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00060111 CITY OF CUPERTINO PERMrrNO. (900,5- /0 / / j BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:. BUILDING ADDRESS: 0(0e.J SANITARY NO. APPLICATION SUBMITTAL DAT[ k) 1 M awl) jOWN' 'S NAME: ON Z O � , S �-sk—`�f /�]�Y Vim\ NIC CCTROL, �Mdd N1_ ARCHITLCfIENGINEER BULDI;IG PERMIT INFO s �� mz 00 CuP�12T la9v � d r y LICENSED CONTRACTOR'S DECLARATION zoIbe,eby,We.in,tE.mrem.wonderpm.;:inn,nrellipses 9(mmmen<in8 Job Description 4 E:wJ with Salion 1000)afDivision 3 of she Business and Professions Credit.sed my license is tc<6 in bill force aMeReci.i2 '0 Cl. s-� n X i O License Lie.0 Dale Gmvectur —LL C g ARCHITECTS DECLARATION 1 understood my Plans shall W used n Public records wm<S a a o Licensed!Professional OWNER-BURDER DECLARATION 1 hereby./flan does 1 un mempr from the Convacro/a License law for Ute 1 5 F p roltownes Emma(Salim 9031.5,Business nM Professions Chile:Any city or wumy 3 m which mquirp a permit tu couswn,aha.improve,dcrrolirh,or nepeu any avus:tme Sq. Ft. Floor Area Val n prior to its osmanm,atm¢quires the applicant formcli permit file a signed etaemcm shat he is licensed punuam to the psovisims of the Cmmttole Liman law(Clugm 9 (cormrcmivg wire Sold..a0oo)nf IN,,mm 3 of the Business coed Prolsourna cede)« ANumbs OC U anC T Nat he is exempt derefrom aM bu the ia for the elle ld eeempim.Any,whis no Of ..v Pttt�����1� ©/ O P Y yPe Section 1031.5 by my eppliclut No a pemdt subjects the iSsFi icanr 10 e civil,malty Of (� not muse Nen fve hundred dollen(35m). Losowner of use propcnI,or my employees with wages as their sole comKwtim, Required Inspections willmNe work,and the mucure is nm imnded or offemil for We(Sec.1016.Business end PmfessianI Colic:The Convector's License Lew docs Iwo apply or,en ow—a gopcny who builds or improves thereon,rued who does Inch work himself or ttIrmgh hiswn employees,Provided thin such improvements em nm intended or offered for sele.lf,however,he building or improvement is sold within me yesrof mmplcdm,rhe owner-mIr') will ova Nc buNcn of proving th.t he ata not Wild.,improve for put- BUSINESS pare Of salt.), ❑I,u ower of the Propene•am Business nOil cmvacting with licenced cinnamon u ooswm Ne Project ISec.Thad,.of and Professions Cede:1 The Connector's hal whom Lew coca nen apply tu ul Owner of property oro od o improves Norton.W wMmnrraw. such projectswiNaronhscmNsllicensedWnumOuthe Conrrecmts LICENSE Licenu law. I om exempt under Sec. .B A P C for this cousin Owner Dee WOhout.S COMPENSATION DECRITf-imme ON REQUIRED I hereby affirm under pcnelty of perjury One of the following decootimu: 1 hove sed will maintain a Cmificmc of CmrennO self-insure for Worker's Coupon. u pion,u provided for by Section 3100 of the Lmm Cade,for the performance of the work for which Nix person is issued. ❑1 have W will maintain Wmkcda Compensation Insurance.as"sand by Section 3700.t to labor Cade,for the perf...of iso work for which this,moil u issued. My Workels Compcwtion Inammcc carrier and Policy number sm: Cartier. Policy No: CERTIFICATE OF MEMPr10N FROM WORKERS' COMPENSATION INSURANCE (Thin section need nm o CmIllnrd if Nc pemur is foromhuedreu Wt.($100) Or Icss.) I ccnify dust in the p ofmmantt of the work for which this pemut is issued,i shell not employ my Person to my Whose., y to C.oubjecr to Ne WortrnCo.,.- section laws of Cdifyrryg,Dan APPlicant YVkb C n NOTICE TO APPLICANT':IL aha making this Cmif eco of Exemption,you should become,subject to the Wo ices Compensation pmvlsims of me Lebo Code,you must forthwith comply with such Provisions on this permit mall be danvd mvoked. CONMUC ION LENDING AGENCY Q p Ihereby Non taw there is.cumtmNon lending agency for the perfomunce of Z the work for which Nis permit is blued(Sec.3091.Civ,C.) Unds,Name 5 lender's Ademaa ry) 1 ccnify that I neve need thin it,licedm and sora that the move in(ormmrion is 0. clover.I ii,me,to comply with 91 city W county meivncu and...It mating to U Z building construction,and hereby stibium mpresmmivea of this city a enerupm the U C above-mentioned pml,my for inspection Imposes. Z /7 CL P (We) S.to save,indemnify and kxP bunt the City of Cupertino a8einsl -7 7 `Q U lieblluiea,jedgrmnts,amtsand csperse.which may in my wry accmeagoul said City } ry) in consequcme"Due Boating of Nis permit. F �• APPIJG 1'I'UNDIiRST'ANDSANIy WIL. OM PI.Y WITH ALL NONPOINTI U SOLI F.f.U1.AT ONS. Sienetwe0 ApplicmdCo mor ye, Y G llL a FiAT.A Us, B MATERIALS DISCLOSURE Wll the applicant or future Wilding mcupmt ouncruhWlehmudous metmd Re-roofs Is deGmd by the Cupertino Municipal Code.Chapor 9.12,and Ne Health and Smfety Type of Roof Code,Section 25532(e19 yP ❑Yes ❑No Will(ho mPlicml or future building occupant tau cquipmem or devices which All roofs shall be inspected prior to any roofing material being -snit hasucmn im cmuminmu u defncd by the Bay Arts Air Quality Mmngemem installed. If a roof is installed without first obtaining an inspection avimt I a e to remove all new materials for inspection. Applicant ❑Yea ❑Na rImove mist haunan themer,moucouiotssin de, mr6.95a Gi- u sten s and will mply with all non poi t source regulations. 'moo, HWN B Smety Cone.Sectimu 25505,25533 and 255.34.l uedcnNat if the G l' O f building dorm rom nculy hmO.temor,shut it is my milibibii'll 1=1 mmpant Or the mmiremenu which must NO m poor to issuance of a Cludiicao of Occupency. Signatu of App t Date Owner or authorized c8ent Date ' All roof coverings to be Class"B"or better OFFICE