No preview available
01010107 ct BUILDING.0cuPEION SPERMIT CONTRACTOR INFORMATION: BUILDINGAfl1 `S': I L srj Co r¢rKc ,- P7 PERMITNO Q lo�f80 , e V w Cao r f q D f ! o tf o OWNER NAMIi: c 1 r or GL C API'I,ICXI'ISIN SlJ❑IL,TIi Crena Cor ora� f%oh Pf NE: y� r �� SANI'1'ARYNO. CONI ROL NO. '{08 3 66 g g ✓f ❑s Z ARCIITTLC'T/ENGINLLR: �/ a (f // �J BUILDING PLRMIT INFO Fw O O h `9 a's's C `�'f a� L HIAG ELECT I'A 11 'CuMI sa� � /VIt9(N�a Ins � [% yZ LICENSED CONTRACTOR'S DECLARATION Job Description Z S m- I hereby affirm mal 1 am Aner P licensed drevision,of Chapter 9 mr,mmed nng P 0,Znf-ce with Section]Ig0l of Dwiriun 3 of the business and Pudecsions Code.and my license a Y I J is in full force and eRec zz:cel Liaanse Glass � Fit.x68.6.6_8 X O a U;nc h¢3/. ' S DECI,or.� ( GONt x13'+N nRCtll'I'[("f'S UIiCLARe�I(1P L C'= 1�.unJe�mxod"uJ�luy plans ehall heJy�yA us Floe rccnl", 'cilme e OWNER-BUILDER DECLARATIO. I hereby affirm that 1 am cumin flan,the Comment's Licence Law for the F-_Z< following eawn.(Section 703 L5,business and Prolecvioro Gdc:Any city or county O which requires it Iprollit to 't a h r,improve.demolish. p any structure prom t also requiresthapplicant fsuch pe'intt fle a%igned statement 6 thath I oo ,I the It s to C ,oratorsI I' (CM1I.ter9 Sq, pt. FloorArea Valuation Iso, bill Seat tual n fU"si , dw 13 . ca Ill I.,not,' Gdu) y 7 7 J2� 0S.:�J ,r mal he is exempt o,eraknm and n,e na.i,for me alleged mm,tnu,n.Any vlolw;nn til'Section 70315 by any applicant flit a pennon subjects the applicant to a civil penally ofn.mom man five handmd dollars(s50). / PN Number Occupancy Type 01.acrmncrofmc property.or myetnpinyces with waon,as meinule rompemation, �jU ©�— will Jo the work,and the structure is not intended or nffercd for sale(Sec.](114, !or one"and Professions Code Me Contractor Lieense Law dims nal apply it,an Required Inspections nrvuer of pmpeny Who builds or improves Ihercnn.and who docs s:wh work hinnell' through fall Awn ctuployccs,pmvldml,nm wen Itnpmvcntann l nut intended nr Ilbr l to, ole.If. .x the b 'IJ' g...talfro,conatois: II ill.. ,in ,it al compt,lion,me toner-builderll hava me burden f proving Ili t lot J'J net build or ,repro far PTI d I ) - 01.as owner ofthepnpen I:inly contracting oithlicensedcontractors;it, omaract the project(S (W ] J B ss Professions f 1 s L )Ifin Contractor's adtodLaw J Implyt of paPeru who Folic:or ragooesmason, M1 't, lo, a,h projecl, still a commenoW licensed purwand to he Com ' Loan,Lu ��AfI C ❑I am�pl1�ti/ A/`�µ_.If HI 1 L l .Ili' rcusn �j Owner WOkKL rate 1 hereby aflinn under penalty of perjury tine of the following declarations. < ❑ 1 base and will noainmin it Cer lfi.-am orf Con,ate to sd6in-m for worker's ' Cmnpemudun, ns ponaidcd for by Scetiun 3701 A in Luhur Code, for the pctktrmunae of he work lar which Ibis to it is issued. Kenand will tnninmin N'oder'sG,mpensatinn Insurance,as rcyuinJ by Section ,=of the Labor Code.lot me performance of the work kir which this permit is tented.M'Wt rsrgQ�C yHsm�um[moraine tamer and policy number an: 01 Carrier: TetCCg!II]I ILT4f0 IF XEM19I N ;ROM WO R ERS COMpENSAnON INSURANCE 'this section need not I,econ,pleled If the permit is Tot one hundred dollars .. SI 00)or less) I calory that in the perfnm,ance til the work for which his .it is I.suad.I shall of employ any perwn in any manner co as to become.abject .,he walker' Compensation Laws of California,nate A,dicml NOTICE TD APPLICAN'Is If,alter making,hls Conificatn of Iiungninn,you should become.,.heal lu life W..W,Cnmpar"'lion pro,siu;u til the Labor Cotle.You slid Q O fanhwi,h comply with such prnviniom or Ibis Penni,shall F,dectnof rcvok,d. (•' GnNSem is a ON1.ENDIlen AGENCY 1 hereby aflinn that there iss nmed(See 097.Co,agency for the pMonnance of nd work for which,his permit is izwnl Isre.309].CCI Q Lcndef'c Name 5 7 Lcndcr's Address U 0 1"c"ify lhlo11"",mail Insnppre,li„naaA chile that,be Anise of Ir adnl,'In [s, P conn,.I agree to clarify wire all city aad aoml y nrduaaees and auric laws relming Q V to building c, uoion.and hereby and tin milm-ntaiveaof his city h,enter.,at W the two,e-men0aned property fm inspection purpo”. O. (We)agreen,save,indemnify and keep hurralem the City of Cupertino agaimt V� liabilities,judgmenn,costs and espemes which may in any way acme against said U % City in cunmyuencc of the un this permit. AP LIC NTUNDF. ST 5 IJW LGnMPLY Wit If ALL NON-PDINr Date souRG RI:cu1, n n �1 Issued by: L — Signal�lL', r'Pla:m c...con6r nafL-[�/ Rc-roots �( HALARDOUS MA'DiRIAIS DISCLOSURE W,II I m applicant or fmure budding lccarym snort or leadle haoundo s material 'Type of Roof m deOnad by Incepted-Municipal Gds Chapter 9.12,and the HoltIm and Safety Code.Section 23532(x)'! >(Nn All roofs shall be inspected prior to any roofing material being installed. win d,e:y,plea.or name bon ding nanpant use Alai m,nat„r dense,w'fan If a roof is installed without first obtaining an inspection, I agree to remove mut beeanfous ulr c noulac nuts m defined by the Bay Area Air Qualify Management ul,lnel, all new materials for inspection. Applicant understands and will comply with El Ye, Nn all non-point source regulations. 1 have mad in hamrdous almanac,rcyuimtncnu under Chapter 1,91 of the California Health k Safety Code.Seams,25505,25533 and 25534.1 understand hal if he he lding Arcs.,it amm�d ha' amnam,that it is my renpomsibi0ry u)notify the occupant of the mquiretne who ,ret h met Prior ,,issuance of a Cenincme of "`L' 'may' Signature of Applicant Date ow er . ah, /-�- yL�' All root'coverings to be Class `B” or better OFFICE