00050210 r.
. PERMITNO.CITYOF'CUPERTINO CONTRACTOR �F4RMTTOVpBUrLDINc DIVISION -PERNiM 2_J'.
0 "
SANITARYNO. "APPLICATIONSUB:7LDATE
DODO EdlES ��l a" Off/ S,GYv/Cl�°Sj,. Lha. J�30 00
OWNERSNAME: NIC `CONTROL# '
L o40ipsy .Bs�o � ,rvP
_ PHON El
AR_CHITECT/ENGINEER //C S- •/ a' ��O utD t' tvlfr'twe
o SiNcc�ie �}ssdGay ata - ,ff
Z HZ ,- LICENSEDCONTRACTORSDECLARATION5 .
C Z 4,_ I hereby a0ine Net I am licensed under provisions of Chapter 9(comma g - r ' Job Description
04= E with Section]WO).M inn 3ofthe Bui ss and Ptofandues Code'and my hostile
4 y P J in fall force and effect. _ - w f' 'i4 - _
55 NNm
License Chss Lit.# tis A
M 3 a r Date • -
o¢ - uga LARAno " /P�rD�NG l W�f' N//W� , /"•"f �t
-' undersrvd mY Plan rhe usede ublic e GA�
gc e r I
u"1 OWNER BUR.DERD RATIO X i , f r, I
i.' > 1 hereby a(B mal 1 inn ex rapt fr the C u t Y Li
e Law f r Ue f •• `
� following is ]031 S B lid Professions Cd My sty or ry F`
van wh ch 't m w t,elle m < dem boli av tdture -
rey _ a pro p d ,Sq. Ft,-Floor Area Valuation
pit he to Lueissuance,edAsir m mgmms Ne applicant for Con pirmfa Licee.nse
Law(charge,
9
thoi heir licensed pursuant to the proviilons of Ne Conmactora License Law fChaper9 I t
"Icommrnmvg with 9ecuon]OW)of Dlna on3 ofth B innate end Professiwu Cad) .• - - i
A Is
shat he is exempt therefrom and the basis f the ll god exemption Any violation f APN Number, yp ce pancy Type
section 7031.5 by any applicant for a permit subjects flue applicant a civil penalty f - _ e3—�V ''a - �� -r
pl mom then five hundred dollars($500) - -' '
I ae owner of Nr proprny,ar my rmployeea_with wages aath it aulr eatnpevswon - t ;Required Inspections- _
s will dothcwork,andthoamrctiim is not intended turreted fwade(Sec 7044 Buiness r .
end Professions Code:The Contianor's Lions.law does nor apply m an owner of
progeny who tined,or improves thereon, pr who does such watk deli or or through '
-
his ownemployres,provided Net such improvemenn are not mtcndod m offered for -
sile.lf,howevrnlhebu Its,burimprovrmenfu wldwMinnn build or improve for
-
poss,obuilder will have Ne burden of proving Nat he�did not tined or improve fOcp
•
pose of
❑1 e f die Propeny,am exclui ly nv l g with licensed mitractors to - -
conswct theproject(Sec.7014 Business d Pmfe ns Code)The C tractor LI '
cense la doe t apply to an owner of l perry h builds or W llcrco and Whocontracts for such projectsw N acovvadons)licensdpursuant to the ConaactOrs c f
Lic.m.Law
'❑I stn excmptmxdu sec t B'&PCfwthismason
. baa
f Owner r Dur .. ` - I if �f. O
i - WORKER S COMPENSATION DECLARATION - !s a ,I, `a•
I hereby affrma der penally of pe jury -_fm f Ilow gal lust oiu ... - y
❑Ilia d 'ediforby eCenf to ofC rnu Ida s ref W.ri Co pe e r
sat phi dal for mi Secure 3]00 of th Labor Cade f lh pert of the '(
work for which this permit issued.
[]'I he a end ill ma m Worker compensation Insurance, req 'rod by Sat
370hoflhela Coder�nlus.,.
ewort for which this permit isi ed' -
•M n t' Polley number are: ,amr, oy No.: - <'CE RMOMWORKERS.tit SURANCE
mon,reel'onneednat be oomplesed lfthe permit ofwom hundred dollars(SI0)) 1 -.�•" f _ t•,4 „ a
or It al ' •.
I cenify that in Ne performams of Ne work for which mspgmo,; issud:I shall
not employ any person in any manner an as m became subjmt w the Wmjke 'Comyen-' - '• '
senior Laws of Califomia.D. `}
Applicant
t NOTICE TO APPLICANT If,after making thiscertificate of E e pilon,you shouts '/ :0r
occume subject to Ne Workers Compensation provisions of the Labor Code.you must 'Il
forthwith comply with such provisions or thi ivemiit shall bu d«med mvoked.";
CONSTRUCTION LENDING AGENCY
' p ` ,d hereby NMfimith 'i aconst coo lending agency for the performance f 3.
the work for which this permit il,,,.d jScc.3W7,Civ C.)
iGy wit Lenders Name
�+y i7 -innddret Address
W I cenify that 1 have read this appfi l d code that th is information is f'
dr t I agree m comply with all city and ry ordinancesand t le laws refining to
i7• ,z building conswction and hereby authoriee _mtauves of thiscity enter upon the
V C abovcmemi and property for inspection purposes.'
�'Lsu (W)agree s give,indemnify and keep harmless the C ty of Cupenmo against
'O CF,) tubliu jdgm Is coslsend ea this pewhmhiney nany way eagmnst snd City * -
�n.W in co cq ence of the 8ranf n6 of this permit +' - ♦ ''� ^ '
-,APPIIO DERSTANDS AND WIT. LY WITH ALL NON-POINT -
V Z 5 CT ;'OLATIONS.
u ig bf ApplinnV miaow Dere r
"s
ZARDODS MATERIALS DISC URE f
Will Ne sppl oro or future building oecupanl sl' orhindle haaadousmem'sl Re-rOOfS ` r
ae dcfind by[he penmo Municipal Code.Cha 9.12,ed Ne Health and Safely j,,,
,cde.snt an sss 2(a)n - Type of Roof
❑Yes ❑ aqe a,- .
" H r prior-to
� �
q ted rior'
All roofs shall begins ec to'any roofing ofmOOr material being
Will the epphcenl Or future buildi g occupant me equipment or devices which C L" q D
emti bawd air conpminmis as deft rd by the Bay ArraA Quality Managr nl installed. Irarotif'is'installed'without firs`t`obtanning sin inspection
Di.v i4 .
❑Ye -. ❑y, - t ' "I agree.to.remoye all new materlals•for'inspection:, Applicant'
'.l have and the hawduue timariile rtquuemrnts under Chapin 6.95 of me Cali- Under nds,and'will comply,with all nom point.source regulations.
foods Health&Safety Code sectors 25505,25533 and 25534 I understand that if Ne -
bod'gd ,sem,which. amn.imrm iamyresof celrymnoufydro occupant y-�Y i
r
d
ofN' y menu which the npriw to issuance araC of sue of Qcopan
" Si ature of App ant - Date
Owimr orauNorizdag t - Da 3 L,' r -
li ,, '`A11'roof verings to be'Class"B",or batter` "
OFFICE
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