00110083 CITY OF CUPERTINO
(suu.nmcDIVISION PERMIT CONTRACTOR INFORMATION:
RUI�IX G ADDRESS: PIKMI'1NO.
22085 REGNART RD OOIJ0083
(IWNER'S NAME: APPLICATION SUB )AI 17
10 HENRY 11/1.5/2000
'IIONE; SANITARY NO. CONTROL NO.
neiARCIU I'EC'VENGNFUR:- BUILDING PERMIT INTO
.00 BLDG Ii1.EC'I' PLUMB MIiCH
Goa
a
LICENSEDt1; colvrlcncruR s DECInanTIGN
I hrrcey nmrm that I aio usco%m oiiaer pros%ioii,orcn.mler n(,,tinit, 'ing Job Description
OZ—p witch SeClbm]a(X»of Divi%ion3.1 beB-inewand iPn,le%%inn%C,de,and my license
I,in muforeeandg
elect DEMOLITION OF SFDWL
currai as_ Lie.»qu_L
W3du me�1�7S-r�� Sii)FC A
n CIIITIie ow Iat,dow netsuN
(=�y d I undersumd DIY Plane dhoti tw-e%I ns public rttvnJ% '
se
p Iian,ul Pru1'c..ional
OWNER-EIUILORII IALCLARn1'ION
1 hereby ci inn that 1 am exempt form the Comnstor's Liccnw Law for the
,F] trillion, ,.mrc (S,,, n 91131.5e
,Ihmi and Proles nv Cnde:Any airy a county
O which y pe ,i1 t e n IDI I Itr.' p J li,h pa y or
toc prior
om t . d.w 4 thef suchpe nix fl gnd.mminent
a. n, 1 t 11 i.1i r1 tin' , 111 iContractor,1 (Ch:mleric Sq. Ft. FloorArea Valuation
(commencing with Secuon J(XXq of Division 3 col the tluenesa and Ynde%%rms CoE) $10000
or that he is exempt therefmnm and the h i%is For the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the a,plivant to a civil,,anally
of not Imre bean five hundred dollars(ss(XI). APN Number Occupancy Type
❑Lrs ownero the pmpern.ormy empioyea%with w,li Hein smclual eii%ati,in, 35502034. 00
will do the work,and the structure is not intended or oli'eml for sale(See 961J.
Hu, and It fc< In Code.The Contmnorx Licon.e Law doe.,not apply ,,an Required Inspections -.
or Th�nrof property Whobuild%or improves thereon.and who does such work lthnwIl NO ASSIGNED INSPECTIONS
rough his own employees.provided that%rich impmvemens once not intended or
tifecd rot%die If,h„wewee the building in pnwcmmn i,.old winds one year o1
couple ion,the owner-builder will have are burden of proving dwl hedid or build or
improve for pta wwof%ale.).
01,a,owner of the p r wri,am eschmsmey contracting with licensed eomraclors it \
instruct the project(see.-nu4.Busircw%and Profeaaon%codon ore Contractors
construct
Law,do,v not apply no in owner in property who builds or imlaoves tbercon.
and who contract%for such projects with r contrarnot Ilcei pursuant to the
i..7nr'.1.1....e Law
❑I an,cncn,c anter Ser. .It&P C lie ffis rano
Owner N
KEH'S
ne
wORCOMPENSATION OECLANAI'ION
I Immby curia mul.n.I,enulty of Iscrinry one in 111I following deolamdu-:
J 1 have and will tommain n Certificate or Consent to wl6insure for Worker'.%
Co....c dion, a, pmv',d,sl for Ery Sttnion 37110'uf the Lahur Code, for the
performance of he work lin wn act this second i,
01 have and will rutinmin Wider'%Cnntpen t inn Ia....t e.av rcyuired by Seaton
337(()of the labor Code,for the performance of the work for which this pemrit is.
kowd.My Wint-er',,yCompen/sulin I In,umnce carrier and Policy number arc:
Comer. /mow/, t/ icyM11 ION FROM WORKERS'
- COMPENSATION INSURANCE
FFnls saauur need run be em,ip W n1'it the per n i is for one humtred brims
(51(XB or le".)
I .lily that In the performance col tho work hit which this Inrtnit Lv,,,uel,I
shall not employ any pec in any brander as to become subject ,the W'nder,
pc
Comnsalion Law%of Culifomir.Uaim r
Applicant
NOTICE TO APPLICANT':If.after making this certificate of E.semplion,you should
Meeonmsudden In IIIe Worker'%C... er,dlo.provisions of the Lehr Code,you mutt
O ZO p,mrwith comply wnh such pookinns ou'his 1i soll be deemed mo ked.
Fy CONS'rRUCI'ION LENDING AGENCY
a I hereby ml tin that them is oractatud lending agency for the performance
of the work for which this vacant i,issued(Sec.3099,Ci,C.)
L Q lender's bit ve
Z Lender's Address
U C) 1 certify thin I have rend Alis appliemin I end Mine thm the above lofonuwion is
corn-.1 spat,to comply with all city and county ordinances and slate laws relating
U to nldlJingcnn.,trmuion,and herchy m,horieeremc,cmmivnuf thiscity to enter ulxrn
} the rNwe nunnu sed property I... -i...I.On %ea.
p, (we)agme rosave.imlemmfy and keep lmmmless the cite,or Cupermo again,
to labililic%..I onum
gnntt
, ,.1,and enPeow.%whwch tiny in any way renue again%-.said
U City inrun%•uence otilegmnlingoflhi%peruck.
nPl'LI F N F:RSTANOS AND WILL COMPLY WITH ALE,NONpOINT IS\nod by: Date � %v
% ninurcofApplienMgnimtmatm Date Re-roofs
IIA%ARDOeS M11nng ape, lon,-ti,nii
wR y t e Cu,wrt nr romre building«eupapt'9.12.a:d the ba amoand Safety
Type of Roof .
a,defined by the Cupertino Municipal Code,Chapter v.12,and 1M1e Ilcahh and Safety
Gale.Scnion 255)2fa):'
oyes 0N All roofs shall be inspected prior to any rooting material being installed.
will the applicant or future holding occupant use caliipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit thmmaou,as conunrdnam%rs dertwd by the Bay Area Air Quality management
iali'Clorea E)No all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I bun:read the I union,noneriul,mquincou nl%coal'Chapar It 95 of the
Calderon Health k Safety CNB Sectio-:55(15.25533 and 25534.1 understand thar
Ove hudding dm.%not curamly ham a tenant,that it is my regx,n%ibility to notify the occupant of the n ore s%which nmrl be „e1 prior to is%n:mec of i,ccltnie:ite t
O cepa
Vis'. / Signature of Applicant Date
Owncrnr authorircJ rgcnl Date All roof coverings to be Class "B" or better
OFFICE