00070054 CITY OF CUPERTINO '
BUILDING DIVISION RMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
1764 NIATInNAl AUE 07/11/2L7100
OWNER NAM:: "� APPLICAHON SUB DATE
ONE:: - — SANITARY N0, - CONTROL No,
s
not ARCHI"FECnENGIN'EER: BUILDING I'I?RMIT INFO
OO BkOO ELECT PLUMB MECII
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SN> LICENSED CONTRACIOR'SDECLARATION WATER HERTE*bDescription
I hereby affirm mat I am Ileensed under provisions or Chopmr 9(commeaomg
14ew with Section 900(dof Divl,in i 3nlthe Bu,ire,, nd Prnfca,inm C.uiI.ter my licen,c
inlull lnrcc am fq{ �•
zLicense❑ass '-/ Lie p ,! —
m 3 a li shal'Ii,use DECLARa 1
1 unJcmmnJ my puns.abaft M1c Ulla as puM1lic records
ae
Licenud Pmfcoinnal
OWNER
a o HUII.DF,R DECLARATION
1 hereby affirm that 1 am exempt from the Contmcu,r'c License Law for the
Kt" following reemn.)section 9031.5,Business and Pmfescinns Cott Any city or county
M p which factitious a permit i construct, Iter.'aniprisoc,derikolish.or repair )a oluam
5e. pram t :. Iso y lh t,pfe tf hp till II g f moment
lb, il liceIn It n n n l be c th.loorl,I Law(Cbaptu9 Sq. Ft. Floor Area Valuation
'(.a ing x,m Sc,uon 9oh0)ot'Iry m3olaha Business land PotLaelnti,Call)
n'mnuhm
ol he is nqa thcrclhmi vnA din bnnin Ibr the nllugcJ ucnrpllnn.Any vlolvtion
fol'Sanion 903 L5 by mry a,licam Bn n permit subject, It,applicant lou civil pcnuhY .
of not marc than G"c hundred dollars Wig)) AP tin er Occupancy'1'ypc
❑1,u,owner of the property.or my employees with wages as their.Ne compensation,
will do the work,and the swemre is not intended or offered for call(Sec.9044, 50P Fit 41311ijS ENERGY
Bu,mc,,and Pmfc,airnc Cold: rie Contractor c Licen„Law d«,amt apply as
5Q6 — GR$ nspecnons
r of property Who build%or impmves immon,and who does such work himself
or through his own employees.provided that such improvements arc not intended or 507 — F I NRL B I NG
offered for sale.If.howls.,,the building or itn nArmem_is IIII w!thin ane year of
nnt,if,hon,me'owne,hailder will base the becdcn of proving man he did nm build or
n,ao,,for mrpn, ul'sale.). .
❑Lac owner of the pmpeny,unl Iain:".Ia ammeting with m:)Ide Co aeon m I
nMr,o the project mp, '_aa Bucitnw'x and Procrin,wi h la,ea edc Cnmmms to
Liam,Fa.does nrulpply to an illi.,of pmpeny ono builds or Ilapmvec thereon, c
and who contracts for.such pmjcns with n cru m um,)licensed pnnuant m the L/
Cnntoctoes License I.aw.
❑I am exempt under Sec. .B A,P C for this mason Q
I Owner awe
WORKER'S COMPEyl ION DECLARATION
I.hereby affna wulm'penalty ill'I,ijury one of In,tin lowing dalumtions'.
],I hnvc and will"maim;:" a Ccrtiliculc of Concent to sclhlnwre'for Worker's
Cuntpvnsniidn, as
par...did fol by Sdmian 39011 of the labor Cud,, for the
` ,afi ruaha of m,work lin which this,matt is i,wcd.
hove and dill r Code, Worker performance%Cmnpof t e wort ee a.c required by Smiun
iss 1 of the tach Calc for then Inrancerr the work far which mi,permit i,
iaattl.My�W�nr{k�crs Compensation Insurance carriSe/rJand
,I'oliry mmmba arc: r
Caancr.0 CF.RTIBIIA EI{(L[1yi OINE%EMpol PTIONFROMWt R KERS'
4 COMPENSATION INSURANCE '
(IIll,e,,horl nod nal bo......plana it ds pernd Ix for ,no la nand dollars
(S I It or less.)
I certify that in the I crit duce of the work fill which'his I'llon is issued 1
shall not employ any person in no,,,,Inner no a,or become.1th*1 In the Workers'
Compensation Lawn of Cuba..iu.Dat,
Applicant
NOTICE TO APPLICAN'e If,cher narking mi,Ccmificvm of li,calu on,you should I
become wb,WI to the Wader's Con cr setion p mnirn.c of'he I.
'he You must
pIonM1with comply with such provieionx or this permit hall W accrued revoked. 't
Fti CONS'IRUCI'ION LENDING AGENM' k
ai } I hereby atfirm th,t there is n ennstmniud lending agency tor he performance
ill'Ibe w ak for which this Permit is Issvnl(Sc,.3097,Civ.C.) f
Q Lmdcr',Name
5 % I,endcr,Addm,, ,
U1 certify that 1 base read this applicwina and Liam that the abate information is
t.. rorreet.I agree to comply with all city and county ordinances and state laws relating \`
U to Wilding construction,and hereby rothove repmrenmaives of this city to enter upon ,
} L4the abrvemer mrudl property for irmpenion mdposo. !
t,. 0, (We)agree
rasa",indcnmify and keep harmless the City of Cupertino against
to liabilities,judgment,,costs and eapenw,which may in tiny way accrue against,aid 1
f) City in et)tiwqu_cncc rl the grid Ing roti.pelma' 11{
APPLICA U F STAND AN WI OMPLYWITHA.LNONPoI Issued by: Dale
SOURCE RE .l'S.
Sign luau EIA Flat FGmI ¢ter Date Re-roofs
BAZAR O MATERIALS DISCLOSURE I
c aPdicmd or future Wildingocapant,lorcur nandlc hrbarmaanarerial Type of Roof
ac defined by the Cupertino Municipal Code.Chapter 9.12,Ina the Health and Safety
Cale.Senom IiS3200? n
Dyes ElNo All roofs shall be inspected prior to any rooting material being installed.
Wil l the applicant or future buil ding becupart use equipn,cnt or allices Is'hl,h If a roof is installed without first obtaining an inspection, I agree to remove
emit District? c air ttmwininamx us def ineJ by the Pus'Aida Air Vuallty Management
l einhall new materials for inspection. Applicant understands and will comply with
CY" [2Nu all non-point s Urce regulations.
I nave read ra
ho huudnun
s ramduls regnibculcnn order Chapter 6.95 of line ^
California Berlth m Sufcry Code,Sections25505,255??and 25594.1 undvmmnl that t
it the building does not c . dyhuveamnam.thatiti,nry m.cpon,flit,mortify the
occur m f the ma ma n 'n which must W are prior a odurnce of a Certificate of ,
""`>' Sig ature of" plicarlt _ Date
`,
m ate Itt r� euro All roof coverings to be Class"B" or better
OFFICE