04020037 CITY OF CUPERTINO at � a k
BUILDING DIVISION PERMIT e,ONT
q I k'URMA' TO a;;
BUILDING ADDRESS: PERMITNO.
04020037 '
NER'S NAME: PERMIT ISSUE DATE
NE: SANITARY A.4 2 OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O 0
L o o LICENSED CONTRACTOR'S DECLARATION - -
z 1 hcrcby off rm that I on limmcd under provisions of Chapter 9(commencing Job Description
<¢ with Sccton 704)11)o17Division 3 of Ne Busi a and Profeuians Cook,and my license is
in full home and effect.
5$z
License ClasaLic.0 DEMO 40 RENTAL UNITS & 1 HOUSE
zil Date Canlrecmf (APN 436619075/#36619076/436619048)
ARCHITECTS DECLARATION
I understand my plans shall he used as public records #7308/#7310/#7312/#7314/#7316/#7318 RAINBOW DR.
U
30 Licensed Professional
OWNER-BUILDER DECLARATION
I I hereby affirm t m I am exempt from the Conuacmr'c :Any c Law for the
O O following moon.permit
n]1131.5. t.Business and improve,
donna Calc:Any city or county
$ which as issuance,
a permit a camuuct alter,impmw,demolish,or repair ed stmcurc
prior,s licensed i p a1.requires Ne applicant tforhe suchCor permit m fie a signed matemenl
Nat mencpumuam 7in the")of Division
of the GaOuacmnd Professions
(Cbloar9 Sq.Ft.Floor Area Valuation
$
(commencing Section 7 and t f D osis n 3 of the alleged
mBusiness prion.Any vi Code)or
.- Net he u exempt therefrom and the Emu for the alleged e.mplian.Any violation of 00
Section 7031.5 by any applicant for a Permit subjects Ne applicant to a civil pemlly of APN Number Occupancy Type
not more than Hw hundred dollars(5500).
❑1.mownm.f the property,or myemployeeswlN wages.their true eompen.tion,
will do Newo,k,and IheaWemre is not intended or offered for sale(Sec.7004,Business 3bbi.9U480 0
and Profemiam Code:The Coarro m's License Law does not apply to an owner of Required Inspections
property who builds orimproves Hereon,and who doessuchwork himselfor through his
Own employees,provided thatsuchimprowmutsarenotintendedoro@rctl formicthe ow.
r.
bull or the building mimprovementis gdust edict one year of completion,the owner.
builder will Mw the burden of proving Nu be did wt build or improv for purpose of
.is I.
;wLho
owner of dm property,am uclusively contracting with licensed contractors to
ct Ne pmjacl(Sac.7004.Business and Professions Code:)The Co mactor't U.
aw does not apply m an owner of property who builds or improver thereon.and,
ns.cts for such pmKcu with a mnhactor([)Ii thmantlotheContractr:
law.eaemptu ec. ,B&P`C/fat1s .onDem ' �RKER'S COMPENSATION DECLARATIONhem yalarm under pemlty of perjury au of Ne(olio" g dalmatis:w and will maintaln a CeNficam of Consent to se161nsurc for Warker's Compew
amI...as provided far by Section 37M of the Isbm Code,for the performeme of be
work for which this permit is untied.
❑1 haw and Witt maintain Worker's Compensation Insur ace,as required by Section
3700 of the Labor Code.for the performance of dm work for which this permit is Who.
My Workers Compensation Inaur nce terrier and Policy number mac
Caller, Policy No.:
CERTIFICATE OF HEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need notbecomplcted lithe permitls Roche hundred dollars(SIM)
or Mas.)
1 certify that in the performance of the work hof which this permit is issued,I shall not
employ any person in any manner so.Or become subjectta the Workers''Compensation
Laws of California Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become subject ro the Worker's Compan.tian provisions of are Ichor Code,you must
Z faMwi0 mmply with such provisions or Nis permit shall be deemed nwrdud. .
.Zi O CONSTRUCTION LENDING AGENCY
I hereby affhm that Nert isaconsuuctinn lending agency for the performance of
ori r7 tite work for which his permit is issued(Sec.3097.Civ,C.)
W Q Landes Nam.
z Lend,es Address
C)t] I ttnify that 1 have mad this city
and
and sum Net and
show information is /
H correct 1 agree m comply with y city and county ordinancesafivOr and stem laws relating a
DU buildingcansuuctian,and hereby euNadw rcprcsenutives of Nis city menter upon 0te
,r G ehovcmcntioncd property for inspection purpaxs.
(Wc)egru Ip.w,indcmnifY and keep h c City of Cupertino againstF"y Ilebilitiu.judgmenu.costs and expenue wh" ay' nyway aecmc against mid City /
C.)7 income ncc of Nc gmnfng of Nis a n.
rte. SA0
P LICARNT l} COMPLY WITH L ON-POINf Issued by: Date
Re-roofs
nam pelican tractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building ouupem arum or handleh.udous materiel
.dented by the Cupenuo Municipal Code.Chapter 9.11,and the Health and Safety
ode,SeNon 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya �N.
Will Nc applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hummous air contaminants as dc0ned by the Bay Area Air Quality Management all new materials for inspection.
Ghoul?
❑Ycs An
I have rtad the hsamdnus make u1srequi maunder aporli.95oftheCalifor-
niaHoalth&SafmyCam,Sectiom25505, and 2553 adersund Nmifthc building
dace not curtently hoses nen r ily u notify Nc ax t Nc
mgaircmenty " u or.Cmdficatearat. - Signature ofApplicant Date
er nr ams ag Dar All roof coverings to be Class 'B"or better