08060226 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT CONTRACTOR I14F.0 ATION
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BUIL ING ADDRESS: PERMIT NO.
.0301. RI:CHWOOD DR ALTEN PRODUCTS CO 08060226
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'R'SNAME: PERMIT ISSUE DATE
. SII:I:VAUN PATEL 2423 OLD MIDDLEFIELD WAY 07/11/2008
TONE: SANITARY NO. CONTROL NO.
ARCHITECIENGINEER: INSTL SOLAR POOL HEATNG SYS BLDG BELwEECI rf SPIT IIwo MECH
0 0 0 0
u o o LICENSED CONTRAC TOWS DECLARATION
I bertbydfirm Wr l am limm<d under provison of chapter 9(commencing ^_ ....._,f._ Job Description
= with Sutton 70001 of Div Wo n3 ofthe Btq. PJp s'an ode d r licenseis
? ufull forte andfe'N -1 �d l(Jg
Z liccnb ��77
F, Dam Contra
clor
n ARCHITECTS DEC ATI N
I undersu J my plan stmt be used as public=coma
'aG
g G Licensed Professional
3 OWNER-BUILDER DECLARATION
E 1 hereby dTimh that 1 am exempt from the Contractors License Law for IW
00 following won.(Section 7031.5.Business and Rofeuion Codc:My city m county
5$V which nsryRu a permit m comerocl sitar,mhpmve,dcmolim,or mpair my structure
_.L j, prior m its Women,so requires the applicant forsuch permit m Bk a signed dabmem
s< that he u lieencd Wom L to the provismstf the Conracmr''s Licerm Law(Chapter 9 Sq.Ft. Floor Area Valuation
YI—O (commencing with Ssdon 7000)of Division 3 ofone Business and Profession Code)or
that he is exempt therefrom and the,buts for the allegnd eaemp im Any violation of
Schon 7031.5 by airy applicant for a permit subjects the applicouo a civil penalty of APN Number Occupancy T e
not more tho lu501B.five hundred dom(SP Y J'P
❑I.uowrra of the popvsy,ar my wploym with vagesn Wee sWc cmnprnvtmh,
will do We worst and the swctum is mica mnded oro0ernd foram(See.70th,Business
and Profossana Code:The Cormacmrs License,Law dean nal apply b o owner of Required Inspections
property who Wilds orimprovesthrrmn.and whodoessuch workhimrJlar Wrough his
awn employers,provided that such improvements are not intended nalfernd Tarsal.a,
however.We building or Improvement is sold within one year of mmpletan,the owner-
builder will haw:the W sho or proving thal M did nal Wild or improve for puryae of
sale.).
❑1.as awrcr of the property con eelasvely contracting with licensed contraclam on
construct the project(Sec.71X4,Business and Profusions Cade:)The Contommes U. .
cense Law does not apply to an owner of property who builds or improves thereon.and
who commess for such projects with a convamor(s)Remand pursuant m the Conuattoh
Lite.law.
Toro exempt under See ,B At PC for this won
Dare
WORKER'S COMPENSATION.DECLARATION
1 hereby af0m under penally of pe0ury one of the following drelarWan:
❑I hart and will msnsio a Cmtincase of Conunt m elfinurt fa Workerscompen-
smm,an provided for by Section 37M of the labor Code,for the Performance of the
work for which this permit is issued.
❑1 have W will msmafn Wortees Compensation Nsurme,as required by Section
37W of the labor Cada.for We performance of the work for which this permits ieund. _
My Warkk M ms�W�u rote carrier and Polity number ane:
Carso: ? Y"��'R Policy No.:/ Z°�
CERTIFICATE OF EXEMPTION MOM RKERS'
COMPENSATION INSURANCE
Crisis ectm cead no,4 camplcud ifft permit u foram hunthcddo0an($100)
orless)
1 certify that in the performance of that work for which this perms,is based.l shall not
employ any person in any another an as he become subject he IK Workers Cmopewtm
Laws of Callfe mil.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate,of Exemption,you Would
become subject m the Wohe's Compenition provision of the,Labor Cnde,you most
.,O lart swith comply with such pn or thin permit•hscemed
l W dmvokcd.
.z.,y CONSTRUCTION LENDING AGENCY
I hereby aRrm this them is aconsnxtinn lending agency,our We perfwmarccaf
Lk ti
the,work for which this permit is usuds(sc,3097.Civ.C.)
!f] A Lenders Name
z Landers Address
U O 1 codify that I have rod Wis application and sum onto the above inrmmadm is
it, ctm=I agree b comply with all city and county onfin.and sum laws muting ut
C) building construction,and hereby au.hod.repm_senmives of this city mcnmr upnn dm
r W movcmamitmed property far inspection puryoms
t••h n. (We)agree to arc.indemnify and help harm4ss the City of Cupcnirm a aunt
rq liabilities,jndgmcn osis end upmun which mry in oy way att7uc gsnrl ssE City
U z SOURCq .th u emit.
.r SOURIC UN TI S WILL PLY WITH A L NO P01ir Issued by: Date
(cJ Re-roofs
tum of Applied HAZARDOUS
Dam
HAZARDOUS MATERI D1sCLo AE Type of Roof
Will Um applicant or forum WIIdCg eavpms rmm and
C e heuNona mamss
sennet by Ne Cupertino umcipal Code,Chapter 9.13,and the Health of Safety
gar p an sss3i(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yn a
If a roof is installed without
.first obtaining an inspection,I a
Will the app0ca ft or ubam re Wilding occuPuse equipment or device which which 8 P gree to remove
emit havallon air conuminanu as de fircW by Lha Bay Ams Air Qua ily Management all new materials for inspection.
Dnsct7
0y. u
I Ile H srequiremmuundcr Chapmr6.95afthCai(m-
hta W C u .25537 arW25 31.1 undmsmhd thsifte Wi1Wng
toes o ere Y h u my lily b nadfY of the
mw eats a art t ar mrm.at !r Signature of Applicant Date
l7y0b
owmer or ruthoded agent ,m All roof coverings to be Class'n"or better