08020129 CTTY OF CUPERTiN0 M
BUILDING DIVISION PERMIT ,COPITRACT,(1R I ( �t.MATINT
BUIL ID]. G�� 1) ESS: PERMIT NO.
�U RIDGEVIEW CT RC08 BSIDE SOUTH BAY CONSTRUCTION CO 08020129
R'S NAME: TNC PERMIT ISSUE DATE
APPLE 170 KNOWLES DR 02/21/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHITECT7ENGINEER: BUILDING PERMIT INFO
BLDG EIECr PLUMB MECH
300 LICENSED CON'RACTOR'S DECLARATION O O O
1 hctcby Nim that 1 un licensed under provisions of Chapter 9 recommencing Job Description
with Section 7")or Division J ofine Business and Profadons C(ff�L .anhe
d my cto is COM'L TI, BLDG CAMERA RM, EXSTNG CEILNG,
nssH rnfWlf�rte@MeRea
� z LleenaCl . Lu.P s7r FLOORNG,HVAC, ELECTRC, NEW WALLS, PAINT, 1 NW DR,
� Date Coutncor ul—Y
eq
ARCHOECsS DECLARATION 2ND FLR MODFCT
understand ooZZ 1 undenJ my plans shall he used as public records i
Mted�a Liat�d Pmfessumal
0 3 OWNER-BUILDER DEthe C.m ION
0 1 hemhy a?m mi 1 em.Bumps from the Cantramr',License c Law far the
O O following moon.(Sedan 703 ensu,Business and ne.der ns Code:Any city m coumy
4� whiah mquim•parols a construct,t a duo.Improve,demolish.or repair any stratum
iy priamits issusae.aloe sryuim dteappas Of for aahpermbo0leasigned ststem"t
�< (died Im comencinwit prominent to the of Disasu of the Galluaemr'lndProf law(Chapterodo)of Sq.Ft. Floor Area Valuation
$ thammancl amps omiSectnn t and f basis for tof he a Business and on.AWnna Cnde)err $25000
- that Section
u exempt Ihemfrom and do bub for bj Nested exemption.M Any l peatloe of
ant cnee M.five
anyapplicantdollfaaparols subjects the appluansoacivil penalty of �ff Number Occupancy Type
rot mere man Ew hundmd dollen(!Sm). 31606046VL'
0 1,u awner of da property,or my employee with wages as their sole campewdon,
will do the wast,and the swctum is Out intended or offered fortau(Ser.7044,Business
and Pro(cesa ns Cade:The Comme mes LianY Law dao oat apply to an owner of Required Inspections
property who build,a improves thereon,and who does such work himself err through hit
Own employ=,provided that such Improvements mount Intended aoRamd fasauif.
howewr.me building or improvement is sold within am year o(ampktion,the ownsr-
buika will haw the burden or pr000t Owns M did not Wild Or improve for purpose of
sak.). '
❑1,u arm of the property,am exclusively conn ding w'im licensed anhaaon to
construct the project(Sec.7014,Business and Professions Code:)The CooOacuri LI-
ecue low doe not apply to an owner of property who builds or Impmm thereon.and,
who contracts for such prejeea with a antaeor(s)licensed perfumes no the Contncar's
License Law.
❑I aut"amp,under See ,B R P C fa mi,mason
Data
WORKER'S COMPENSATION OECLARATION
I hereby affirm under pe"Ity of perjury One of the following dalmrWom
❑1 haw and Wil mainW n a CeNOaa ofCansens o self-luurt fa Worker's Compem
sNon,as provided roe by Semlon 37M or the lobo Code,fa the perfannaae of due
were for which this permit is Issued.
❑1 have and will maintain Worker's Compensation Insurance,u mquimd by Station
3700 of the labor Code,for the performance of the some fa which this permit is issued. '
My Worker' Into rue a 'a(and Policy number am:
Gassier. W Z,My No.: Or7l 7.T-Z-(�
CEI[rIFl OF E%EMPIDON FROM WORKERS' '
COMPENSATION INSURANCE(TOM Madras Madras need rot ba completed If Ik permit Is faane hunde ddrellus(2100)
or leu)
1 tt+Ofy dot in me perfomaae of the wak for which this permit is Wood.1 shall not
employ any parson in any mucor are as m become subject to the Warlcn'Compensation
Law,of Califamia.Each
Applicant
NOnCE TO APPLICANT:11.after making this Camillus:of Exemption,you mould
become subject to the Worker'.Componssdon provisions of the Lahti Cade-you mute
.J O forthwith comply with such provisions a this emit shall be dcemed revoked.
,z.i�•' CONMUCf10N LENDING AGENCY
IZI(•' I hereby affirm mat mem Is construction lending agency for the Performance of
ai ti the ooh for which this omit 4 lured(Sac.7097,Civ,C.)
Q
Lender'sNoe
Lar
= z lurdee.h Address
V Q I certify mat 1 haw read that application and sure that the @bow information is
n. ccrm7.l agree to comply with all city and county ordinances and sur laws¢lasing to
0 building convection,and hereby aommix mpresnuOwe of this city to enter upon me
W show-mentioned property for inspection Purposes.
y (We)agree to save,indemnify ted kap harmless the City or Cupertino against
t„ VI Babuiaa.judgmenu.cauana"pwa which may In anyway @maagainstseid Chy
) Aco ofinegnntingaf Otis pc it. Z/u U� —
APP A orthe fANQQQBBB'td' ILL COMPLY WITH ALL,,,,NNNt�!ON POINT Issued by: Date
SO CE EGULA O Z�l�
Re-roofs
Si of AppllanUContracor Dau
H,V.aRDOUs hiding ocA33 DISCLOSURE Type of Roof.
W.11amapplicantorMunicipal Cgeaupansmaca handle huordousmaterW
dcBSea Section
the 32(a)?m Municipal Code.Chapter 9.13.tea the Halm and Safety
.Section 33573(1)? n4jlL1\ All roofs shall be inspected prior to any roofing material being installed.
El yes
No
Will me applicant err futu bolding occupant sec equipment a&M.which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvisdw air conuminanct as dc0ad by the Bay Area Air Quality Management all new materials for inspection.
DimicR
El yej
Ihew mad me h"arames,2esu-ri P533remcnuunaet 6.95 Calif¢`
nbH"IN&S@fcr Code,Sreaau 33703 3JJ @m135531.1unMwnd mnifthe buddies
t ntly hew a tmanc t mY raponsiNlitY u twtifY t of da: ad t�✓"—
mme _wp�hmnssbe�mer r �ua�nao(j'fiwteof
Signatu e of Applicant Date
L�Gf.� r All roof coverings to be Class"B"or better
Own r orOwn ror amhoriDau' g