00110068CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
21_'221 MCCLELLAND RD
SARATOGA BUILDERS
PIIKNIIT NO
001.100E;8
OWNER'S NAME :
�P Ce 4Y5fyqn
000
CUPERTINO CITY OF
12244 SARATOGR—SUNNYPH�tr`KL'L1/
PHONE :
SANITARY NO, CONTROI. NO.
(408)252-9404
ARCIIITECr/ENGINEEK: t
BUILDING PERMIT INTO
NLDG r:1.liCl' PLUMB MECII
r_I u Ll
LICENSED CONTRACTORS IIECLARA'I [ON
lob Descriptionn1
thereby .flirm thus I .,it licensed] under provisions of Chapter 9 (cn onraclug
with Section 7gX)) of Division 3 of the Rmines, and ProfieasionsCWe, and] nlvlcense
ADA UPGRADE
in1'ull force nnA cf"e`er_
sc Cl...ATH
w I.iap_ 6T93as/
on
Done CDECI-A
,
ARCHITECT'S ECr'ti DECL tic ace JN
1 unacrsmnJ my plans shell M used as Puhlic tewtrds
/
/
Lians.:d Pml'ex,inael
fJWNI?K-ItUll.blilt UIi.CLARA'IION
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1 hereby affirm that I am exempt from the Contractor', Liceme U. for the
following rennin. (Section 703 L5. Basions and Prfessisns CWe: Any city or county
which 4. permit Locleastroct.411CF, imprt)vc.detiit)lish.orreptiraliy%tmctum
O
/
(ni... Inds': of y the up,11.1iI lot suchpermit tfile asigned nmtea
Sq. Ft. Floor Area
Veluatio
then he licc,i,dP mcnin, the milisono,ol11 Conamnim., License (Chapter9
(commencing with Section 70(X11 sl Division 3 of the Boniness and Prolix.ions Otdc)
l
or that he is n arld therefrom and the basis for The alleged esentption. Any vinlation
,it section 7031 5 by any applicant for a Permit subjects the applicant to a civil Penalty
APN Number
Occupancy Type
of not more conn fee bandred dollar. (as m)
�T
35706011.00
0 L mnwnerof the norm laces with Isms., lhcirsWccnm tion.
Props r v t pc.7
RR fired Inspections
structure i. not intended o, seem, far sale (Secy
will Jct the work. and om iv
)an
it)
business and p, Code: The License Law, ansa not apply u) am
whobdad.. wn,knimmdr
Who
SEWER 8 WATER
close', proPe cY or,,,idceOil a,h,nnewhodm,..,nen
property newsContractor'stherco
ar,,rough his own cmPever, t Prov Wed mol ouch imnpmvunw7m ee no In(ended] ar
oecrWfon sale. iLhowcvcp mellawthebrdenvemenr. sole within one year or
1.06 —
20.12 — UNDERFLOOR PLUMBING
will nave the sordes of proviso that he ata not hill m
u,,prove sfor
i pose of sane.)
nP,ovc impose of
301 — ROUGH PLUMDING
01.mowner, the pno,ny.cmc.em,iveiyeonner, ... tgwhnlicensed eontrone It,
302 — TUB R" OR SHOWER
construe, the project IS,,. "QW. Burins.,, :mJ ProGsdans Corse:) a is Conwetn "
ENERGY
Liecme law does net.PPly to answme,ofppi who bold, or improves them,
502 — FINAL PLUMBING
nand who commcu for such Projects with a asnmctods) ,kerma pn„uant to the
506 — GAS TEST
enmctor's Lic„c Law.
❑Iamexcn,ptunder See , .BffiPCILrthis falon
507 — FINAL PLUMBING
owner Date
W'ORKER'S COMPIiNSAI'[ON DFCI,%RA'I'[ON
I herhy nation ...nlet penally of pc jury ane of Jm follelic, dl'Da oaien.:
Y0 1 have and will maintain a Cenilicate of Consent to self insrc for Worker's
Compensation, as provided lo, b) Section 37IX1 of the Luka CWe, for the
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perfnnn:mce of the work lit which this, permit to issued. _
01 haw and will reach.... Worwas C.... cm,,ieu Inwruncc, as reytdred by section
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371X) of the Labor Code, for the pefinmmnce of me work for which this period is
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sued. My Workers Compensation IInnsurance carrierandoumber at
jPolicy
C'africr:-CIO lC.UtTllaCAl1ON'(JI'1IXLMI'f1O�I9tOh1 N'ONKhH+'
COMPENSATION INSURANCE
,
This stet ion need not lac completed if the Pcrmit is for enc hundred drams
'
(s I IIID m' Icxr.)
1 cemly That in the performance m the work tsr which Thi., permit i, i....d. 1
shall not employ any Person in any .tanner to as to become subject to The Workers
Comisnwuon Laws of CeliTerm Date
Applicant
NOTICE 'IY APPLICAN P hoofer making lo, Cermif-br o1' :wcoptim6 yrnt should
hrvm.suhNct tome Wnrkre's Cten,m tion provisionsofenc Looe CWe, you must
Inrthwith comply with such provisions or this permit ,hall be deemed revoked.
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CONST RUCTION LENDING AGENCY
1 hnahy affna ohm there is n on,msoom lentim, vE,avy Ger he perrnn rare,
of the ..,it for which his peril is ironed (Sec. 91X97, Civ. C.)
I.ender', Name
Lender's Addm,,
I cushy IMn I hoc read thi.....Plication anal nwm Ina, the Lot v mromndlimt In
correct . I .glee To cont Ply with all city and county ordinance, and name laws miming
m building conswction, and hereby uuthori¢ representatives ofmi.v city is enter upon
the aMwc.mentloned property far inspection PurPta<es.
(We) agree to saw. indemnily and keep hnnnleo, the City of CUIFnino against
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BnMrTie" jud,m nt....ar.. art espmues wMch may In any way ecus again.,) sail
City in coneoyaence of the granting ill this pirmoL
UNI3F.RSTANUS AND WILL C(JMPLY WITII ALL NO I'OI�f
Date' L` `�
APPLICpsT
Issued by:
y'
SOURC
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Signuwrc nfApplicunUCun.neo, Dale
Re-roofs
e hvaNnus
Will Hans is, carre hlA'IP,It1AL4 D6CLor Moshe
(Neto heal Coit,
u9,12,arm
Type of Roof .
e.oreChant
and t Safety
enc btunicipal Code. CM1upmr 1.12, and] the Ileahh and safety
m y the Ct,eroar
Coot,Section 32(a)?na
Code. El ye, 2553$uyl ONu
All roofs shall be inspected prior to any rooting material being installed.
Will the opphearorhome m0dingnec.andme vii,iman a,de two which
If a roof is installed without first obtaining an inspection, I agree to remove
emit na.ardo.e air emmtninaots a. defined by the Bay Area An Quality Matmgcment
D.Inelr
all new materials for inspection. Applicant understands and will comply with
` ONo
/m GYes
all Icon-point source regulations.
I have read the hvanlous maerials myuiremcm, under Chuprr 6,95 of he
Califomlo llcahn & Safety Code, Sections 25505, 25533 and 25531. 1 understand that
ifthc milding does not contend, have acerae, mal it is on, rapoobilhym notify the
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nc'cupam of he ,ryunen vot, whleh must be nict poor It) i..uanec of a Cenifwte of
Uuu
"y � ��/A
Signature of Applicant Date
All roof coverings to be Class rB" or better
I wcc, oranmoued ngce i 1a
OFFICE