01120024 CUPE
CI BU DF G OFNGCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22350 REGNART RD R.J. HAAS CORP 2000 01120024
qyyry�g�qqgj� APPLICATION Sy B DAT
KHNll IL DICK J TRUSTEE & ET 12226 SARATOGA-SUNNYVALE RD. 12/O5 2001
r (408) 725-0300
PHONE: SANITARY NO. CONTROL NO.
i
MOO ARCHITECTIENGINEER: BUILDING PERMIT INFO
CFy
BLDG ELECT PLUMB MECH
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wZ LICENSED CONTRACTOR'S DECLARATION Job Description
Z C I hereby°firm thin 1 am licensed under provisions of Chapter 9(commencing * NO CONDITIONS
x ith Sermon 70(10)of Division 3 of the Business and Protcsswri Cure.and my license
6 x I is in full force end effcm.
x O�U License Class Lic.a
Dam Conte."[
LL ARCHITECT'S DECLARATION
1 understand in,plans shall be used as public rcmNto
_
dO O Licenud Professional r
5 OWNER-BUILDER DECLARATI v
1 hereby vffrtn that 1 oin
exempt from the Co. se Lu ;f the �, a,M!
t i< fallowing reason.(Section 7031.5.Business and Professions r Any city er _ my 0
f F O which req a permit to construct,alter,improve,dental rcpav n: re t
CQ pro to iu
issuance,also requires the applicant for such 'loflea gu uiu I
3- Ir
thtbefh¢nfedpuismnjtothepmvisionsoftheConuacI Cha b, Valuation
(common g with Section 7")of Division 3 of the Busm s nd to fe limns Coe
or that he is exempt rherefiom and the basis for the alleged exemption.Any via then
of Senion 7031.5 by my applicant for a Permitsubjectsthe applicaafto a civil penalty- 1 O 3A V Y'>•JIF
of notmmethan fivehundred dnnarsg5l)O. PN rOccupancy Type
❑Las owner of the propeny,mr any employees with wages as their sole compensation, 304 - ROUGH ELEC R AL _
-'will'do the work.and the structure is not intended or offered for side'(Sec.70ad. Required Inspections; -
Business and Professions Code:The Contractor's License law does not apply to an tl p '
owner of propany Who Wild,or improves thereon,and who does inch work himself
or through his own employees.provided thin such improvements ore not intended or'
-offered for ole.IL however,the building or improvement is sold within one yeau.f --- - -- -- - - -- -- -
completion,the owner-builder will have the burden of proving that he did not build or
improve for purpose of sale.).
- __ _
ownanf rhe property,am exclusively contracting with licensed contractors to
_ construct the project(Sec.7 Y,Business and Professions Code:)The Conmcan's -
License law does not apply m ea owner of,ropm,who Wilds or improves thereon,
. and.who contrens.for such jens..with a<ommcmr(sI licensml pursue..tu the _-
' _ Cantnnor's License{yw
❑lam exempt PatrSe ,B a PC for this mason v
Dori /e/
ARK dB IJSASION DECLARATION
I hereby M.under net,,of perjury one of the following dmlmtions:
O I have and will maintain a Cenircate of Conant to selGimure for Worker's
Com,maetion, as provided for by Section 37M of the tabor Code, for the
performance of the work for which this permit is issued.
❑1 have end will maintain Worker's Compensation Instance,ai reghirtd by Section
T/D0 of the Labor Code,for the Performance of the work for which this p Tran is
houed.'My Workers Compcnastion lnsuance canis end Policy mumbo me:
CCERTIFICATION OF EXEMPTION FRM,WORKERS..
O .f 1. '' 'tl > `.:u f♦ - _ - ... •�.,.i.
Policy
COMPENSATION INSURANCE. _ • ._.,..._...____ _ .. ._._ - __..-._ ..-.. ___..
1.
'[Ibis seeion meal nus be cbmpleted if the pmnit is fm one hundred dollen '''
(s100)mlcss.) t r -
_.,.I•cenify Nu)in rhe perfommnce of Ne work for whichthis .it is issued(l•
shall'not employ any person'In any manner so as to,become subject to the'Workers
Compensation laws of California.Dare
Applicant .- _._ - .. .�
^NOTICETO APP LICANT:It after mnsatio provision o of Exemption.you should
O Obecome subject y the Workers Compensation provisionsofthe Coheir Code,you must
fonhwirh comply with such pmvisionx or this Permit iJmll be deemed rtvoked.
CONSTRUCTION n _ LENDING
.A.GENCY
1=elnthat is wet onlending agency for thte'
penmmrentt
whichth spenuisissued(Sa3097..CivC)
Lendss Name
.-
.._ `. _ . .. . .. .. .. . . ...
a,z Lender"Address- ,
7 0 1 certify the,1 have read this application and suite that the above information is
W canow.1°gree to comply,with all city and county ordinances end state laws relining
0 .to Wilding consimcdon:and hereby militarize iepresemativa of this city to enter upon
Liz ,tbe mcso,-menime4propany for inspection purposes.- _
a (Wc)egre,e to move,indemnify and keep hamtless the Cuy of Cupeninoagainst
rA liabilities,judgments,costs and expenses which may in any way accrue against aid
V 7u City in consequence of the gaming of th' unit.,
SI URCA G EAST SAND L'COM LY'WII'H ALL NONf:POIsir,, ISSued by: Date
_ pate Re-roofs --T/
/ /y /—
WiII the applicant ore future W ltl g occupev mare or IaRE �/
HAZARDOUS MATERIALS fff
tstoreor handle h2molous an=coal - Type Of ROOF -
n defnM by the Cupertino Municipal Cade Chapter 9.12. d the Health end Safety t _, r
Code.Section❑Yet SSRO ❑No ;3. . 7 i
_All roofs.shall be inspected.prior to any roofing.material being installed. . _
Will the applicant,urfm..building aceuPa.,taeequipment ordevices which If a roof is installed without first obtaining an inspectiofi,'I'agree to remove
emit hazeid.us air cdntaminn s as defined by the Be,Area Air Quality Management'
District? all new materials for inspection. Applicant understands and will comply with
(� \ °Yrs ON. all non-point source regulations. „
r t '
I hive read the oy c�de, mamnels requid 5.33 a under 34.1 un 6,95 of the
if the
mil Hnith, Safety Code,have
a t s 8505,l it ti and 25534.l undersand that -
ifth56uildingduesnot cunemlyhaveimnite momt.ireauxcabilityavfifi a the
cupant of ,requirements w 'h mon ci poor to is¢uanee ata Cenificem of
Signature of Applicant Date
amputnmdaed,agent
Nd", All roof coverings to be Class"B"or better
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