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CITY OF CUPERTINO -
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BUILDING DIVISION PERNUT
,O,NTItACTOR�IN1H'ORM
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BUILDING ADDRESS:
NOVO CONSTRUCTION
PERMIT N004120090 -
2 RESULTS WAY
W NER'S NAME:
_
PERMIT ISSUE DATE
GOSVENOR
1042 HAMILTON COURT
NE:
SANITARY NO. '---'- CONTROL NO. --'
(650)701-1500
ARCHITECTIENGINEER:. -
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BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
� • LICENSED CON IR 0.'S DECI-aRATION
Job Description -
launch affirm Wm t 1 Lim rad a vwon of Chapter 9 (commencing
Mesr
with um )ef DiAmA.3aftWB ti Prefwion Cede.sudmyliceucia
enroll AdeRen.0 (DIDa
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INTERIOR DEMOLITION .ONLY
Littn Clw'Lie.R
Date CantoWu r hJWD C oM q c..
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ARCHITECTS DECONkA'rlpY
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y plans mail W li u p�IRrc
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Licewed Pmfesumul
OWNER -BUILDER DECLARATION
Contractors cence Law for the
I hereby Affirm that I am Attempt Brom the Li
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following reason. (Section 7031.5. Business and Professions Code: Any city or county(]�
, nr Pull y Structure
p. mmuliehan
which mgoima • permit t... svuet, alar, immw
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prim an its issuance, Alm requires the applicant for such Permit It, file a signed suamem,
mu M is licensed pursuant wde provision of the Can=cer's License Law(Chapter 9
Sq. Ft. Floor Area -
u(�_�f Jj �4yaluation
(commencing with Section 7000) Of Division 3 of the Business and Professions Code)or
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met he is esempt memfrom and the basis for tie alleged eaerepdon. Any violation of
eruU
OccltPan-y7•lpenot .
Scerwctll6bya,applican»raperril subjects the Applicant W.&II maralty Of
❑ I, u owner of W pmpmy, m my employm with cages u thetr wle companndon.
.
Required Inspections �•..
will do the work, and thestrumum Is not intended oroaemd fonale(Sec. 7044, Business
and Prorwions Code: The Canmctor't Littwe Law does not apply to an owner of
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property who buildanrimprons tMman, and who doeuuchwork hMselforthrough his
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own employees, provided this such imporn menu am nminunded eraBened for Asia.If.
however. the building or impmmeent is mid within one year afcompktion. the owner.
builder will NOW the burden of proving this he did Am build or impmw for purpose of
4W
SS1, u amner of the property km exclninly contracting nim licensed contractors a
. street the project (See. 704,4, Business and Professions Code:) The Contractor's I.I.
newlaw does not "ply to an owner of property who builds or Improv them W, and
who contrecu for such pmjecu with a conuactorO licensed pursuant to the Contractor.
---+-
L' toe law.
am exempt undo Sec . B k P C for thismason
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w—Dam
.. WORKERS COMPENSATION DECLARA3`ION'^'-^'�;--5-�_"_._
1 hereby afllrom under penally of perjury ane of rite following decimtlon:,
Ej Ihaw and will maintain a Conlftnte of Consenitoself-insum fm Workers Compen-
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utlan. u provided for by Section 3700.1' the labor Cade, for the performance of the
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work for which mite permit is Wood.
❑ I Iran and will maintain Worker's Compensation Insurance, As mquimd by Section
3700 ofthe Labor Code, for the performance of the work fnwhich this Permit is Wood.
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My Workers Compenasdon Insurance carrier and Policy number m:
CartJer' Bey No.:
/ CERTIFICATE OFEXEM FROM WORKERS'
J COMPENSATION S ANCE
(Thu mnim need not W compkted if tle lermit Is foram hundred Oil=(SI00)
or kis,)
I aNfy Not in c performance of the work for which this permit Is lasted, l shall not
employanyik ninmymumrwuwbecomcmbjmttotMWor WComfewon
I Laws of Califomia. Dam
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ppicaut
NC E TO APPLICANT: If, afar making this Ccnificam of Exemption, you should
beW F subject In the Waher's Com W sadon provitions of the Lahr Code, you most
fuMwM comply with such provision or this permit ahall W demand invoked.
CONSMUC ION LENDING AGENCY
I homey e(Ilrm the mem is a comuucdon lending agency for the Performance of
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the wish for which els permit H issued (Sec. 71197, CO. C.)
Lenders Name
\
Lentleh Atltlmss
j 1 ce dry that I haw mad this Application And state Nu the men Information is
' contact. 1 agra to comply with all city and county ordinances and full laws mladng to
Wilding consuuction. and hereby authorim omma unfins of this city an enter upon de
above-mentioned Property for inspection purposes
(We) agree to tow, indemnify and kap humkss Ne City or Cupertino against
j Ilmilides.judgments. costs and espewu which may in any way accrue against Said CityIn
/
i eUNDERSTANof the grunfing of tAND WILL COMPLY WITH ALL NON -POINT
APPLICANT DS
Issued by: Date t L /
SOURCE REGULA NS,
Re-roofs
Type of Roof
v k_
um of ApplieanVConua' D.m
HAZARDOUS MATERIALS DI SURE
Will the applicant or futons Wilding Occupant more whandic huardow material
As defined by the Cupertino Municipal Code. Chapter 9.13, and da Health and Safety
Code, Section 25532()7
❑Yes VN.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
pa equipment it devices which
Will the applicator or future buildingaeca net use
emit hauumbsus air ronuminwu ufir
ded by time Bay Ama Air Quality Managementall
new materials for inspection.
District?
[I Yes VIN.
I have mad the haardnm mmrials mqulmmam.rnk,C1mpmr5.95ef the Calif.,.
nice Hu]Lh&Safety Ca,Sadons25505.25533am127534.1unticuundthatllmc Wilding
does our currcn0y hew a tenant. Nat it Is my mapanihility to modify the Occupant of dm
mgWmmcnu which most be met prior w iuu fate of Oempancy.
P
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner m autunincl agent Dam