05090070 CITY OF CUPERTINO gnorw t "' "'
BUILDING DIVISION PERMIT C(SN�fT 2AC' C1'R'INT„�`O� ATYq "
BUILDING ADDRESS: MADLEM MECHANCIAL INC PERMIT NO.05090070
19050 PPUNERIDGE AVE 2ND F
OWNER'S NAME: PERMIT ISSUE DATE
MISTHETOE TECHNOLIGIES 1990 OLD MIDDLEFIELD WAY 09/16/2005
E: SANITARY NO. CONTROL NO.
(650) 934-9485
ARCHITECUENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
G� O O O
uoii
LICENSED CONTRACTORS DECLARATION JobDescm ti n
rd 1'Gn7 ).f Nat1amlicemedunder dPmf.u.f.C.ft 9(commeouing t� \ J/� t{ t'�r\
with$CI kmbyaffir DthatIoofthe Bd urkleand Pw(cssiof Coo, 9(com cement r6i1?� \'l�,lf/�y�1�1177T 11'tl{m'"1�[—It1/}�!
^� mfull mreeanderl& ?J f— INSTALL 2 WATER COLOSETS
y tg Z Lianha ase t... C Uc.k
Date -��conhacmr 2 LAVATORIES/HC COMPLIENT
¢Q A
2 ECPSDEC RATION
Iusmcrsund my plan shall Ias public recards 20051
se.
spt; Licensed Professional
y3 OWNER-BUILDER DECLARATION
y 1 Mresimaro.(kc Nn 1 am exempt from the Conwnoro Ucuse Law for he
p o following mason.[Section 7113 t.5,Business and Pmfeumm Code:Any city or county
$ which requrch r permit m e.moucL alter,improve,demolish,m repair any araeture
—iy PA.,m its issuance,also retinues use applicant for weh permit to rile a signed statement
< thatMislicensedpursuamloNepmvivomortheConuacter'sLcen¢Law(Chaimr9 Sq.Ft. Floor Area Valuat
(commencing with Section 70M)of Division 3 of the Business and Pmfessiam Code)or
that he is exempt therefrom and the basis for the alleged exemption,My v(oh ion of
Section 7871.5 by any applicant for a permit subjects Neapplicant to a cM1 penalty of ;e ypN]}�` ber Occupancy Type
oat ream Nan live hundred dollars(5500). 31s90 O 0 O��3 . 0 0 .
❑I.mo ofthapropmy.mmyemployecawithwgmuthekwlecampe=tion,
will do Ne=on and the he Core re ter's Lt.cera w do Tomah(Sec.]011,Buatnw
and property
ho
Cade:The Gmacmis License law arca cot appy lf an owner of Required Inspections
own cro wMMlldovied Improves utherm.,and who dossuchwmkhhnselfedNrsals nth
own a however,
the Wilding
that went Improvements art not intended moaered fm oak It.
builder Nebuildingarimpmvemviniomid within one year or complefor thes=of
builder will love the burden of proving that M did not build or Improve for purpose of
sale.).
❑1,as mum r or the property.am exclusively contracting with licensed wounwloro to
consumer she project(Sec.7044.Business and Profession Code:)The Conmemfs U-
came law does not apply to an owner or property who Milds or Improves hereon,and
who==Ufarsuchpmkmwithacmtrmmr(,)Iiann dIumwntwIMGnoxto/s
Dame Lew.
[3m I son under See ,B k P C for this womm
Dow Data
WORKER'S COMPENSATION DECLARATION
1 hereby 11firm under penalty of perjury one ache following deductimu:
have and will maintaina Cenifswteaf Coment m self-Imam far Wartafs Compen- .
ution.ss provided for by Section 37M of the labor Cade.for the Performance of she
work for which this Permit is issued.
❑1 have d will maintain Worker's Compewtion Isumana.as resimmd by Settle.
3700 of LaMr Code.far performance of sM wade for which this permit is issued.
My War s am artier and Policy
Gris:r. - Polity No.:
ERfIFI, OF E%FSSPfION FRO WORKERS'
COMPENSATION INSURANCE
front section need not M completed if he permit is furanchundmd dollars(SIM)
or leu)
1 certify that in the performance of she work for which this permit is issued.I shall not
employ any person in my mmnerha as m become subject to the Workcrs'Compemation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CertlOcam of Exemption,you should
became subject to the Worker's Compensation provisions of IM Lader Cade you most
.,O forthwith comply with such provisions or this permit shell he drcmed revoked.
tiCONSIRUCION LENDING AGENCY
(~m�—m I hereby aArm that there Is a construction lending agency for he performance of
CC the work for which this Permit ls issued(Sec.3057,Civ.C.)
Q0n Q Larder's Name ,
Z Lender's Address
V 0 1"Ally that 1 haw read on,application and sum Na the above information Is
U.h cannot.1 agree to comply with all city and county eminences and ante laws relating to
0 Wilding construction.and hereby sen t representatives of this city to enter upon Ne
W aMve-mentioned property for impectias purposes
a (We)all=to save,indemnify and keep harmless the City of Cupertino agaimt
,..n m liabilities,judgments,casts and expenses which may In my way amus all Said City
r,7 In eMEE
[ egrmting o[N'
t1— APN EST DS 1 COMPLY WITH ALL NON-POIM Issued by: Date
SOS �I i
N Q _(/,—Or Re-roofs
Signmursof AppliunUContnctor ` Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant car(uwm Mil ' aceuput nom or handle haurdous material
u deRrcd by the Cupertino Muriel Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yos u
wnI the applicant art stare Mild' aaapant aha equipment or devices whish If a roof is installed without first obtaining an inspection,I agree to remove
hazamnm air eonumimn u nod by Ibe Ery Area Air Quality Management all new materials for inspection.
suict7
❑Yes o
I have mad the luxurious materialsmquirementa underChapter6.95 of No Califor.
nice HealthB:Sarety Cad.,Section 255015,25533 25534.Iundersmud uotirom building
does not c ntly ham a nen4 at I Is my wimlity m notify the occupant of the
vi c which mel 'or i eCeNficamor5)c-yp c!ht_ Signature of Applicant Date
0 eau ori. (�' II Date All roof coverings to be Class"B"or better