06090248 CITY OF CUPERTINO _ _ , » ara�^au -r"``* '^ � "^
-BUILDING DIVISION PEIRAHT TCONTBACTQR INFI�RMATIgN
Haats'.,'ttt+�h• n.rv',3 ws3.
BULGING ADDRESS NATIONAL CONSTRUCTION REN `ff'NG'06090248
10280 MORETTI DR
OWNER'S NAME: PERM"ISUEDATE
1355 FILIPE AVE 09/29/2009
NE: SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1 0 0 0 0
1oaa LICENSED CONTRACTOR'S DECLARATION - IObDOSCi] tion
i 1 hereby affirm that I an Returned under provisions of Chapter 9(mmd
muin{ p
SZ with Son 7gMB ofDiviuon 3 of dm Business aha Profinsmu Cade,and my license
lz ectiimm�forceandeffen. INSTALL TEMPORARY POWER POLE
jn? License Class Lie.• _
Dau Convenor
qq ARCHITECTS DECLARATION
i2< 1undemard my It.Nall he used as public namds
)y
'G Licensed professional
s
OWNER-BUILDERexemptDECLARATION
00 1 muse adinn on I sm exempt from the Cmtrtctao License Law for the
O C following won.(Section ID]I.S.Business and Pre.dem a Cole:Any city ere mousy
3$V which im its n .al re ennstrun,alar.improve.f" demolish,i re repair my swmcnt $200
z t„^ tat he ire isansna,alwnt to Ma tie applicant fm smh p actor'mimetic Law
(Cha mem
2 0
that(commencing
eBuinurSlJmvclaw(Chapur9 Sq.Ft.Floor Area Valuation
S 9 (cameis exe pttSection,000)ofteDivision 3of alleged
prion.Any kilma.Code)of
s, that io e exempt b thdefrom and de base it Ne cls Me esempaim.Any violation of
Section 7031.!by any red dont far a permit subjects Ne applicant •civil penslty of Occupancy Type
mon...Nan five hundred dation(33(10).
❑Luowmrofthe Property.Ocmy employed with notion Neb vele mmpensadnn.
will dothe work.ands: suuaontrom inundedOrowit not ppaJOan Bwaimf Required Inspections and arty who
Cada:The Canuactonndwho law dao not apply m an awns is q p
properly who buiMs i ed theca Musson.rsedwho da oumhwokhinsanf er Nrou{h he
man emploeinclprovided improvement
Is
idints not earMNoro@tvA for sale If,
however.the building or improvement la veld within one year ofwmPkdoo.the owner,
builder will het cite burden of proving that be,did Out ddW or improve for purpose of
❑1.as twine of the propery.,a.Business,siwly mnuwsint with Idonsed mnuanon ,
wnsn La it p soot(Sec.704x,wnrofrod property
who ns Code:)The Cmtesmh lnd /
muse Law dace not apply m w owner of properly who builds m imProwa thetmn,and /
whou for such Drokna VIN a eontrOcw(e)licensed pwaam w cite GntramoM1
larr..LaLo w.
0 lam tJ/
acmpt undo See .B dPCfor Niartmn (�
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aB-umundrc oiler penalty of perjury aof de following daleeWune
1 have and will maid.a Canificata of Comenuo self-inure for WorkersCompton-
alio.,an provided for by Station 3700 of Ne Labor Code,for Ne perform..Of Ne
were for which the permit is iaued.
❑1 hast and will maintain Workers Compenwian InsusaOce,u seyuired by Semon
370i the Labor Cade,for the perfaemwea of the work for which this permit a ie ed.
My Warkere Compensation Laurance carrier and Policy number art:
Cartier. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mise emaim need ret be costumed Ifthe permit is intone humireddullde(1100)
or tesa)
I artily that in the performance of Me work for which this Permit is issued,I ilWl not
employ any person in any in rmum becamom ml LOlm WOrhn'Camperoauan
Lawsaf {/ _ �.�
Applicantd —
NOTICE TO APPLICANT: afar making this Ccrtificae of Esemption,you should
become subject in Ne Worlems Compensation provisions of the Lama Cade,you must
.J O forthwith comply with such provisions or this Permit he]be,deemed owumd.
H, CONSTRUCTION LENDING AGENCY
t~ I hereby a hem Nat Nem is amosuasion loading agency for Ne performwmuf
y'> Ne work for which this permit Is issad(Sec.3097.Ci,C.)
M Lender's Name
z Lumbers Addw
U Q 1 certify Nat I haw rod this application and sue dead the above information is
TL F' cones.l agree to comply with all city and county ordinances and sue laws relating to
0 building convection,and hereby authorize rcptesenusives of this city to cnmr upon the
above mentioned Property for inspection purposes.
Oor the(WO)agree to low.indemnify and keep nameless;the City of Cupertino against
in
ti H liabilities,judgmenti and"Form s which may in my way amtte glia.said City
U APPLICANT UNDERSTANDS ransfing of I
STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Type of Roof
Will de applicant or future building Occupant store or handle hanNo"mauml
as defined by the Cupertino Municipal Cade.Chapter 9.13,no the Health and Safety
code.Secure 255324)7 @N — All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the appncwt or forum building occupant use equipment or devlcen which If a roof IS installed without firs[obtaining an inspection,I agree t0 remove
emit harvdoa air canuminwa ss dc6tted by the Bay AmaAie Quality Mangemem all new materials for inspection.
District?
❑Yes u
IhavcmaJNehvamnus ma M5.25qui 25534.1 Chapter Matifhebin
nixes"IN&$aldyhe..inmo, 25It4 m 37ateria .I understand =up NildNg /�!/ � /—d�
Jma not cuncntly how a tenant dW Is U my mapomihilitY m nobly Ne oaupws of
Dau All roof coverings to be Class"B"or better
'