00070058 CITY OF CUPERTINO
UUn.t11i1t!5XllsuREDONDO EHRMIT C0NTR*fiT(*W§0jWAT10N: 00070058
BUILDING A DURESS;
U PIiRMI'I'FO. '
NASSAU ERNESTO M 2531 GRACELAND AVE 07/11/2000
^ OWNER'S NAMH.. APPLICATION SUR DATE
(650)298-8494
ZONE: SANI'T'ARY NO. CONTROL NO,
p rc z ;1RCUITIiCT/F:NGINIiER:
BUILDING VERMI'IINFO
BLDG ELECT I'LUAIH MUCH
Hat LICENSED CONTRACrOR'S DECLSRAI ION WATER HER �
Z' bDescription
- 1 hcrchy a it m mhet I am licemmd under provision,of Chapter 9(commencing
a—
.
Sectio....ig of Dission 3 of the lh„ine,and Pmfca,inna Cor and my Miens
Y -i is in full Three and elren.
m ¢ Llcensc Clan Lia.b
5e O a.u
wDate Comment,
3 u.y ARCIUrHC7p'S DECLARATION
yI understand my plans shall "
as public records
I�app Liectived Prnfieso nul
°�
OWNER BUILDER DECLARATION
m= I hcmhy arrnt than I am exenrjd from the Conoucmr',Li'en,e law Ln the
following reason.(Section 71131.5•HoJnm,and Professions Col Any city or county
s€o which"'rim,a permit m'onnnn'h aIle,,in nl,rn,I.den li,h,o,repair pay amamre 4500
enh
ii3 prinnoin inuwce.vhu myuircsthe xpplicmnfnr wch permiuo Blest signet stann
than he is lmemed pm.uam rote proo,lonsof the Contractor',License law lChaper 9 Sq. Ft. Floor Area Valuation
or
that
heeis exempt
and
eb basis
Sof the Puad exemption.
antioni AnyviCodd
or Shat he 7031.5 b merttmm and the basis for the alleged e,empann.Any violation 35621.0 7 1. 00
of Senior than by tiny hundred
dollars
for a pc it snhjcaa Shc uppliavm m;,still penalty
of not more man Pae named dnnae,fssaH. A PN Number Occupancy Type
❑I,mox'mm,othe propeny.—any employees with wage,a. 502 — FINAL PLL BING ENERGY
will do the work,and theswcntim is not intended or offered for vale(Sec.7044.
Panno,and Pmfc,Mm,Cot, 111w Connaen...Lu en,c Law doe,mit apply m.,1 506 — GAS RitcfiiflkTd Inspections
r of property Who bunds or iml'nwes III and who does such work himself
,i;
aper(if his own enmpWyre,,pmmided nim sorb impa.ement,are not intended of 507 — FINAL PLUMBING
offered for sale.If.however,the building or improvement i,sold%don line year of
imnplction.the nwnerboilder will hoot,tho huMen of proving thus he did not huild or
mprove for purpose of s:deJ.
❑1,w owner ol'the properly.an,exclnvivcly co arocnng wall licensed cnnimcam it,
construct the projcat(Sec.7144.Puniness and Professions Cmc:)"Om Contractor's
Licenser Law docs not apply to nu owner of properly who build,lir itnprien nhemon,
and who contract,for such pmjmn with a nnmmwngs)IimnuJ pursuant to the
a on,ever Liccnde Lnw.
01 I am exempt under Sec. .11&1'C for this ns,
Owner Lou
WORKRH'S COMPENSATION UECIARAI'[UN ^
I hcmhy union under penalty of perjury one of the following drOwlilions: V O
j I have and x'ill maintain a Cerinc:nc of Consent to.self-ins rc lir Worker', "
Ctnpenatlon, an provided for by Section 3710 of the Labor Cmc, for the
prfi m once of the work lin which Shi,permit In i—nd.
❑1 have soil will maintain Worker',C.... ensation Imurnnee,vs required by Section
37110 of the labn Cala for the performance of the work for which this Permit is
nwed,MyWorkces Compen.vaoiso Insurance carrierand Policy number are. r '
Carrier: Policy No.:
CLKI ;]CATION OF EXEMitrioN FROM WORKIiRS' _
COMPENSATION INSURANCE. -
o'llw section need not be completed if the permit is for one hundred dollen
(Slurp or las,I
I ccnify that in the performance of the work for which this permit is issued.I
shall not employ any peons In any manner w tart ,1 become subject to She Worker'
Cnmlvnvmion Law,of Culflo nia.Dam
Applicant
NOTICE TO APPLICANT:IL after making this C,rificac nl ExcmPnion,you rhnulJ
hems.xrdi oShe Workce,Canq,umadva pov'vinon of the Labor Cade,you most
0 2 forthwith comply wIll such pnrvinion,up thl,pc,,,III.hal l be deemed revoked.
F ^ CONS I RUCTION LENDING AGENCY -
1 herehy anirm that them i,a construction lending agency for the perf rme nce
fine work tot which this pcnuit i,issued(Sec.3097.Civ.C.)
Lender's Name
0 7 LcnJcL,Addre.v,
U 0 1,crily than l have rend this application and.are that the above information is
voice,I agree ,comply with all city unit eounD ,,it or",and atm law,relding
0 V mo building consuuchon.and hereby authorise representative,of this city to enter upon
} W the abwonmntinned properly for la,"t1on purpo,o,,
ry IWd agom roaave.indemnify and keep hmmlmsthe Cityof Cupenmo against
h liabilities,.... nwnt..sed,and cxPrn„v which may in any way accmc rl dost said
City in annsegnence of the Staining of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY Won ALL NON-POINT Issued by: C/ � Date
SOURCE REGULATIONS.
Slgnommol Ap,inandComrector Dm, Re-roofs
NALARDOUS MATERIALS DISCLOSURE
Will the applintml or lotare mdldingn,tamtm Iu,m Or handle ha.an! nmaterial Type of Roof
as defmcd by the Cupertino Municipal Code.Chapter 1.12,and the Health and Sale,,
Crile Se roto 25532L,)7
0 Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the appEcamm fmnre building oeenptnl use e,laimnt,mt lir device,which If a roof is installed without first obtaining an inspection, I agree to remove
mit hvadous coir contaminant,as defmned by the Bay Arca Air Quality hlanaFement
yarie,r all new materials for inspection. Applicant Understands and will comply with
eve, 0N all non-point source regulations.
I has,,cad the hmurJou,materials m,.,mn vrls under Chapter 6!95 of She
Cnliforniu Ilmlth&Salcty Code.Sections 25505.25533 and 35534.1 nnder,mnd that
it the Ill docs nmt
' rimly have aberrant. or nt,nit 1,my mIll,notify the
I pant of the requirements which must he met Prier to issuance of a Cerlticate of
`1{ °"ulia.r,. Signature of Applicant Date
I,/ Owoe,orauthorimdagcut Dam All roof coverings to be Class"B" of better