08040095 CITY OF CUPERTINOr
BUILDING DIVISIONCC)NTRACTORI IVI+'OILMt1.TIf1N
PERMIT
BUILDING ADDRESS: PERMIT NO.
10121 PHAR LAP DR AMERICAN BRANDS CORP 08040095
NEWS NAME: PERMIT ISSUE DATE
ROD H00 1145 HAWKS HILL RD 05/09/2008
PHONE: SANITARY NO. CONTROL NO,
(510) 440-9850
ARCHMICTIENGINEER: BURRING PERMRINFO
ELDO= EO PLUMB MECH
O O
COQ LICENSEDCONTRDECLARAT
ACIDIS ION
m 1 hereby afRrm that 1 sum licensed under provisierw of Chapter 9(romamncina Job Description
U with Section 700M of Division 3 of the Business and Professions Code.and my,icer is ADD PATIO CV ENCL 12X22 264SQ
"N o full fertt and UfecL
�qz Ucenae CTw�.e��Lc.♦ 3 ZL AMER BRANDS CORP #22737 RNWD BUS LIC
3t-,q Doo: — Cnnuxlor
z7W7W ARCHRECI-S DEC 710N
1 understand my plans Mal,W used as public remoras
�yV
y o
Licensed Professional
y 5 OWNER-BUILDER DECLARATION
CO F 1 thereby aRirm Net 11. exempt from Nc Camnnors :A.,c Law for county COO o following mason.(Second]031.5.Business add Profusions Cade:A4Y oily m ceunty
K which nalosom n Permit re cores the ,,lira impmse,de Permit
or repair any swmurt
prim m its l licensed
p Jsu mgoithe the applicant for amh perm',b a a riga statement
a Nwhcuccenwit pursuant to the of Division
of thCGmnanesandPrSlaW Professions
Sq.Ft. Floor Area Valuation
Y�$ that hemingwith Section 70and the
bads n3 of the Business and Professions Codo)m $22500
— mea be u ezuvpt therefrom ado Ne b..:.for the Jogrd absorption,My Nolauon of
Section 7031.5 by wry applicant for a pemdt subjects the applicant w a civil penalty of py Number Occu ane Type
ma come Nan raw bmmdred dollars(ssom 3 2 618 012'.d'0 v' P Y YP
01.ssmarcsof Die property.or my uoployca with wages m their sole cme,crea on,
will do the work.and the suucturt u not intended Or offered for We(Sec.7044,Business
and Profesdens Code The Commerce,License Law dons Out apply to an owner of Required Inspections
Property who Wilds uimprows thereon,and rhodoeasuch work himself.,through his
own employees,provided that such impmwmenu art net Intended oroffered formle,IL
bowers.the building orimpwwment u sold within arc year of carepkdon.the owmr-
builder will from the burden of proving that k did net build or improve for Purpose of
sale.}
0 I.m owner of the property,am ucluiwly contracting with Became omucww 70
cmuuum the project(Sec.7014.Business and Professions Code:)The Cmua s U.
cense Law does not apply at ad..of property who builds ser improves thereon,and
who ommmut for such projects wideaconuamm(s)licensed purwam or Ne Comracmh
Lt..Law.
O lameumpaunde Sec .B&PCfmthi..
Dean
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under peulq of perjury one of the following dalan0ou
0 lluw se 0081 maintain a Cenifiecm•of Consent w relf-insure fm Wartrls Compere-
saaion,as provided for by Second 3700 of the labor Code.for use Performance of the
work for which this;permit is issued. .
0 I haw and will maintain Wmkers Campewlian Insu ..u required by Section
3700 of the Labor Code,for the performwtec of Ne work for,which NU Permit is;traded. '
My Wmlmeess.C�roj eca moan sun
I�0,
.carrier and policy number are:
Carver. \\s+�w�v� " Polity No.:k0 Q16 Z 6 '
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need WE W compote if the permit is;for mm hundred deBws($100) .
or bear)
1 cannily Wt in the perfmnance of the work for which this Permit is issued,I shall not
employ any person in any marmran as w become subject to the Workers'Compensaden
Laws of California.Due
Applicata
NOTICE TO APPLICANT:If,after making this Oerofrom of Faxmption,you should
become mbicet On to Workers Comporandon provisions of the Labor Code,you mute
.J z foMwith comply with such provisions w this Permit shall W doomed molted.
z Vy CONSTRUCTION LENDING AGENCY
the[-+ 1 for which
Nlthe 000 dart ii a ro(sec. lending agenry for tion performance of
Uj Le work(tar which Nu permit u issue(Sec.3097,Cir.C)
131 Q larders Name
z keels Add.
U Q 1 muff,that 1 haw rte his spplicalk.and sou Nat the ahem of..0.u
IL - Correct I Igoe On comply with all city ad County erNnancrs and sum Ian Waling to
C) building consuuctiod,and hereby au l onm mpnsenuuws of this city to amer upon the
above-mmmdened Propony fm inspection paryoses
F y (We)agree to sale.indemnify and keep harmless the City of Cupertino against ,I\',
vy fly in conniu,judgmfthe ipsuarW oapcnsuwhich may in any nyammm yalnst did City /—_�/�J3/
V z A APPLICANT
of the granting of this O WILL
^ APPLICANT ULATI ANpS,AND WILL COMPt,Y WITH ALL,NON-POINT Issued by: Date
SOURCE REGULATION S/ _, _� J// S4O�N
_ �dKH t S.C�/� L O Re-roofs
smtnwum of ApplsunVConuecwr paw Lf
HAZARDOUS Wilding
ALSmstme0DISCLOSURE Type of Roof
Will oreapplicant mfotumbuildinge,Chaptr9,,mand the
Health and
ss defined io tion Cupertino Municipal Code.Chapter 9.12 and tion Health cetl Safety
.Section 8s32(U7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu rj Na
Will the applicant or future building occupad,um c4uipment or dcviw which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnardous air Contaminants n defined by tion Bay Acta Air Quali,y Managcmem all new materials for ins ection.
Dimiict7 P
0Yes ANo
I have mad the hanrd ss,mamcrisumquirtnemsumor Chapwr695 ofNcCJi(or-
nu Hulth&SaletyCado Srsomm 2505,25533 are 25534.1 mak n ced thuifthe Wilding
deu mo,'emody haw•comm.dud It u my responsibility on mofy the occultism of thc
requirement t, mnwxmet ,t�ronr,cm;rK,ld er Occupancy. Signature of Applicant Date
400
s-4-0 g
Owner olauthodred agent paw" All roof coverings to be Class'%?."or better