00120057 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: IIHRMIT NO.
7359 RAINBOW DRIVE SOUTHBAY CONSTRUCTIO14 00120057
OWNER'S NAME: APPLICATION SUB DATE
SGIJ DESiELOPIhENT S1i DIVISION STREET 1210812000
PHONE: '� SANITARY NO. CONTROL NO.
(408) 379-0400
BUILDING VERMIT INTO
0 YO ARCIII'1'Ef-f/ENGINIiIiH: BLDG ELECT PLUMB MECH
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day
yG lmnLICthlEDCONN,IboarRACfOR'Sde,s Dirous of Cl N
Z Hamby union tow 1 rrra ncan.ed nnacr nroni,ian,lar cl:amer 9lemmneneing Job Description
FRC. Is th Scdion 7000)ol'Divivion 3 of the llnvine2.and Prnl'rWitc.Code.and my license
a-� i,irr Tau fame and euect. DEMO
Sz c a Licence:Class Lic.p
y P n O Date Commemr,
W 3 a.�; ARCHuEcl S DECLARATION
C O< I t derit my plans%ball he used as public record.,
w i 5
p z Licensed profes+:oiml
OWNER-BUILDER DECLARATION
I hereby alrrm that I ran canopt form the Coutmctor's Liccnu Law lit the
C>
following reason.(Section 7031.5. 1.ol1rs%noel ,,,lemons Code:nnY city lar ramnry
G•LO sublin 1 n ll I Ilt n lo lin 1' to am
to Itinrt t L, y I .. tl Ipc I I g Int(Chapter
morn licensed p . a rt m m . nn tContractorsC 1 onsCodY Sy. FL Floor Arca Valuation
(commencing e with Section lain)d t Division hi3 the lege tic.,and i nen..a n.cede) $,:,5000
or that M is exempt therefrom; yphi and the hoes%for the.,,ha exemption.Any violation
of Sectio 711315 by;wry shod doll r, n pemrit snnlecu the applicnm m s civil penalty
anmttnrne litre live.hmdra�l nannt,(,sou). APN Number Occupancy'Type
01.as owner of he I topcny,or my curplo,ocs with wages as their sole cour,ensecon. .36231.029. 00
will do the work,andthe,Vadum i,nm order or sale uttered far le(Sec.1014.
an
Business d Profession,Codi:The Contractor's Licca¢Law dons not apply to an _ Required Inspections
nt� raf l,ro@ny Who bunds or Improves mcman.:md who dues.arch work himself NO ASSIGPJED INSPECTIONS
11 [1 In,own anployces.provided mat such improvcnand arc not imarded or -
ofland tit sole.IL however,the building m improvement is stilt]whhin one year of
completion.he owner-Wilder will have the burden of proving that he did not Wild or
mp we for pm row"Code.).
I,m owner of the pru,o i I csurvive,cuntrnci ng with licensed contrac tors to
rnt the project(Seg.7044,Ilaninros mW frol'esxinns Ccal,0 IIt,Couraclo,1
Luice e.Law,does not apply to in owner til property who builds or Impar es thereon.
and who contracts for such projects with a eommctnr(s)licensed mursmm to the -
Cnntratorz License law.
❑1 um esu r under Nyyy,RJ'C for this Hasan
Dwrr
\VOR IiR'S COMI'IiN5AT1(lN DECLAN ION
1 hereby affirm under penalty of perjury'Inc of the following leclarmini
. ❑ I M1ava and will neuntan it Ccrllfca a of Consent to self-insure for Wud.cr'n -
Cnrnvariation, av provided for by Section 3701 of the Laher Code, fur the
pcdbm,ance til the work for which this permit is i¢uul.
01 have and will maintain Wader's Compcnnation Imumnm,as rcyuired by Section ,
3701 011 the labor Cate,for the perrormano,of the wad Ivor which this permit is
ural.My Wader'.Compen.enion Insurance corder and Policy number are
cam": looter No.:
CLRI'HICATION 01'EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
of his rection nod not be conrplend it the Punnir is for one hund,cd dollar%
(Slap or lits)
I certify that intone permo mneu of be.,,,it for which thin permit is issued.)
shall not employ any person in any nunner so as to become subject to the Workers
C....mcnnmlun Laws of California.Date
Ao 11 -
Not ICE'1 O AI'I'LICANT,IC unor nr.Aiog this Certificate of Emmaption,you should
become whject III the Worker;Cmnpensation missions of the IaMt Code.You amid
OQ forthwith comply with such provisions or this armritshall be deemed envoi
CONS'FRUC ION LENDING AGENCY
1 hereby mann That there is a nrn.vtmcuan landing ugcncy trade p,Hor anee
tithe work I..which dn,Inmril is issued(Scc.3097,Ci¢C.1
1 Q Lender's Name .
.= 7 Lender's Addre,s
U O I certify thin I have read this application and%ane that the above mfrocalt r is -
�+ [yr correct I agree m comply with all city rind cnumy mdinfor-v amt s0m sews relating .
O U to,gilding con,oadinn,and thereby ardam,c epnsemative%af his city to inner ufran
the aMrromernloned prnpcny for inspection put ii
[.. 4
(We)agree to%rive,indemnify and keep harmlesv the City of Cupertino against
(n Iinhilkic,,judgnunn,costs and eyx:nsc%which may in any way accrue against said
U Chy in coura"un a or'Ire granting tit his proud. �z—O
APPLICANT UNDERSTANDS ANI WILLC(IMPIN I Ah1.NON-1101 IsSuedb Date a
SOURCE HF.GULATIONS. ! O Y'
Signature of ApplicanVCnmracmr Dgtc^^ Re-roofs
HA%ARDOUS 1ATERIALS DISCLOSURE
Will he applrem, itm
more holkhro,accupam item ar hamm
le namou.,raedal 'type of Roof
m dctlnu,l byline Cnpenlnu�l Pel Code.Ch,,acr 9.12,unit te hHealth and Safety
Gde.Section 2553240 \�
O Ye; lNo All roofs shall be inspected prior to any roofing material being installed.
Winnie applicant(it boom building oc'cupmt use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit houacho,mr aanuunimml,us dclined by the Bay Amu Anr Quality Munagenant
Outdo! - all new materials for inspection. Applicant understands and will comply with
G Yen "Ito No all non-point source regulations.
I have road the Wound.., naerials re,mothacnts under Chapter 6,95 of the
California Health k'.S:dcty Code,Section,25505,25.533 and 25534.1 understand that
l the FuQ
yn.htilconyu=,pons.Whty mamlfy the
accopwre,ncola which btu be met prim to issmmce of g Cenrrc te ofOccap / � Signature of Applicant Date
owner el agrrt All roof coverings to be Class 'B"or better
OFFICE