00110102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
1.0760 MINETTF_ SUNBORO 001. 10102
OWNER'S NAME: APPLICATION SUB DATE
SUNEORO 11/20/2000
-14 PHONE: SANHARY NO. CON'T'ROL NO.
BUILDING PERMIT INFO
O ARCHIT IiCf/[NGLYF.GH: BLDGEI.Ii6T PLUMB ME; H
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OHS LICENSIiII C(INTRACI'OR'S DECLARATION Job Descript' n
0 Z_ I heresy anion tma I am li...fwd under Pr wnworr,of Chan,a 1,..mwer6ag -
r:_w with Sechnn 700(tof Division 3 of one Bnxinesx:rod Proc,,ion,Cutle.nnd my license
�x sire amcffq� �—.�+ DEMO
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ARCHITGCP'S DIiCLARATION
t:- J 1 understand my plan%shat)be ave)as public mvord, 46
ws C O Licensed l'n,fe,aiuwl
a.°' OWNERBUILDERUIiCe Contractor's
1 hereby aSam Ilia I hal cBu%it fnmt me Cssiou% is Licence Law for the
C K.G whichlollo,ia,re noes s 15caion]1131 S,Ihl,llla,and Pndea,ion,Cute:Any city or county
O which requires n Inrmit In oon.arua,alleq impose,denuJi,h,or repair any aruaurc
ce
W3= Prior t I c b,requiresrise pprcanl lot h pe d t I g t J l mens
a. 'hat he is liccursclP It the poo,isions.oftb C I t is Lican.,c L (chapter 9 Sq. Ft. Floor Area valuation
Fenn s 1 s n 71F]) I D' 1110 3 n1 H d Prot .: .Code) $10000
what he n,e,,cnn,a puwI nn call the ba,i,I...Om alleged exOnsio. Any v olai ou
of Section 7031.5 by any applicant for a Iw am%objects the applicant to a civil penalty
of not more than rye handled dauars D50B. APN Number Occupancy Type
D T.a,oxmeret he Prolan,army andoyce,with wase,a,one-ole eompn,ahon. 37531037. 00
will do the work.anal the structure is not intended ar offered lin,ale(Aa.7W4.
Easiness and Prolcsaons Code:line Commalors License Law doe,not apply to an Required Inspections
r u1'nropcny Who halt'],ur Ila......thneon,and who doe,ouch work,him,dr
orthrough his own employee,.pmvidN that such ii nmocracnts am not]mended of NO ASSIGNED INSPECTIONS
offered for sale,If,howm'er,the Emitting or improvement is,old within one yew of
eooplcron,the owner.builder will have Inc burden of proving Thal he did not build or
in, a ro,parpow of,lde).
01,m owner of me property,am cwlmim)y comment,with licensed eammcmr,to
Ln,lrecl Iha prcjcm(Ste]Ilia.unnine„;std Prom,shm,Coden'fhe Contractor's
iccn,c Law Bros not apply to an owner III popcny who buid%(It Holpf'ort,Imccon.
and who conmael,Iia such pmjace,with a swaracum,)li iwwd.tutu..]le the
Cou n tior',Liccnm Law.
D l:an ex nlpI ender Sae. .H N P C tot mi,re u,u I
Owner Date
WORKFR'S COMPENSAr1ON DrCLARA ION
I reit chy aRnn under penally of perjury one at the following declamliom:
alEl I base and will maintain a Ccnircale, of Consent to self-insure lbr Wnrkcr:s
Compensation, ax Pnoldad far by Sectio.. 3700 of the Luhur Coda. Ibr the
pertnnnance nl lac work for which Thi,permit i, It.
01 h:we:wd will inuinlain Wurker'x Compenanion brow:mc,a m,requiwd by Section
3700 of the Intim,Code,far the I arfurma,c o]'Tho wad for which Thi,panni I,
issued My W,o,1 C Nn lion to uranee cania,mul lYolicy numMwre:
Carom J" - t',oliey No.:_4 < f -C"')
CI7K1[F]CAl ION Oh RXEMPI'ION PROM WORKERS'
COMPENSATION INSURANCE
this wction need nal be emnnletcd It the part lil is far enc hundm]dolia"
IS TOB,or le,.)
maty that inline perfortanance ofll k tor whichm pernatc l
,null I ply any p - Y nc I M t l 0 de WtokWorkc s _
Compc 1 Laws rafCf Il I
NO[IApplicant
AVIPILICAN W." If C.....
,mon, ro ill I tix .. y should
became tub/ccnolhc Nadas Cu gw,.,this.lilt,,shot bet Labor Calc.Yat n,l
C Q
forthwith conn.],with ouch Pn,ai,inn,or this pemnit shall h JecmW revnLed.
Fy CONSI'RUC'I'ION AINDING AGENCY
71 herehLy a1nn that mere i,It corwaruaion lending agency for the Performance
W of the work for which this permit i,issued(Sec.3097.Civ.C.) -
a Q l,m1w',Name
= z Leader',Addre„
V Q 1 certify that 1 have Lead this application and lone mm the above inWmution is
W Fy
correct.I agt ply withail city d totally 'at] ,.,a I:(ng
Q U tobuilding commiction,andh Ey nuffirtin,coa,,walafise,Itthis all,Is cine,'ulam
} 4: the ItiaLve-wernionad pn,ny for inspectionp Try e..
1.. 0.,
Wa)agree to save,indemnity andkeep harmless dCn fCpcnagainst
V] lu h' "'It'
t < I my navy ywane a,airm nall]
f..) z 1I'YLICA ct " ITAND AnL ILh OMPLY WITfIALI )N- INP
tnc ,u . .s Issued by: Date
sig sureof Applie C roam Dane Re-roofs
HAA Is RDOUS MAD DUALS DISCLOSURE
Will the applicant or future Imidiag,ccLLante or handle harardow,mwcrial Type of Roof
n,detiiled by IIIc Caperrnm Mmnlcted Cots,Chaplet 9.12.rand the Health and Safety
Code,Section 25532(x)"
O Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the nlTlicamormmmwilling ox=nnamuse equipmamorLit sice,which If, roof is installed without first obtaining an inspection, 1 agree to remove
mil haaaNnua air w,maminmts m JcrneJ by the Hay Arcn,\ir polity htanagemcm
Cismic, all new materials for inspection. Applicant understands and will comply with
OR0 YL, °No all non-point source regulations.
1 have read me M mous maeriul,requirements under Chapter fi 95 of the
California Health k Safely Cole,Section,25505,25533 and 25534.1 understand mm
I dmbuildin,d'xXnot eul'ren11,have a Terms],that a"my mst I'l il'ey mnutily the
"ccupan tyrEach sena Ee Inst Prior to....`m race of a Camr,w,N
�Let
y /
�� Signature of Applicant Date
ox armwo I" d al Date
All roof coverings to be Class`•B" or better
OFFICE