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05010091 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATIgN``� 41411 BUB.DING ADDRESS: SYL-MAR CONSTRUCTION PERMIT NO 05010091 NER'S NAME: PERMIT'ISSUE DATE HEWLETT P SNE: SANITARY 0. CO OL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LOp LICENSEDCONTRACf00.'SDECLARATION Job Descri U 1 hereby affirm Nat 1 am licensed under provision of Chapter 9(mmmencing n� whits timer 7")of Di k n 3 ofthe Bull.and Profession C de,and my license is L�� © T. I . /INSTALL 3 CHILLERS ��iiii{{�� Connector o n p Dam CammcCL MAR R {9 2006 ]W ARCHITECTS DECL1 re ON ` Is Y1R N L u� I undcwnd my Plans shall W used as public mcmrds DyU Licensed Profcuionel ft �#'-�•, 3 OWNER-BUILDER DECLARATION �� S<0 I hereby.(hers that 1 1. exempt from the CanuactCod License law for the INl pO which reason.(Schon PIJLABuainus and Improve. damn Cam:Any city or coumy $ which fus i ssua a Permit re cores The alter,improve,h Permit i erra ed,sig any structure prior N its issuance.also requires the applicant for such permit to file a signed statement ZRCmat he u licensed pursuu ano the provisions Li visioof Contractor's ccnm law(chapter 9 Sq.FL Floor Area dust mi- (canmencing with Section 7")of Division 3 of Ne Business and Pro2viou Cede)or $ that he u exempt therefrom and Ne basis for the alleged cxcmplion.Any violation of Schon 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3]!$�1uh$et0 O Occupancy not mum than five hundred dollars(8500). p Y Type I,uownu of the proputy,mmy employcu with wags uux'vsale compensation, willdo Newark.and Ne an Crmunotintet. Law an and property Wilds or The Conmcsm'.Liana law uch not apply 1f an owner of Required Inspections Own aro whobuildsorimpratuchimprovndwho...,i tendo himselfor Waugh his ownemploycuiprovidedthat suchimprovementsamnot ear ofeoraRUW for Aide.It. however.Ne building or improvement is sold within one year of completion,Ne owner. builder will have the burden of proving that An did not build or improve for purpose of sate.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to construct the Project(Sec.7064,Business and professions Code:)The Contractor's Li. . cense Law does not apply to an owner of property who Wilda or improves thereon.and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. I am exempt under Sec. ,B&PC for this moon nor Data WORKER'S COMPENSATION DECLARATION 1 hereby arfmn under penalty of perjury,one of the following declaration: I have and will maintain a Certificate of Consent to selGinsum for Worker'sCompen- sanon,as Provided fu by Sutton 3700 of the Labra Code,for the performance of the work for which this permit is issued. we"for and will maintain Works'Compensation Insurance,as required by Section J of the labor Code,for the 6..0 of the work for which Nis permit is issued. My Work CA Cyoympe.A onslnns/y6�ance artier and Polity number Cartier..!//r/E //ir/ Poli,No.:� :51aa CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed if the Permit Is rare nc hundred dollan($100) or less.) 1 Unify that in the Performance of the work for which Nis Permit u issued,I shall not employ any person in any mannerso as on become subjects"the Workeri Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Ccnifcete or Exemption,you should become subject to the Worker's Cnm,.tion provision of the Line,Wr Cade,you mon Q O foMwith Comply with such provision car this Permit shall W domm ed aked. z Di CONSTRUCTION LENDING AGENCY f'ate' T hereby all'mm Nn Nem is.emsuueunn lendmg agency for the off....of fJ: the work for which this Permit is issued(Sec.3097,Civ.C.) 0 Lender's Name L)Q 1 cenify that 1 have mad this application am sum Nat the above information's comma 1 apo m comply with all city and county ordinances and nam laws relating in Q V building consuuctlon,and hereby authorize mFmsenmtives of this city to cuter upon the C above-menudgin Property for expenses puryuea (We)agree to save,indemnify and keep harmless the City of Co,anino.,,lost iZ incoiseajucc OfthAostsandOf thisumit. may inany way scenic Against=to City t)z Aconsequence of NegranANDSNisDWIL APPLICANT UNDE STAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S LA ONS./ 9 �('�H Ag-- Do Re-roofs at cos Applicant ictor Da Applicant RDOUSMATERIALS DISCLOSURE Type of Roof Willy t e Cu,pont or future Wilding e.Chapter 9.1 of handle Health and As Ocfincd by Nc Cupertino Municipal Code.Chapter 9.17,and the Health and Safety tile,Sec yes 355J2(a)? All roofs shall be inspected nor to an roofing material beim ❑Yat n p p y g g installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haxardow aircontaminans as&food by NC Bay Am.Air Quality Management all new materials for inspection. nrict? ❑Yea ° I have mal thc hanrdnusmawdals mquimmens under Chapter 6.95 of Nc Caliror- niaHIO&SafctyCadc,SttvU.nM5.25533and755M.1u� dNuirtic Wilding docs rot curmn ly m a brant at it u my responibiliry m notiry fl axupanr of Nc re menmust W pIoiasurceofacutifmateora r. Signature ofApplicant Date mer°rapt nixed., Dam All roof coverings to be Class"B"or better