01330050 CITY OR CUPERTINO
BUILDING DIVISION PERMIT LCONTRACTQRaINFORMATION
BUILDING ADDRESS: PERMIT NOO 3110 0 rJ 0
'111 PALO VTqTA RD
.R'S NAME: PERMIT ISSUE DATE
RICK MULTAGH CHLISTINA ARMO TR 11/12/2003
ONE: - SANITARY NO. CONTROL NO,
ARCH TECT/ENGINEER: BUILDING PERMIT INFO
BLDG
t ELECT PLUMB! MECH
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10, LICENSED CONTRACTOR'S DECLARATION Job Description
I O I hereby affirm that I am Iiae
nd under provisions of Chapter 9(commencing p
with Scnienl )o(Div iion3 of the Buxin mfessiuns Codcmd mylicense is ��IVg1,°E®
Io fall fOKC n =L
)q� Llcane Lic.g Z79ZZ5 FOUNDATION UPGRADE
Oats c�mmfor COW CONTACTOR: VALENTINE CORPORATIV 92003
(x l-a9 A OtIITECr$D TION V{.0 �-
e W.tea l un Inland my plans shall M used as lb IL recnrda
'03 Liecns dPnefcssional BUILDING
OWNER-BUILDCR DECLARATION
<X I hereby affirm that I am exempt from the Commodes License Law for the
CSG fallowing ocnon.(section 703 1.5,Busidammd professions Calc:Any city or county
42[! which requires a permit In cnnalmct,slur,improve,dcmolialb.at hepair any structure
ui< prior to its ismance.also requires the applicant former Witail to file a signed statement
2that he is licensed pursuant othe provisiomofthe ComracuriLicense Law(Chapter 9 Sq. Ft. Floor Area Valu [ J,i360
2 $ (commencing with Section 7000)o(Division]of the Business and Psoressions Code)or
^ Not he is exempt therefrom and th
herefroe basis for Ne alleged accordion.Any violmion of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 y�'p� jjr]�ter0 0 Occupancy
not more than five hundred Italian(S500). as pane Y Type
❑I,as owner of the pmpwy,or my employees with wages as their sale compensation,
Will do the work end the sWclem is not intended oro@std for sale(Sec.7W,Business
and Professions Cod=:The Constrictor's License Law dors not apply to an owner of Required Inspections
property who builds m improves thereon,end who dauech.,it himself or through his
own empinyen,provided W1 cash improvamena art not intended or.Rercd for sale.If,
however,the building or improvement is sold within as year of completion,We owner
builder will have the burden of proving that he did not build or impfon fa purpose of
sale.).
1,as owner of the property,am exclusively contracting with licensed comments to
constraint the project(Sec.704,1,Business and protection Code:)no Con iston's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a Lumnnor(s)licensed pursuant to IM Contractor
License Law.
❑,I am exempt under See. ,B&PC for this mason
Data
WORKER'S COMPENSATION DECLARATION -
I hereby,aRrm under pena0y of pmjury one of Ne fallowing dedfidau arts:
Thaw and will meinaina CeniOcne of Comem to Ulf-insurefar Wortrr'sCumpen-
aslion,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is lamed.
C1I have and will maintain Wonders Compensation Insurance,as required by Section
3700 of the Labor Cade,for Ne parformmce or the work forwhich this permit is Issued. '
My Wnrkcl'e Cnmpensatian lnaunnce/canter onPglicv number am:
My Wto.Gkcea�fiod ( ISPra�'Cy4N^o�.: f
CERTIFICATE OF EXR ON FROM WORKERS'
J' COMPENSAiiII NINSURANCE
(Tib section Bad nor becomphad If the permit is foronehuedmd dollen(5100)
I'm.)
I c=itify that in the perfo mmes,of the work for which this permit is issued,l shall not
employ any person in any manner an as or become subject in the Workcn'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifcate of Exemption,you should
become&object to the Worker's Compensation provisions of the Lmor Code,you must
.,,Z forthwith comply with such provisions or this permit shall W deemed evoked.
y O CONSTRUCTION LENDING AGENCY
I hereby affirm that Nen is commotion lending agency for the performance of
x the work for which this permit is issued(See.5097,Civ.C.)
W Q Le traces Name
= z Lander's Addroom .
U Q 1 anify Nal 1 ban read this application and ads that the above information is
V. H Correct.l ague a comply with all city and county oNinances and stage lays misting a
pU building comtruClion,and hereby mlborim repromnlativm or this citym enter upon the
purpo
W
above-mentioned propcny fond expense,which may
(We)agree la save,indemnify and mcp harmless the City of Cupertino against
1)
i.. Z in
r the
and of
may in any way accuse agelmt mid City
C.) z A ""CANT of the RSTA g n(This permit. - r
^ APPLICANT ON RSTAN D WILL COMPLY WITH AL(,NON-POINT Issued by: Date /
SOU gR U N5.
�' a Re-roofs
go o H on DOLS MATERIALS DISCLOSURE Dau Type of Roof
Wi the applicamor future Wilding aenpamsmaeor handle haramil material
as defined by the Cupenina Municipal Code.Chapter 9.12,and the He&11h and Safety
.Section 2553200? All roofs shall be inspected prior to any roofing material being installed.
❑Yns V.
,�.,wm the applicant or mtare building a=Lapanl use equipment or device,Which
If a roof is installed without first obtaining an inspection,I agree to remove
II handhous air contaminants a defined by the Bay Area Air Quality Management
imict? all new materials for inspection.
❑Yes
I have mW the ha plousmaterials nquimmcnu under .Chapter 6.95 of tM Califor-
niaHcalth&Safely CWc,Satioas 25505.25533.d15534.I undenaM the i(tbe Wilding
;09
ihility u notify(be acupam of Oc
Signature of Applicant Date
Date All roof coverings to be Class "B" or better