04070174 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C01�1TRACTORTNFORMATT�N
BUILDING ADDRESS: ABCO CONST PERMIT NO 04070174
I IW NEWS NAME: PERMIT LSUE DATE
m
ONEN SANITARY O. CONTROL NO.
(402) 779-7577
NITECT/ENGINEER: BUILDING PERMTT INFO
BLDG ELECT PLUMB MECH
0 0 0
LOo LICENSED CONTRACTOR'S DECLARATION lob Descrl tion
t�. I hereby affirm de
Thal 1 am licensed unr provu idOof Chapter 9(commencing p
n� with Sec00n7")of Division 3afthe BusimoxxmM Prafesiom Code.and my license is
�M`in run force end effect DEMO /Y fill
i License Class Lk.0 ZQ�A
Z11 Data.Contractor
ARC e DECLARATION my®�
1 understand my plana shell all Im W used u public records ((�1
'cG Licensed Predominant
OWNER-BUILDER DECLARATION
gm 1 hereby affirm mal I am exempt from dm Conuectes License Law for the
po fallowing masan.(Section 9031.5,Business and Professions Code:Any city Or County
$ which requires a permit to construct.aloe improve,demolish,or repair any ammurc nnnn
prior to its issuanco,also requires the applicant for uch permit m file a signed suument
mhe is licensed puntim,win,provisions of the Contractors License Law Sq.Ft.Floor Area Valuation
m
y (commencing with Section 7")of Division 3 of the Business and Professions Code)or
mat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit ubjects ma applicant to a civil penally of 37�BB13`QIH$er00 Occupancy Type
not mom man fin hundred dolts.(ML
I,uowreaofthepmpeny,mmyemplayeeswithw smuduUmlecompen=tion,
will do the work and me structure is not Intended.,offered Wash.(Sec.7044,Business
and Professions Cods:The Contractor's License Law does oat apply to an owner of Required Inspections
property,who buildsor improves thereon,and whodoessuch workhimselfor through his
own employees,provided that such improvements ac not intoned oroRered forsele.If,
however,me building or improvement is sold within one year of oompledon,the owner-
builder will ban the burden of proving that he did not build or improve for purpose of
=101
Dy.As owner of me propeny.am inclusively contracting with Iittnud contractors to
Construct the project(See.7044,Business and Professions Code:)The Contracmh U.
come law does not Apply to an Owner of property who builds or improv memo.,and
who contracts for such projects with a concom or(q licensed pursuant to the Cantrantoes
License Law.
1 em exempt ander sec. .B&P C for mb mason
Owyer/ OI au
�(/ WOR -R' 1PEN ONDECLARATION
I Mmby Air. er penalty of perjury arc of ft,*A'ii,declantlau:
I haw and will maintain a CeNOate of Covent to=If--insure for WorkcesCompen-
on,u provided for by Section 37M of the labor Code,foe the performance of the
i
'for which this permit is issued.
❑I have and will ode.fon Worker's Compensation of the w Insurance,as required by stench
ssu d.
My oftireLabor Cone,formsurancrmanderand work forwhichthis permit is issued.
My Worker's Campensauon Insurance es.ia and Polity number arc:
Carrier. Polity No.:
CERTIFICATE OF EXFFM PITON FROM WORKERS'
COMPENSATION INSURANCE
(Thu meuon need not W completed if the permit isfnonchundrcd unit.($1 00) -
or Inas.)
I certify Out in me performance Of use work for which this permit is issued.I shall not
employ any person in my manner in,As to baomc subject to the Workers Compeuauon
Laws of Califomia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become Subject u the Worker's Compensation previsions of me Labor Cone,you mut
.JO foMwith comply with such preyisimo Or this permit shall W deemed revoked.
Z h CONSTRUCTION LENDING AGENCY
[—t 1 hereby oPrn that them is a comminution lending agency for dm perromunce of
C' the work for which this permit Is issued(Sar.3097.Civ.C.)
H7 LOndcls Name
z Lmder's Address
V Q 1 certify ths I have read this applintinn aW sum that me shove inforr ion is
E cone..1 agree to comply wise all city and county oNlnanns and furs Tawe relating to
p V^ building construction,and hereby authorize reprc=mnins of this city to enter upon the
4k1 above-mentioned property for inspection purposes.
C (We)agree to save,indemnify and kap harmless me City of Cupertino against
run liabilities,judgmens,costs and expenses which may in any way accrue against And City
t„)z inconseq as orate grantugofmis peril.
APPLIC UNDER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: at -
SOUR EGULA
Re-roofs
Signatu of Appli Comoro r Data
HAZARDOUS MATE IALS DISCLOSURE Type of Roof
45; 11, .rlul.Wlldi .cupanistamorhaM]chri NousmawfaI
ss, find by the Cupenino Municip Dde.Chapter 9.12.and the Health and Safety
Code,sermon 2s53xa)7 All roofs shall be inspected prior to any roofing material being installed.
Yu
Will the applicant ortum holding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardom air Common u efined by the Bay Area Air Quality Management all new materials for inspection.
tricR
❑Yes o
I he.mal the In=Nnus nou,nalsmquimmcnls under Chapter 6.95 of me Califof-
ni.H.bb&SafctyC Sx6.25505.25533 md25534.1 underesed thin ifdtc Wilding
does not ciumndy hon moans mal it u my resporenhility m nouf the occupant or de
mquirem which bcmmpdo W ccofaCertifcac CY Signature of Applicant Date
owner raamoriae a Dam All roof coverings to be Class "B" or better