00080106 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERNIIT NO,
OWNER'S NA .. NEW5011 AVENUE APPLICATION SUH DAT E.
PHQNE: — CHEN SANITARY N(l. CONTROL NO
Om% ARCHITECT/ENGINEER:
BUILDING I'RkAlll'1NF
CO
O
❑ BLDG IA.ECI' PLUMB MUCH
v b
��" Job Description
LICHhatI UC'Ohrowd ITot'SUECLA RA I'IfIN
p1 hcrchy ofiinn that t um oftho b unUar Arad Pions nl'Cha odea and
any
liver,
w s-w withSeetion)lXXp nl Divi,cinnlnf rhe BusinawanU Pmicpiom Cee.unJ my littn,e
is In full force an:l�rIV —���
�0LL Lfcen, C ur." TOURCH TO TOURCH
od Dale rJ6T C.urral ar
ARCIIUECCSDECLA ATI .
1 undersand my plan,ehall her toed 0,p.hire records ,
y0�
Li aroved Pn,fessin Or
XOWNiat-aUiLDF.R DECLAitAt'ItIN
W :2 m 1 hereby iPur NUI I am eacmpl I the Cul.hator',Licence Law bar the
C 5< lollowinp to..ao ISc lien 90.1I.5,liuninw.to d It l'e,ion,Code:Any city or enumy
x=❑ whet 9 1 nits I t her,- p J fish pY outure
prom Ito .y theapplicantf hpc nits Ile ,g m n
d:men,
It. priori()
licensed pursuat in the MOVOUNN ofth Contractors Lc Law(Chapter 9 Sq. Ft. Floor Area Valuation
tcommenang with Sectio]1[X11 of Division l of the Ruotne,s and Profess,otn Cover
or that he is exempt therefrom and the basic for the alleged exemption.Any violaion
or Section 7031.5 by any applicant for a period robjects the applicant to it civil penalty
of or more than five hundred ill 50). APN Number OCCup' n• ype
Cl 1.n,ow oaf lire propcny.urmy muployoco with wage,,as doi r sale compennution,
will do the work,not the etraaare is nor intended of nffertJ fur ale IS,v.71144, .�; D}
Ro,lnen and 11 le,oinn.Code: ow Contm,faC,License Law docs ourapply In an required Inspections
Owner of pm,uy Who builds ar Im,m,c,thereolo and who does such work himself
or through hi.,own empbyecs,provided that such hnprovemenrs are not intended or
offered for sole.If,however,the building or improvement is sold within one year of 305 — FRAME
icompletion.the owneel,uilder will have me burden or proving that he did not build or ''07 — INSULATION
mprove for par hasc of sale.).
❑L as owner of the property,ton exluovely cnanwting with licensed contractors to 601 — ROOF TEAR OFF
mstrua the project(Sec.](W,Business.and Profession%Cade.)"rhe Canlraaor's
`irnm.w Law cine.,mil apply la an t,wna,of Pro,co,who amid, ,,improve,throe„n. 602 — ROOF PLYWOOD NAIL
thel whit cnnlmn, mr,ueh Pn,jeeu with Ito tor.adols)'lieome Pat,lnml In the 603 — ROOF. BATTENS
Co ban...'..l."Ooo Law.
❑l am caempt ander See. ,B k P C for this ma"on 604 — ROOF IN—PROGRESS
Owner Dvte
WORKEWS COMPENSATION DECLARATION
1 hereby affirm ander lwnallr of periarr tome of the following eeaamdnn,; '
❑ Ih d ills t ' Crlal I'C Imslt' f Wnker,
Con p I pct I by om in.11 the Labor C J n Inc
ord
❑Ih d ill 'Ito Worker rf mance I .u'nre � i JM1y Becton
TAXI of the orke Cee,lora then Insurance of the work for watch this peon is
isove<L Mr�Y WmA r>Cnmpenw,ion Insurance.corer and policy number are: !/
rmmicrs�l 1`"✓ Policy No.: �k/'G. '00&' j
CERTIFICATION 01;EXEMPr10N PROM WORKERS'
COMPENSATION INSURANCE O
('Ila,oec(um need an he annplaul it Ihu porntit is ruche hundred duller,
(Y I IIB)or la,n)
I really Ihu,in the peroo move of the work Bora which this pemti,is iso.J.1
shall not employ any person in any manner so as a)become.subject to,he Worker%
Compensation laws of California.Dale
Applicant
NUE ICE TO APPLICAYE 11.after making this Certificate of Exemption.you should '
become subject ,the Worker's Compensation provisions of the Inbor Calc,you nmol
O aforthwith comply with such provision%or this permit shall he deemed revoke,
z [ CON S'rItUC'I'ION LEN DI NO AG IiNCV
a ] I hereby affirm that mere is u canmmtct len lending agency for the perrornance
Id f the work in,which Ibis pcnnit i,i„rind(Sec 3097.Civ.C.)
rice Q l.endcr'a Name
z Lender\Address
V 1 certify that 1 have read this application and state that the above information is
correct.1 agree to comply with all cityand county ordin urem and slam laws relating
V (,building chlor.,inn.anti hereby awhorive represenmlivcs of this city in enter upon
r ;4 he h J prolverlyra _pack P p
G
W r)a,m,r s: J t,and we,1 ,the Iit: fC prtooaE ria
O) Ilah r -j ly r.,t r P so, 1 yivany y' gllino s:'d
C.7 zChY' 4 f Il b I S flhl. p l
P111CANT UNDERST NDSAND WIILCOMIIV WITH ALL NO MINT Issued by: Date
•.a a ran sura mvcanlranar Dam Re-roofs
IIA%ARDOUS A/ATEReA1S DISCLOSURE
swu y applicant or future%,ell Cg a.Chart r 9.12,handled thna awmadSaf;ty Type of Roof
C le,SeU by the 320)?no Municipal Rde.Charter 9.12,and the Health and Safety
Cndc,Sermon 255321x)!
❑Ve, 0N All roofs shall be inspected prior to any rooting material being installed.
Will It,r,lieamorramresodding nca...Iaeryoilncont"rdevire,whirh If a roofis installed without first obtaining an inspection, I agree to fernove
noir h,adorn,air commnminanu m refined by the limy Area Air Quality Management
[)i.sIriet+ all new materials for ins ection. Applicant understands and will comply with
Ore, ON. all non-point source Mations.
I have read,M haaardous materials requirements under Chapter 6.95 of the
Carmarin Health to Safety Cee,Scour,25505,25533 and 255311 undersand that
rl the building docs nm cumrcmly hove numJhat it in my res nsihility h,polity lime
occupant of the re,monrtents wti noel prior Io' me of a Certlnen e _
urrapnnry. gnarfjrof Applicant Date
agent lone /`` All roof coverings to be Class"B" or better