00110047 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BURANNG I I F K R• M DEVELOPMENT INC1`ERMITMoll 1,10(l7
� �.�5 ORANGE AVE
OWNEWS NAMIr,: 1.k6m WEST HILL CT APPLICAT11lli3uCCNATE2000
KAVG, MARTHA
NIONE: (408) 253-9787 SANITARY NO, CONTROL NO.
M aO ARCHI'1'I MIENGINEER: f BUILDING PHRhfl'f INFO
0
wp BL ELECT I`LUMH MUCH
FQW L '1
¢y
LICENSED
onon II licensedON I OICS ordrpooEout—of clu, lob D85CCIpl1 ❑
4 L'O I hereby uRvm non not licensed unJcr purvlxinnx of ChupaY 9lcmmo¢ncing
F"JFw wnlm saeran lag»nl Droi.xn,n3m'(lot Haxmex.Ona rn,mxxinn,Code.nnA limy fiatmxe DEMOLITION OF SINGLE FAMILY DWELLING
¢Y^
is in full(ince and effect iC ,
d rep m U License Chis /G Lic,x��
3 a Dam _ Cont.""
C O ANCIII'TECT'I DECLARA' N
1 an ere a, aro s1r asst oWi t cords
gI>.,
'NIiWItU11,DGR 1 ' .r ATI(.
v5 1 herehy affirm Orr 1 mo exenmp m the Com tor'.License Law for rbc �O ✓LJ� _
C Z a following¢av+a(Section 7031.5,Ifus e. and life ns Ctde:Any city or county
F O which pe.it t o t m t x I:h P y swmum
C m prior t t also y the fit n 1 pt n file g ed walament p��1 p IlM�1TT
bou he I,licensed If the p fon,Q oral1 I (Chapter9 Sq. Ft. Floor At
(,t anet, ,with Sc.t ++700,Ouf Uvie'u.3 lfn.lit: m.0 I lbor.:' r,C+.le)
n thea he Innmpt thetetrm I not the bassi.,for lW alletprd exemption.Any..manias
of'Section 7031.5 by any upplicam ban permit,ahjnu me applicant run civil penalty
ofirm mare man five numbed dollar.Tl5f(h. A%..N Ilrlobf'L0. 00 Occupancy Type
01,as Owner of the prpeny,lir my employees with wages as their sole cnmpeamtion,
ill do the k ad he n f I,ona intended or+tmed for voic(Set.7W4,
nus t r d ro,vay Who laLidw ran, C �rll i cal%lit)does slim w rk hi,tomlf NO ASSIGN E q F$ !`I�P,IS
,ov W
f erect to hi.Own employees.provided thin win ourvaleis old arc inn intended lir
cOeaeJ for sole.If.eowrxcr,the l have t of irdenof Prov is the within nue year of
oprove I n,the tnvn of sale.).will have the burden of proving that he did not buil)or
completion.
mmrve lar pamfa,xe ofsale.). -
01,as owner lathe propen,inn cxclusivdy commea Ing with Lemsed annlraetms no
....uet the pwjcd(Seo 7044,Business amt pmfneien.Code: The Conna'aa.,
Lnicensee Law dres not apply In un owmr of pmpery who builds or Impnwes thereon,
and who still for such pmjeea with a ommemrp)licensed pursuant to the .
Com aim's License law,_,711C
P C I this reason
01 amxempt under Sas e %"
owner rJ'9Rjt/9 Das v J
��(IvDRKER'SCOMI`ENSATION rR CI, A'IION
I hereby affirm under penalty of Injury one of the following declarations:
0 1 have and will maintain a Certificate of Consent In w1bimum for Worker's
Compensation. as provided for by Section 37(XI of the Labor Code for rhe
performance of the work for which this permit is issued.
O I have nnal will Nomads W..ka a Cninpmumiva Wxaranea lir royal... by Section
3700 albe labor Qdc,for the po rfunot nce of the work for which ills permit is
cue),My Worker's Compensation Insurance carrier and Policy mother art:
Carrier: policy No.:
CEM IFICATION OP EXEMPT[ON FROM WORKERS'
COMPENSAI'[ON INSURANCE
ffhix sec0on aecd nm Iw sou Ideal ifthc wr,ul is future a i red dollars
(SIM)or mo.)
I terrify that in the perfeaanet,of the work for which his Penni,ix i.med,I
mall lar employ any perum in env manner so m to become subject It,the Wm2nY
Compematina I,awo of Califnmla Mare
Applicant
NOTICE'1 D APPLICANT'',IL al'tor muting this Cadticare of Emmpdun,you should
hreenc xuol w the Worker's Campenumimm movions of the Labor C dc,you must
Q Q mard wil comply with such pmvixions or this permit shall be deenme l resulted.
FCONSTRUCTION LENDING AGENCY
C I hereby allinn that there is a constrctinn leading agency for performance
of the ,,,it lot which this perms is ixxucd(Seo 1)Y4 Civ.C.)
ALOI&Cs Name
7 Lender's Address
U 1 etusay mat 1 have read this application and x,me that the aMrve information is
(L F. correct.I agree to Comply with all city and county ordinances and state Tawe reaming
C) f,I to building crmstrction.and hereby authorize repro.sentmives of this city to enter upon
the nMwonnatured Fra vo,for impection purposes.
Est W (WC)agmelnwve.indcmmlt'yand kroplundces the Ciiyof Cupertino against
W Iiabilntca,jou gmmits,a ors and capcnwx wets buy in any way u"um again"sold
U Z City In nmrcyucncc of me gunning of this"no su. /♦
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH At.I.N 2N-Po Issued b c, n.7 / Date
SOURCE,RRGU AsS. if —1a ; y
+a ...a to Re-roofs
ZARIOUS MATE LSDISCLOSURE
WOI tee nI Beam m ol+ mg occupant untcor handle ha.udmta mnmdnl ;type of Roof
as defined by tea Cupcnino hhmicipal Code,Chafer 9.12,and the health aced Safety
Crile.Strait 25532(a)? / -El Yet, ''9'F All roofs shall be inspected prior to any roofing material being installed.
Will heappltamlirfuture building occupantwev4alpmemo,de,iceswhich If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hot don,air'containment,ae defined by me Hay Area Air Quality Management
Di, �� all new materials for inspection. Applicant understands and will comply with
OYas - all non-point source regulations.
I Owe rend the I....th as mamrialx mduiounema made,Chapter(a95 of The
California health&Safety Code.Sections 25515,25533 mJ 25534.1 understand that
if the building dtws not currently have a tenant,than it ie my reprmxihility m notify the
..cupant of the m ui mens which most he met prior m issuance of a Cenificafe of
Occupancy. re
Signature of Applicant Date
tillJJ
pmt II ..�dase —yin— All roof coverings to be Class "B" or better
OFFICE