07060115CITY OF CUPERTINO
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COIVTRACTQ)gNF'ORMATI0r
BUILDING DIVISION PERMIT
BUIT.18Q,IDSR MINE CT LOT 3
TBD — TO BE DETERMINED
PERMIT NO.
07060115
NER''Sf1NAME:
PERMIT ISSUE DATE
06/11/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTfENGINEER:
BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACIDR'S DECLARATION
Job Descri tion
p
1 hereby affirm WI I am licensemd under i eitimu of Chapter 9 (ttmmeneing
with Secuon MIND) arDiviuon 3 of the Business mall Po(uaiom Code. and my license is
SFDWL-2 S'T'ORY 1,728', GARAGE 436'
in full fame and effect.
Liecrumams, Lc.g
PERMIT APPLICATION EXPIRED 12/14/07—EXTENSION
Gate ARCHffECConmrsucer
SDECLARATION
DENIED—DIDN'T REQS' EXTENSION UNTIL 2/08. NEEDS
I understood my plans shall W used as Public records
TO
Licensed Prom&uonal
OWNER -BUILDER DECLARATION
I hemhy alRrm Nal I.. eumpt from me Conuacmes Lcense law far the
fallowing mason. (Sccuun 703 I.S. Buumem and Pmf xecons Code: Any city or county
which rtquims a Permit in content alcor, impmve, demolish, or mpair any suuelun,
prior an its issuance. Am requiw the applicants for such Permit to Oka signal smu mcm
lost he is licensed o the of the Comment's License law (Chapin 9
Sq. Ft. Floor Area
Valuation
pursuant previsions
(commencing with Sent 7000) m Division 3 of the Buainecs and Professions Cede) Or
$180000
Nal he Is exempt therefrom and the basis for the alleged eaempuon. Any violation of
Section 7031.5 by "applicant fora permit subjects me ."licanuo to. civil penalty ofNumber
31647017
Occupancy P Y Type
and team than rK hundred sonars (M).
.�
❑ i.uowres of the psvpmy, car my wplayw wish wagrs udevwlc emnpew0on,
will do the work and immoclumh nal intended or Orfemd for rale(Smc. 7044, Busineu
and Professions Cade: The Conumcm's License Law dao but apply m m an uncr of
Required Inspections
q p
property who builds aimproses maeon, and whodocs such work himself m through his
own employes, pmNded that such impmlements am not intended aronertd forest, If.
,
however, Ne Wilding or improvement is mid within one year of completion, me Owner.
builder will have 0e Arden of proving that M did not Wild or impow for purpose of
axle.).
El 1, as Owner of the property, am esduAwly contracting with licensed conmmusm to
counteract the pojea (Sec. 7044. Business and Professions Code:) The Covuaemr's U,
come Law does not apply in an Owner of property who Wilds or improves thereon, and
who co muctsfor such projects wim a contriamA, licensed pursuant th the Convector's
License Law.
❑ I am exempt under See. ,B&PC for thus moan
ner �%9'aAr1 B�+-iS Date In
WORKERSCOMP SATIONDECLARATION
1 hereby aRrm under penally a(perjury ane of de fallowing deelanuonc
❑Ihsm and will of self--insuree
funtunaCeni 3700
w as four Section 3]00 a( the IaWr Cade. for the pcdanneri¢ Of the
the Laborerformaceofth-
works ,which t
work (car which Its permit is iata:d.
t mi
❑ I lam and will malnain Workers CompemWon Inam., u required by Sauon
37W of me Laor Codefor the pedo... of me, work for which mis permit is issued.
'
My Workers Compensation Imuran. cortin and Policy number arm
cameo. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This see0on reed nal be completed if the permit is foram hundred emarem (5100)
or less-)
I cooly the, in the performance of 0th work for which this parnit is issued. I slWl sol
employ any persen in my manse, to as to become wbjecl o me workcri Compemadon
Laws of California.Dmm ate. _
Applicant Te sA�`/ 'r2
'
NOTICE TO APPLICANT: If, After making tFm CemficaM of Exemption, you should
bSOTe subject in the Worker's COmpecommit poorest. Of IIIc U!Wr Cod, yum mast
forthwith comply with such Previsions or mis permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby of iron that inert is a compensation lending alxcy for the Performance of
the work for which this Permit is ivucA (Sec. 3097, Civ. C.)
Lenders Name
lender's AM.
I cool Nes I hale mad in. aPPlicauob and sate that the move mfam tdun is
correct. 1 agree b cmbply wire ill city and country mdomakn and.mte 1. relaubg to
Wilding construction, and hereby authodae mpmanlNvu or Nis city to enter upon Oe
cove-mcnuorred pmpcmag,co y for inspection purposes
(we) agree to save, indemnify and keep harmless the City of Cupertino agaimt
h, ensu and nes which may in any wey attme agums said City
liebilidn,jboaC
Ofpcma
Of
of dm granting car this D WILL
A APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date i
SOURCE REG"�l.A'T10NS,YY
Re -roofs
signaturearAppllauilVcanuxoru'
Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof "
Will the applicant Or future Wilding occupantsnre sir handle havallons material
ex de0ned by Use Cupertino Municipal Code. Chapter 9.12, and the Health and 59my
. Secuon 25532(x)7
❑Yu
All roofs shall be inspected prior to any roofing mat al being installed.
joNO
Will me Applicant car future building Occupant use equipment on dcvim which
If a roof is installed without first obtainingan inspection, I agree to remove
P
emit hAvardnm air conaminim s as ofrned by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes G'Nu
1 have mal the hvardwsmaseriahmquimmew underCWp crh.95ofum Califor.
nu Reshot & Safety Cade. Smote 25505, 25533 am125534.1 undersand thmif de Wilding
does nal acmntly ham a enanL that it h my nexponuimbly a century the occupant or the
nequimments which mast be, met Prior in trounce, Ora Cenireac of Occupancy.
'[o Ii&" b io--i(—M-'g
Signature of Applicant Date
All roof coverings [o be Class
g or better
Owner or summonedAgem oma'