03110114 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR=INFORMATION +'
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DING ADDRESS: GREATER BAY CONSTRUCTION IIIRNo03110114
ER'S NAME: PERMIT ISSUE DATE
GB ESTATE H
NE: SANITARY NO. CONTROL NO.
(408) 248-6600
HITECI7ENGINEER: BUILDING PERMIT INFO
BLDG EIER PLUMB MECH
O � O O
u00 LICENSED CONTRACOR'SDECLARATION JbDescription
mC 1 hcmby affirm Nliecm
at I am ed under proo
visions Of Chapter 9(commencing
iW with Sec'ion7000)or Division Sof de Busim..and Rofessiors Code.and myli<eveu
'rt« inClasstlercec'. SFDWL-ONE STORY LIVI-NG 3390 SQ FT
S R L full force Cleo Lk.M
Dam c.nthetar GARAGE 634 SQ FT
ARCHITECTS DECLARATION
�i I understand my plans shall W used as public necards
�yU
'G G msuo
Liceed POd. nal
3 OWNER-BUILDER DECLARATION
I herchy effinn that I am eaempt from the Cantranars License Law for the
'0 following msson.(Scefiun VMS,Business and Profession Code:Any city car county
m which acquires a permit to convect,suer,improve,damoluh,or repair any M acom
'a prior to its issuance,also requires the applicantforsuch Permit u file a signed statement
that he u licensed pursuant to the provisions of the Conuacmrs License law(Chapter9 Sq.Ft. Floor Area Va fljP160
itt- (cmnmencing with Section 7000)of Division 3 of me Busineasand Prefessimu Com)m
ERR - J
Net he u th
e moan, .mm froand Ne basis for the alleged esemptlon.Any vioutio of
Section 7031.5 by arty applicant for a permit subjects the applicant an a civil penalty of raw APN Number �O •T��
riot mart Nan w hundred dollen(5500). ccu ane/ P y Type
01,aownerofNcpmpersy.mmyemployerawi0wagesulWUalecompenutlon, 35922075 . 00
Millon Rework and Ne structure Is not intended oro@red Torus(Sec.TUC,Business ,
and Pmfessiom Codc:TW Contractors License Law Baas an,appy m in owner of Required Inspections
property,who builds m improves themon,end who des such work himself"mail his
awn employers,provided that such improvements tie..,intended moRrW forsee.If.
however.Ne building or improwment is sold within one year of completion,the owner.
builder will law the burden of proving that ha did not build or improve for purpose of
sale.).
Q.as mmar of the property,am eacluuwly commcting with licensed centrarort an
smut,the pmjem(Sec.7014,Business and Professions Code:)The Contractor's Li.
cc=law des not apply to an owmer of property who Wilds or improves Dreman,and
who contracts for Much pmjeea with a contractors)0cemsed pursuant to die Contractors -
Liceremlaw.
0 1 Ma...P, a c. B k P (or this reason
r Dam
RKER S COMPENSATION DECLARATION
1 hemby Kinn under penalty of perjury ane of the following declarations:
I haw and will maintain a CeniOcae of Consent to self-insure far Workers Compen- _
atitio
an,u Provided for by Secn 3700 of the Labor Cade,fm Ne performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,a aquird by Section
3700 of the labor Cade,for the performance of the work for which this permi'a issued.
My Workers Compensation Insurance canner and Policy number Me
Center Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CMM smuan reed not W completed if the permit is farmer hundred dollars(SIM)
or less.)
1 certify Net in the,penformmxO of the work for which this permit is issued,I shall nm
employ any person in any mancr an as to hecomc subject to the Warkers'Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nu Ccnifcec of Eacmption,you should
become subject to me Worker's Compeneati.n.previsions of the labor Cotler,you must
.Jz forthwith comply with such provisions or this Permit shall W dermcd ewkcd.
Z O CONSTRUCTION LENDING AGENCY
P4
> I hemby affirm Nat them I,.construction kralm,.1hey W the perfufmanec of
Uj A the wars far which this permit is issued(Ser.3097,Civ,C.)
IfUnder'.New
D. Lender's Address
Z)z
U0 1 certify thn I have read this appliem--and sum that the aWve information is
Is.E•' toren.l agree to comply with all city and county on inanees and sum laws rusting to
U Wilding construction.and herby aummim rprsenutiws of this city to eater upon the
W above-mentioned.u.c., for o.P .c an purposes.
chima
H G. (We)acre to ave.indemnify and kecp hu.less the City of Cupertino agora'
0Vrp incoiues.judgments,cosaantl Ospis pCmdich may in anyway aceroc scum,aid Ci(y 1 -)
z APPLl #NT of ure DERSTAN of oris D WI Issued by: Date
'•` APPLf�ANDS AND WILL COMPLY WITH ALL NON-POINT
SOUR RE LATL NS. ...�//� )O `rRe-roofs
a{�
SignApph _ Y/ / D HAZARDOUS MATERIALS DISCLOSURE Dee Type of Roof
Will the applicant or futum Wilding oecupnat tram or handle ha adous material
s dclinctl by the Cupertino Municipal Code.Chapter 9.13,and the Health ad Safety
k.Section 2553](a)?
0y. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining P an inspection,I agree to remove
Will Nc applies'or f verNo
Wilding aceupam um equipment or device which
mit hamrdnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disvia?
❑Yes NO
lhew maJ the harandn /materials mquimmcna under Chapterfi.95ofthcCalifor-
niaHcalm&Safety Ccum Semlom 73505,25333 and 25534.1 undersand this if the Wilding
does net eumently haw a mnas sat ii u my mspomihility m notify the mcupat of Ne
mquiemcnsw Wmet proratissuance ofaC -aa �pcperry. Signature of Applicant Date
Owner an au4
atioddagent Dam All roof coverings to be Class "B" or better