05030002CITY OF CUPERTINO
BUILDING DIVISION PERMIT
, INFURMA.'1*Igl�i
eCONT.RACTOR
BUILDING ADDRESS:
71C) qANTA LUCIA RD
HENRY LITTLE TRACTOR SERVI
ffMITNG05030002
OWNER'S NAME:
PERMIT ISSUE DATE
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SANITARY NO, CONTROL NO.
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CHITECT/ENGINEER:
BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
T kreby,dram that 1 am licensed under previsions of Chapter 9 (commencing
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Job Desenpuonfi
with Section 7")of Divislon 3 of the Butlneu and professions Code, and mylicenmts
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full effect.
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DEMO (E) HOUSE/GARAGE
Dau Contractor
ARCHr1ECrS DECLARATION
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1 understand my pmmi.hall be tried u public words
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Licensed Prefeam... I
OWNER-BUILDER DECLARATION
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ContrON
I kreby, .(Sere Net 1 exempt from tilc Lew for Inc
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1. fessim Co :Anse
fallowingrecon.(Semon]1131.5,Bulnsssand ions Code: Any city or county
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which requires n Permit re mnswcL Blur. improve, h Permit t ri mash ed structure
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for mchpermitmcense rile a signed statement
banrriiulssuedinulm.,to Me visions of the Comrcur'a License lAw(Chapter 9
the
Sq. Ft. Floor Area Valuation
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Pumlmun pro
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(commenein{witheDiof Business and avi Codd) or
Nat k b exempt therefrom and the bassfor OW alleged cmmpdon. Myviolation of
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Occupancy Type
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Section 7031.5 by any applicant for • permit subjects the applicant to a civil Penalty of
out mom than five hundred dollars ($500).
L ss owns rf the property, ormy empkyen with w{e u dleb sok mmpenss0on,
Required Inspections
wiBdothew rk.mdOczmclamism,immndedmoffcmdloreak(Sa.7tW.Businw
and Professions Code: The Crematories License Law dote not apply W in owner or
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property who build, orimprows thercon. and whodwlluch work himself orthrough his
own employee, provided that such Improvements art not Intended or offered forlek. if.
however, me building or improvement I. sold within oro year delimitation. the m.r.
builder will haw du burden of proving that W did not Wild in Improv: for purpose of
sale.).
❑ 1, as owner of the property. am exclusively contracting with licensed corrasion to
construct the project (Sec. 7044, Bines and Profusions Code:) The Contraries U.
came Law dote not apply in an humor of prepeny who Wads or improw, Women. and.
who comosm for such projects with a eomrmur(!) licensed pursuant to the Contractor's
License law.
Alama under Sec. BkPCfrM ma on
Owner D.m
Own
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WORKER'S OMPE DECLARATION
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I hereby arm under penalty of pert' a of me fallowing decimations:
have and will mainum a Cemfieu of Consent in self-insure for WorkefsCompcn-
ion. u provided for by Student 3700 of the Labor Code, for the perfarmma of Ne
work'hr which this permh i! issued.
❑ 1 have and will maintain Worker's Compensation Immnllce, u requited by Section
3700 of the Labor Code. for the performance or the work for which this permit is issued.
My Workees Compensation luunnce artier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
- COMPENSATION INSURANCE
rfbb section need not kcompleud Utica permit is two= hundmddollan (SIM)
m leu)
1 cerofy that in No perimmance of the work for which this permit is Wued,1 "I raw
employ any person in my mmrlfr Rras�ty Wcoru subject to led Worked Compensation
Laws of Ca[ifor ' Dau a / O
Applicant -1i�y f 1 rte. aegQ
NOTICE TO APPLICANT. If. afar making this Carolina, of Evemplion, you should
keome subject in the Worker'! Compemdon provisions of the Liquor Code. you most
forthwith comply with such previsions or this Pmmii shall tic tl mu
deemeted.
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LENDING AGENCY
.~N.,CONSTRUCTION
1 kreby affirm that More is construction lending agency for Ne performance of
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me, work for which mb permit Is Wood (She. 3097, Civ. C.)
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under's Name
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Lender's Adder..
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I certify mat I have reed this application and mite that the slew, Information Is
eorrcnt. I agree in comply with all city and county ordinances and sum laws misting in
Wilding construction. and hereby submarine, represe milm ofthis city to enter upim the
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akve-memioned property for insp T9011 Purposes
(We) agree to save. indemnify and kap bumless the City of Cupertino against
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liabilities judgments, cam, and expense which may in my way mane against sold City
In consequence of the granting of this
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Permit.
APPLICANT UNDERST AN ILL COMPLY WITH ALL NON-POINT
Issued by: az Date
S REGU TION
Re-roofs
Si amrcofApplic. rnlnclhr Dona,
HAZARDOU MA IAIS DISCLOSURE
Tjrpe of Roof
Will da, applicant or'mure Id' occupant nomwhandk hazardous material
u defined by the Cupertino Municipa Cade. Chapter 9.12, and the Health and Safety
cora. Section zss3z(a)7
❑Yc! �1Nu
All roofs shall be inspected prior to any roofing material being installed.
.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Uu applicmt or fuwre Wilding occupant use equipment m devices which
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havardrns airemuminanu u defined by Ile Bay Area Air Quality Management
all new materials for inspection.
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❑Yes o
I have mW the huxrdlms museum, requirements under Chapter 6.93 ofthe Collier.
nb WAI "Safety Cade, senium 25505.25533 and 25531.1 understood Met if to Wilding
does not c... lly kw a ten 4a it b my m"a"IbIllly u notify the occupant of the
rt re nu which must mtp'r lie, aacemnaa r ama,Y.
Signature of Applicant Date
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All roof coverings to be Class or better
Ownm onmkrizeda ret - m