08020007 CITY OF CUPERTINO "..T"F'*^; L'w4:u �`r."s�sr
BUILDING DIVISION PERMITCQ11"Cn'R11 '0 'MAT'I1V
PERMIT NO.
BPL LARR
UILDINO,AOORESs:IEDEL ABEE & ASSOCIATES INC 08020007
NER'S NAME: 1't PERMIT ISSUE DATE
TONY UNGER 36 RAILWAY AVE 02/01/2008
PHONE SANITARY NO, CONTROL NO.
(408) 364-9000
ARCHiTECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB - MECH
30, LICENSED CONTRACTOR'S DECLARATION IW Description
1 heat mby affirm th1 am O ]licensed under provisions of Chapter 9(commencing - p
with Season 700y)of Divides of the Business;and Profeas+ans Codd.and my licmad is HORIZNTL -FRACURE REPAIR LFTSIDE—GARG AREA,TOTL
, u«� oren and c.♦He . LINEAR FT REPAIR APPX 13 FT
DauCommetor
ARCH rtECTSDECLA ATION
a�GI understated my plans shall he used as public mcnNa
Ste�a Licensed Prefeasional -
m 3 OWNER-BUILDER DECLARATION
I hereby affirm Net I am cacmpl from we Cantraclars License Law for Ne
p o following mason.(Ballon 71713,Business and Professions Code:Any city or county
which requires a Permit to construct.show.improve,demolim,or m*r any structure
priarto its issuance,alwrtquirca theappliwt forsuch Permitter Ale.signed comment
< thar be is licensed pursuant to the proviuou of the Commutes License Law(Chap=9 Sq.Ft. Floor Area $7500 Valuation
�ct (commencing with Section 70t)(3)of Division 3 of de:Business and Probations Code)or
e R 9 Nat he u exempt Nert(rom and the beau for the alleged mistrial Any violation of
Section 7071.5 by any applicant fm a permit subjects we applicant to a civil Penalty ofNumber Occupancy Type
not mom than 0m hundred dollars(5500). 316 210 6 0
❑I.uownerof tlm propmy,ter my wployw with wag,uNehwk compewtian,
wi0do Newark,andIhes u .tsmti.un WoroRemdfocuk(5..7044,Businw
and Professlou Cade:The Conuamh Licettm Law that cot apply in an awtur of Required Inspections
Property who bu it ds or im prom,thereon.and who dw such work himself ter through his
own employees,provided thasuch improvements ate not intended aronered fmsale.if.
however,we building m improvement is soldwithin one year of completion,the owner-
builder will have du buNen of proving Nu M did cot build or importance for purpose of
ask.).
0 1.as teen.of the Property.am udmimlY'amazing Mth licensed rontramon to
coutruct Ne project(See.7044.Businw and Pmfewau Code:)The Coouas mes Li-
cence Law den not apply w an owner of propany who builds or improv Merton.and
who contracts for such projects with•conuacur(s)licensed pursuant an the Conaacou A
License law.
❑Iamaemptunder Bee .BRPCfathumawn
te Dau
WORKER'S COMPENSAnON DEC"RATION
1 hereby alarm under penally of pedury ane of the following dal.ntiau:
❑I have and will maim(.a Certificate ofCa sem as self-iwm fa Workers Compen-
salon.as provided for by Section 7700 of the Labor Code,for the performenee of the
work fa which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
77M of NC Labor Code.for we performance of Ne work for which this permit Is issued.
My Workers ComPemm(on Insumme carrier and Policy number art:
Ems,.Sknzyf- r-4A%w Policy No.:m
p�q—�DO /
CERTIFICATE OF EXEMPT ON FROM WORKERS'
COMPENSATION INSURANCE
fihtsscatiw need not M completed If the Permit Is forane hundreddollan($100)
or leu)
I certify that In we performance of the work for which this Permit Is issued,i shall not
employ any parson in any rainstorm u w became subject to Ne Workcn'CampeuaBan
Lave of CaRfomia.Dau
Applicant
NOTICE TO APPLICANT:IL cher making this Ccnincets of ascription.you should
become subject to the Worker's Compensation provisions of the labor Cede.you must
.7 Z forthwith comply with such prewinom or this permit mal he deemed revalued.
Z'-" CONSTRUCTION LENDING AGENCY
iNw F Ihemh .M.tha ft.iso eommixtion lending{a gercy for Ne performance of
g1i Le work fen which Nu permit u issued(Sec.3197,Or.C.)
Le
D Q nders Names ,
,z I<ntleh Address
U 0 1 certify Na I ham mad this application said sate dal the above information is
D.E carat I'V"ro comply Mth all city and welcomes aNin ¢s teed sou laws willing an
ng
.0 building construction,and hereby auNarim repmsautiv of this city to enurupon the
ahove-mentioned Property for inspection purpoxes
(We)alae to am,indemnify and kap harmless the City of Cmscnino agaiut
Pq liabilities,j.dgmcnu,cow and..Pa.which may in any way teems against said City
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOUIssued by: Date C�
RCE REGUfA
/ /,of- Re-roofs
Signature of nppliwnt/Corammor Data,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building occupant mom or haMk huamaus material
as dented by the Cupatim MurriciWl Cede,Chapter 9.12 and tite Health W Safety
.Saman 25532(.)7 9 All roofs shall be inspected prior to any roofing material being installed.
❑Yca
Will the applicant or future building occupant use cqulpment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove
each haamnm air cenuminams as defined by the Bay Arts Air Quality Management all new materials for inspection.
Datict7
OYca
I have mil the umkr Chanter595 ofthe Celifoe
nia Health A Safcty Codc,Sections 25505,25533 and 25574.1 undcrsuW thmifthe Wilding
den ant currently ham a_mniboatigh u my responsibility u mdfy the occupant of the
ruqu(rerien mu mrunWu of.CertincauofOccupancy Signature of Applicant Date
owner ter mthoriv All roof coverings to be Class"B"or better
of