04030229 CITY OF CUPERTINO "'�w * g' • °' �° - "'
BUILDING DIVISION PERMIT CUN�LRAGYT.UR INk'UtA3A'I;I()1!7
BUILDING ADDRESS: ZIVKO CORP D.B.A METAL BLDPERMIT NO.o403O229
OWNER'S NAME: PERMIT ISSUE DAMNE: - SANITARYMMOL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB .MECH
u o o LICENSED CONTRACTOR'S DECLARATION Job Descri t
1 hereby affirm Nal 1 am licensed undera
provisions of Chapter 9(commencing P ' L ®
a� with Section 7")of Division 3 of Ne Business srM Professions Cade,and my licensee is
zgnmusclassand err«l. METAL ENCLOSURE
a DaenseClass Ctmr AUG 17 2004
p Dem Contractor
my ARCHITECTS DECLARATION
Y Iunderstand plans shell hmu
e used records 'CITY JOB-NO FEES DIE U BUILDING
c G Licensed Profcumad
3 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License law far the
3:0 O following reason.(Section 7131.5,Business and Professions Code:Any city or county
M2 which requires a Permit to convect,alter.improve,demolish,or repair any structure
prior to its issuance,also inquires the applieam for such Permit to file a signed statement
�Z< that he u licensed pursuant to the provisions of dm Contracteri License Law(Charter 9 Sq.Ft.Floor Area Valuation
z� (commencing with Section lBOB)of Division 3 of IM Business and Professions Code)or
$ that he is exempt therefrom and the basis for the alloged exemption.Any violation of
Section 1031.5 by am applicant fora permit subjects the appliesnl m a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars($500).
❑I,asownm of the property.or my employcu with wegesas Nelr sole campenulion.
will do the work,and theewmum is not intended or offered for sale(See.1044,Business606052 . 00 Required Inspections
and Pmfeuimu Cade:The Otmentmrs License Law does not apply m an owner of 9 P
property who bui Ids or improves thereon,and who does such work himself or through his
awn employees.provided that Such improvements an,notimm�ded waacred forsde If,
however,the building or improvement is sold within one year of rompletun,the owner-
builder will have the burden of preving that he did not bold or Improve for purpose of
tile.).
❑I,as owner of the property am exclusively contracting with licensed contractors m
ConsWct the project(See.1044,Business and PreGesions Cade:)The Contr«mr'a Li-
cense Law does not apply to an owner of property who Wilds at improves thereon.end.
who contracts for such projects with a commclor(s)licensed pursuance the Comtracmr's
License Law. /�
C3mempj•bgder S«. B @ P C for this reason
ave v U�/
w er \ a
t,..r WORKER'S COMPEN.A 10' T NDECLAR ON
1 hereby Strum under penalty of perjury orte of dm following declara ions: -
.I have and will maintain a Cenifieam mfComm�t m self-imus fm WmkabCompen-
.ution,as Provided for by Section 3100 of the Labor Code,for the performance of the
work fm which this permit is issued.
❑1 haw and will maintain Workers Compensation Insurance,as resolved by Section
3100 of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu seeliun necd not W completed Hill,Permit Is faronc humdreeldnllars(SIM)
or less.)
I certify that in the performance of Ne.,it far which this permit is issued,I shall net
employ any,maxot in any manner so as m become subject to the worker'Com acnsaRan
Laws of Califinmia.Dam
Applicata
NOTICE TO APPLICANT:If,after making this Cenifcam of Exemption,you should
become subject in the Worker's Campem thin provisions of the Iceisr Cede,you must
.,O forthwith comply with such provisions or this Permit shall be deemed revoked.
„zy i CONSTRUCTION LENDING AGENCY
(~ I hereby affirm That Nem is a convection lending agency for Be performs«of
Na IW work for which this permit is issued(Sec.3091.Civ.C.)
Q Lenders Name
:D z Lender's Address
V 0 I certify that I haw read this application and slate Nat the show information is
IL H correct.I agree m comply with all city and county ordinances and state laws mlating m
0O Wilding construction,and hereby auNarim repmaenutim of this city to entre upon the
{2a shove-mentioned proto ertysaw,for Inspection purposes.(hoc)acme to saw,indemnity and keep harmless the City of Cupertino against
fad liabilities, toss and expenses which may in any way Steven against aid City
U Z in co an cc of Ne gmalimg f this Pcmail,
APPLICA UNDERSTA SAND WILL COMPLY WITH ALN-POINT Issued by: Date
H.cl,
GULATIONs.
4 l U'{ Re-roofs
Signat re of Applicam/Canwnor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future Wilding occupant some or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and Bat Health and Safety
Code,&COon 25532(d? All roofs shall be inspected prior to any roofing material being installed.
❑Yes BF'u
Will the applicant or(alum building occupant sac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rah hazardous air contsminans as defined by the Bay Area Air Quality Management all new materials for inspection.
•District? 1�
❑Yes JNu
1 haw mad the hasardaus materials requirements underChepmr 6.95 of the Califor-
niaHcalth&Salm Code,seeioas 8505,25533 and 25534.1 undcrsNnd thazifNc Wilding
docs oat Cu tiy�have a morn at it is my responsibility m notify Ne occupant of Ne
-4inc which most Wm pdarWissuance orlCenific ofoccupan , Signature ofApplicant Date
r}
0 ,t f�1 0
Owner ser Narizcd seem Dam All roof coverings to be Class"B"or better