordinances am sae laws bepiing to n V Obuilding construction,and hcmby audwrize aeprt®matives of this city to enter upon the t. aMve-memioned Property fm Inspection puaposes. sat F., - (We)again in save.indemnify and kap hamlas the City of Cuanino against - .,C V liabllitei,judgments,costs and expenses which may in Bay way accom agatnv said City } W in counuence of the graatng ofthn permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.P01NT ' p) Z SOURCE,REGULATIONS. - I SignatumcfAMbeant/Contrwmr ! Dam ' '• HAZARDOUS MATERIALS DISCLOSURE ' ' Will the appftcam a,Poore Building ompmt sera orhamle hazead...maria] '.Re-roofs M deflated by the Cupertino Municipal Code,Chapter 9.13,am the Health and Safety Code,Section 25532f o? Type of Roof ❑Yds El No ' ' Will the.,iauta,future Wilding occupant um ognipmemar de.icea which All roofs shall be inspected prior to an yy roofing material being emithaardove rev contaminants as defued by the Be,Area Au Quality Management installed. If a roof is Installed without tirst obtaining an inspection District?. - .I agree to remove all'new materials for inspection. Applicant ❑Yes [3 No d ` I luvea ddo,nomrdsm..ills mluirtmena user chepe,1 6.95 of to Cah. understands and will comply with all non point source regulations. Roma Heats&Safety Cade,Sections 2 ERP,25533 and 25534.1 understand that if ter Wilding does a cumnty hove a unapt,that it is my responsibility mortify the occupant � r y/ _ • of the rtq Lu9y4.t�4w_hichmumbemetpriormislae eofaCen Licata of Oce pmsy. ...•YYYYT/�`'///���`�������( U`i t3wnePdF thonlm•ens` t"'�7 dv//7� Signature of•Applicant'. - Date ea a Allroof coverings to be Class"B•'or better OFFICE