02090031 CITY OF-CUPERTINO -
91JnAINGmvtSIONPERMIT CONTRACTOR INFORMATION:
'D 11 D1ADDR 55: " PERMIT NO.
S. .R(5BINDELL WY BB CONSTRUCTION 020900{3,1
'AM?' GO E AND E-PING S 3535 ROSS AVE. STE 105B APPLICAa1�NMu Aj e002
( PHONE: (408) 266-6266 SANITARY NO. CONTROL NO.
O O o ARCHITECUENGINEER: BUILDING PERMIT INFO
CC BLDG ELECT PLUMB MECH
a i U L=1 t'-1 I-"1 LU
Z l)y z LICENSEDCONTRACTOR'S DECLARATION - .IOb DeSCCIpI10n
gsa"P
llamlicenscd under rn �ams of Chapter 9(commencing TEMP POWER
0=�ad wiNSi club But rid Professions Codeo�my 'cense
ION
z c p;� is in fs ✓�5'''as a Lic c.Dat< o an Cfs puhlR mrda
trc+s p O Liccnud Ymfes i al
WBUIL R DECLARATION
'I he y alErm t at 1 amine t from the Contractor's License Law for the
z< fanowin sen.(Sermon X031 a memand Professions Code:Any city or county $1000
Z F-p which qa e. a Pe t m a t Iter, mpmvc demolish,or repair any structure,
t�3CQ
do, t I y ,,Itreat(.,such Permits.file n signed smostrat -
ss . ... ....._ ....-
that IraisIttlsudp itoI ProvvrixofclicConsraclolsLmcmcLaw(Chapmr9 r r369(1@t0M4o70s�a Valuation
(con encmg with Section 90f)))of Division 3 of the Business and Prolli Code
) _ ,,t, s.,,.s, s,,z,• o;yc M; T,
or that he is exempt therefrom and the basis for the alleged eilmp ion.Any violation
of Section 7031.5 by any applicant for a permit subjects she applicant to a civil penalty Of not more than live hundred dollars(S5W), 10 3APN t1REk r .I Occupancy Type
[]Lnswner of the propery,or my employees with wages as their sole compensation, 304 - ROUGH ELECTRI AL
will'do'the work,and the'suuctum is not intendedor offered for'sale'(Sel.0044.' t,
Business ora Professions Code:The Contractor's Liscns<law tires not apply to an Required Inspections.•,',
caner of prnpeny Who builds or improves thereon,and who does.such work himself
or Ned F6,his own employees.provided the such improvements mems art not intended or
—dBe.ea for aal<:v.However, he bvdem - - tis sola within eine r ----. _._._. _ .. .-----------...__.._..__._..._._ ........—_ '-_•, _ _ -.__.._.
go1indenof en Ycaro
prove the rase rr da.),will have the M1uNen of proving that he did not build or I�sn o 2
completion.
improve for Purpose of sale.(.
-... .__...... cote ..__.- ......._ ..... _
❑Lasowner oflhe p(Sec.7rare<sdusiveland Professions
NliccnsThcontractorsConnector's
il.G. v 'I">R' �!
cicenseawoes not apply
Business andertywho
ho bills or Theeves theron, �.r ,; , - ,
r
and who
Law arae.not apply 1"an owner"f a,em property woo,alice or improves thereon, S E py •t Q.Q QOQ_ .
(. _ and who,contmcu.for each prolecu.witha.contracta(sl licenud.purvum4o.the .. -.. ._._.-.._ Lr 1 l7 L L __.. -._____.:.__... .__._...__ _.....__..___._.-..- ... .._.... .
Contractor's License Law. ..
_ ❑I am exempt order Sec. ' '.B&PC for this¢assn _ '• !•;,._Ty r:iy(,
'WORKER'S COMPENSATION DECLARATION BUILDING
rI hereby affirm underperahy"f parjury one of the following declatntions:
"r O 1 have and will m"inmin a Cer ificam of Consent to sell-insum for Worker's
Compcmmion, as provided for by section 37W of the Labor Cod<, for the
- perfoinlanta of the work for which this pcnnh ix issued. ,
❑1 have and will mtain ainWdrker'a Compensationns
Inrance.'a required by section
37N)of the'Lab it Cale.for she rerf9rmame of the work far which this permit is
: y Wo eI C penution Insure a sumer and Pol y b< _ _ _ .. _
i9/az�e�'o/ it.i. Sv i Ix l f �IJ�t %'_ t � I
a
CmetlfFICATI� ON FROM WORKERS .. .. ..
_,rI t COMPENSATION INSURANCE°, „ �
.I
(This're
recd not be completed If the permit is for ora hundred dollars s. t t;' v
IEI W)"r less.( t
- I ctirify that in iRe peH rk for ..r,_. .... .,...,. ....
nccr the co n sit ct i s timed.1 �. f,. s 1
shall n t - m Low.,
perm any man t become subject t thb Workcm
Co pensaaon Laws of C' f 1 a.Data -
•NOTICE TOAPPLICANT. ,afier making,th a Cenilicum 6f xanquar:you should `
Q Qbecome subject to the Workies Compensation provisions of she Labor Cade,you mum
fanhwith'cmr,l,wah such powi aaw or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY -
-' 1 hereby affiam that thconstruction lending agen:y for the performance t'
W;.. or the work'for witch titspsimtus issued(Set)0491.Civ,C14,_t
y:o 'Under's Name's,. . . .. :..._1....- ; -'-...... .__ ... .._
tier's Addrcn"'
1.
1 cattily that 1 have read this applical nn and state Online bo information is
Bit-E,e
context,1 agree to comply with all city and county ordinances and state laws mlaung
Q,V lob Id sic wetio Jit hY umhic itpassemadvas of this city to enter upon
the albootmentionedp pony for usPva
t4
(We)agree to s d keep hornless the City f C pen o agdom ;
rA lie,I t j dg cru, .t ca ch y.' any ay ceraagainst said
U Cit) nsequen a bfs g pc t
�5PPLO\NIL UNUF AN S �I LL Ob1PLY 'ITHALL ONPOINr Issued , Date
SO CC REG UL ON _ Yw
sl nadrcrar I. nvc tact D Re-roofs
'� RD MATERIALS DISCLOSURE
Ith<uppli<ent rf baddiag mpmat..orhandle hasm nam .d Type of Roof _ ... .. _ .- .. .. . .�. -
o:def dbYshe Cupenn ncipal Code.Chapter 9A2,and NC Health andSflyi t tf.
Code.Section 25532( 1 t -
0Y"' ,y•'"I �,,,, ` :, __ A1Lroofs.shall.be.inspected.prior to.any.roofing.material.being.installed.
. ...-.._
Will the ppl'ic t or future building occupant use equipment or d a...mch If a roof is installed without first obtaining an inspection;-Itagree,to'remove
emthzdous air annommaint, sdcfned by the Bay Arca AtQld,Management
District . all new materials for,
t oY for inspection..A, pplicaIn,u„n•_dqerstands and:wt
ill comply with
all non-point source regulations„
'
1 breve i;ad 11c h zor rials rtymrcments under Chapter 6.95 of the
California HeultH&Safe scions 25505.25531 and 25534.1 understand slim
u I have LtM1as is ism
ifshe builJins doesm yresponliiy otmlyv
ocdtipant ra(Ih<¢ vemenls un he net prior to isenance ala CeniOcase raP
°cup'"`y' Signature of Applicant - Date
Al] roof coverings to be Class"B" or better
OFFICE