00060028 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING@21360 SANTA PAULA AV PHR,MfrNID0060028
OWNEIt'S�,18 , CINDY API'LIC-0 eyeell'2000
'HONE: SANITARY No. CONTROL NO.
❑z 2 ARCIIITECHIiNGINECIL BUILDING I'ERMI'I INFO
O C RLDG I'LECf PLUMB MIRCH
U^
a �i I_I IJI_I 1=1
H5 j LICENSED CONTRACfOR'S DECLARATION 4 1 hem,,arum,that I am uccn,w under pmvminm of Chapter 9(commencing Job Description
K
with Sect i,nVillofDloi,ioa,3onmc,Ba,in...indlhtfes,ioaI,Cndeamlmya.ens. DEMOLITION OF SINGLE FAMILY DWELLING
^ ,in full hire and effect. ,
z a Licca,eClass Lic.a
O O Dote contractor
4t„3 u v ARCH11ECr'S DECLARATION
E °; I understand any plans rhall be used as pnbliu rncord,
vat
ur a Limoed
cSProlcssi,nal
�i
%
OWNER BUILDER DECLARATION
I hereby,front non I an,excanpt fmm he Coamenc, -iaensa Lew rest the
C Z rnllowing r t.(Section 7031.5.Bar and 1'mlm ..Cis e:Any ci,y o nary
nem
^s O which requires a permit to construct,ider,ahnpmve.drumi,r or repair any nmoue
ams p,imbiOi...mce.alw rommos,'he„pplieam for such permiuo ale-signed smmr,em
�— that he is licensed pursuant the mvisions of the cannot License Law(Clingier 9 Sq. Ft. Floor Area 4'�t1LDIdtOQi
(cou.ntencing with Nems..9001n of Di,tcau 3 of the Budnee,and Prtfcsxiet,CW e)
or that he is excmga thercfrmn and doe basis ha the alleged exempla...Alation
of Section 9031.5 by any.,plicant far m .it objects the applicant 1.a civil penahy
of not mom than five hundred dollars(S500). Ag,?J-fij$t55 00 Occupancy Type
[11,es owner of the Pn'perlri or by on.playecs w,,i wage,a,cher r...le mnnpaantian,
will do the work,and the dracum is not inmoded or allured In,sale 0".9044,
Budari and Pmre.dons Code:The Contractor',1 teethe Law dee•,not apply to an NO ASS I GNE8egp*0JEY2gct0tgS
urr of prnlmny who build,or improves thereon,and who does such work himself
through his own ceploycc,.provided that such improvements art not intended or
oltbred far sale.IL hnw,wa..the building lir improvmncnt'd sold within nuc year of
iuaotAtuoo,,6c nwni,,milder will havc,he moLo lir proving that hadol on huild or
mprove for pugwm of svlcJ.
❑h it,owner of the prol,cm ,am calu.ively canumeting with licenced contractors in
the pmjce(5th.90 o,43.It , and Profc„ „Codop The Convector's
Lmama im.se Law does not apply a an owner of arm
whoahailds or Improves thereon. .
and who contracts for such mooch with a contracm,ts)licensN pursuant to the
Comaeor's License I.aw.
p I ,.sem t under Sec. .B&P C for this rmnon
Uwne U
O KIiR'S C 11' TIOR'Q-CLARATION
I beelyo affi,n under Ix nilly of 'dory one of the following dWlurutiml,:
❑ I have and will n airmin a Certificate of Consent to scll.ms m for Worker's
Compensation, as provided for by Section 3900 of the Lahr Code, for the
perfo r ance,fine work for which this permit is issued
❑I have and will main(air Worker's Cmnpcosmion Insurance,it,rcquined by Section
3700 of the Labor Cade,for the Icalormance of the work for which this permit is ,
,wed.Sly Worker',Cmnperodum In,umnce currier and Policy number on,
Carrier: Palley No.:
CERI'IFICAI'ION OP UXEMPI ION PROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed it the permit is for one hundred dollars
IS 100)or us%.)
I camly that in the performance of the work for which this permit i,issued.1
shall not employ any person in any manner x,as as become subject to the workers'
C pen.ui .nw. fCnliWmia.Dam '
r, _
NOOCE 'Y IC, I':If,aft kI I. It Ccnif of Exeanptinn,you should
llmm s jet mthe Workers Compcns"'nn rnvixinns of the L,Mr Code.you mu.0
C forthwith comply with.such pmvisione or,thi permit shall be deemed revoked.
F lZ) CONSTROCIIIIN LENDING AGENCY
1 hemby affirm the there is a cnmwcion lending agency for the mcdcrnam.
of the work for which this warnit i,issued(See.31X97.Civ.C.)
P. A hcndcr's Name
z Lender's Add ,,
t..) C l cenify that l have mad this application and oma that the have mfnrmelan is
E.a correct.1 agree to comply with all city and county ordinances and sem laws relating :
Q V m building ennswnion,and h.aby anionic mimasenetives of this city u,enter upon
G91 meabnvc.memGoned p,,,,rty for in,pcction unposes.
y
(We)ugrm ,, .,I.'mdcnnd y and keep larndc,s l he City or Culsunino agni list
TA liabilities,jmpmcntn,costs and expenses which may,n any way accmc against said / /�
v
z Cir'in mnscquemce or the gaming of,hu permit. /'_ �(/
A LICAN'r UNDBRSTANDSANI WILL COAO
COMPLY WITH ALL NONINT y'
Issued by: Date VVV
ID :NEr ILLATIONS. �
,'ig—e, nl peaanuc ,actor Dam Re-roofs
f1A'ARDOUS A'MRIALS DISCLOSURE
will the;mpdc torfuture ending„Ccap,ntonto(it handle harmm,m-retial 'Type of Roof
o defined by the Culmnlnn Munlelpul C,nlo,CLapmr 9.12.and thc lleulth and Sadcty
Code,Section 25532(a)y
0 ye, ON. All roofs shall be inspected prior to any roofing material being installed.
WI I l the applicant or hum re hawing occupant use cgmpmcnt or dev ices which If it roof is installed without first obtaining an inspection, I agree to remove
,alt 6aa,rdou,",cattattnimm�l,
as defined by the Bay Area air Gwality SLawgmncnt
...
all new materials for in Applicant understands and will comply with
�YeB 0 N all non-point source regulations.
I have mud the hamNoua tnwniaN requirements ander Cnopmr 6.95 of the
Culdorme Henllh&Safety Code,Sections 25505.25533 bud 25534 1 understand thus
if the building does not currently have a tenant.that it is my rolxmsibildy to notify the
ant of the requiamene which aunt he NI prof,.i,Ne,ce of a CmifiCam of
°c T'an, Signature of Applicant Date
n m mIl — Date All roof coverings to be Class ..B„ or better -