04090297 1
CITY OF CUPERTINO
BUILDING DIVISION PERMIT yCONTRACTORINFORMATION
BUILDING ADDRESS: PERMIT N%4090297
,4090297
OWNER'S NAME: FlUUATI 5UEDATE
NE: SANITARY NO. CONTROL N0.
ARCHITECMIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOo LICENSED CONTRACTOR'S DECLARATION Job Description
r 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing _
iw with Sermon and effect.
3af the Business tout Profestiuv COM.and my license is �� ���®
mm�rnaanaerreet. NEW STUDIO (498 SQ.FT. )
n�i License Class CLic.on X
nF O Damn Convector
ARCHITECTS DECLARATION
sg� I understand
mnJ my plans shall M used as public menrds
-T LLt, LICCRStd PNreSS10Nl
FEB 9 2006
�ct g OWNER-BUILDER DECLARATION
<� 1 hereby al'rrm that I am exempt from the Convenor's License Law for the _, o
no following...A.(Section 7031.5.Business and Frofeaslov Crude:Any city of county .ss /❑'
K m which aqu.a Permit to construct,alter,improve,demolish.An repair any structure I G
prior to its issuance.also rcquims the applicant for such permit to rile a signed awmment — ate'--
FSothatheislicensedpu.uamto the provisiavofthe Contractor's License Law(Chapwr9 Sq.Ft. Floor Area Vali2atldn"
As (commencing with Section 7000)of Division 3 of the Business and Professions Chile)or
i 3$ that he is exempt imminent and the basis for the alleged cxcmption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of 3 SAMV902n:0 0 Occupancy Type
nal more than Eva hundred dark.(5500).
1,as owner of the property,or my employees with wages as their sole compensation,
will do Ne wart and the structure is not intended or offered for sale(Sec.7060.Business
and Pmfesiam Cole:The Contractors Licanu law dors not apply to an owner of Required Inspections
property who builds orimprovcs Nercon,and who d.essuch work himself.r through his
own employees,provided that such improvements are not intended reoffered for sale.IL
however,the building or improvement is sold within mm year of completion,the owner,
builder will have the burden of proving that M did not build or improve roe purpose of
sale I.
XL as owner of the pmpcny,am exclusively contracting with licensed convectors to
c tract the project(See.7066,Business and Professions Code:)The Contractor's Li.
cave law does not apply to an owner of propeny who Wilda or improves thmeon,and
who contracts for such Projects with a contractor(s)licensed pursuant in Ne Contractors
License Lew.-
❑1 am exempt udder Sec .B&P C for Nis Icahn
J
Owner —/ f Date —?,Cs �
i WOR R' 0 h el SA'ION DECLARATION
1 hereby arm under prnaRy of perjury One Of the following dedsommate
Iand will maintain a Certificate of Consent to self-insure for Worlrers Camper.
A.u provided fort by Section 3700 of the labor Code.for the performance of the
work for which this Permit is issued.
❑I have and will maintain Wurkcr's Compensation Insurance,as mquircd by Section
37W of the labor Code,for that performance.(Ne work for which this permit is issued.
My Workers Compensation Insurance canner and Policy number art:
Cartier: Policy Na.:
CERTIFICATE OF EXESSPrION FROM WORKERS
COMPENSATION INSURANCE
(Thkaaetion head..tWc.mplewa ifihe permit is far hon aeddailass(SIM)
or less.) ,
X 1 cery Nal in the p Ifo 9spec f I e work for ich Nis omit is issued.I xhall not
A any perso /manna ff wbeco subjK) yr W naeicm.penumon
Laws o lifornin t jr
10
APpiicant l f
NQITCE TO PLP NT: f,of r fin(this Cenifieam of Exemption,you should
become sub' t m the Workers Compevminn provisions of the Labor Code,you must
.,O foMwitheinno, Nsuch provisions or this permit shalt he deemed mvoked.
Z " CONSTRUCTION LENDING AGENCY
Eforthe
.N-. hereby firm that Nene iso construction leadin
Iyo g agency KIP.....of
S thur which Nk permit is issued(Sea.3097,ON,CJ
�lel z 1<.daeanders Namc,� 4ndar's Address
U O 1 comfy,that I have mad this application and sale that the above information is
LT. coned.)agree to comply with all city and county ordinances and suite laws minting to
L)(� building construction,and hereby authorise mpoesenutives of this city to enter upon the
G ahovc-mentioned Property for inspection PuOrostA
(WO ago:e to save,indemnify and keep harmless the City of Culler..against
iF.t N
liabilities.judgments.costs and expenses whichma anyw cmcagainst said City
Uz in eWsequencc of c mining a' pis
gemit.
APPLICANT UUp�ib SEAN NO WILL OMP ALL NON-POI Issued by: Dale
X -SQ RCE RE UL IONS.
j C 3 1 Re-roofs
Signator .fAVPlinnUConnacmr Dam
( HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuwrc building occupantsmre ar handle hanrdous material
Ax defined by the Cupanino Municipal Cade,Chapter 9.12,end the Health and Safe,,
Code.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑secs
W.
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
,it her tonus ail couominams.defined h,the Bay Arca Air Quality Management all new materials for inspection.
isuict?
❑secs6u
XI have mad Nehvanlousmamrialsrcquimmcntsun r Chapmr6.95ofthe Califor.
nice Health- afety ade,Scetiov25N15,25533 d25536 rndcmarb thuiHM Wilding
J of eurten0 ha amnn Nal it is myr sponsih' ty 1. 61,the oWupam of Nc
r ircy chyltustM c liar wiss cc ora cru0cam of Occupancy.
Z� 5' Signature of Applicant Dale
th
Owner.dam.rid agent i Dow All roof coverings to be Class "B" or better G