08040164 CITY OF CUPERTINO
BUILDING DIVISION PERMIT e'CNTRAC�TQR`�INFURMATIO
BUILDING ADDRESS: PERMIT NO.
10421 SCENIC BLVD TBD — TO BE DETERMINED 08040164
NEWS NAME: PERM'r ISSUE DATE
JEFFREY W MYERS 04/28/2008
PHONE SANITARY NO. CONTROL NO.
ARCHI ELTIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
�00 LICENSED CONTRACTOWS DECLARATION
i 1 hereby ammo thal I w licensed under Provisions of Chapter 9(commencing Job Description
xx hhSection70110)ofDivision3aftheBusinessandPro(esdo.Code,memylicenanla REVISION HARDY FRAMES—FRONT
a! in full fares and effect.
g? License Class Lk.N
St Dau Contractor
ty!qj ARCHITECTS DECLARATION
S 1 undersand my ph.Nall k wed ss Public records
gtad
Licensed Pref.damd -
5 Oat I an attempt
mDECLARATION
C<s hemhy.(Seco(Section n I em exempt from No CanOutafa L cony law for the
O O fallowing mann. pandai7031.5.Badness and ere.do ons Cade:Any city or county
5$
which requires a penis ac crtrstnscl,alar,Improve,dimnlW.our repair any swmum
-iy priwbih issuance.alar requires
€< Nf for Ychpermit unleaagawdaaloromnl
NathelslkmuedpursuanuoN povisiosofdo Contractor's esnm
Law(Chapter 9 Sq.F[. Floor Area Valuation
8 (commencing with Section 7000)ofDivision 3a(theBusiness and Profession,Code)or $100
that be in attempt therefrom and the buin for an alleged exemption.Any violation of
Section 7031.5 by say applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
rot mom than five hundred dollars(5500). 35702014 .,V(
❑I,a awrcs of Ulo NaPrItY,w my.ploy.WIN wgn u Neo wk emmpewtin,
willdo Ne wartandtheaaunmehntklomded.WrR fw We(Sa.70s4,Budneu
veal Professor.Code:The CAnVCaf/Unions Las,dMJ.1 apply he se awM/0( Required Inspections
property who huildswimprarea Nemon.and who donsauch wast intersellar Waugh his
awaemployxn,pmWded NasuchimprowmcoutietutinmM wageredfmula If,
bawever.the building or Improvement is mid.lade ane year of compkder.Ilse awanr-
bullder NO low the Wrdan of proving Nat k did n1 Wild or improve for purpose of
ale.).
r acr of the property am nelusively cramming with Demand conweoss In
construct the project(Sec.7041,Business and Profession Cans The CnauaYs u-
comes Law don net apply m an owner of progeny who Wilds or Improves Ncmon,and
wbo contacts for stub projects NN a cnunmds)famosed moment to the Conumtoes
License law.
❑"eve—
ares e�aerrpt oder See B At P C far this won
WORKST COMP SATION DECLARATION
I hereby affirm under penalty of perjury ran of the following dnlwWans:
❑I lam and will maintains Certificate ofCanunt to self-insure for Worker'sCompn-
antian,as provided far by Stamina 3700 of Ne labor Code.for to perfananm of W
work for which this permit is issued.
❑I haw and will maintain Workeei Compensation Irtauanes,as required by SeNn
3700 of Ne laborCode for Ne pedorma.e of Ne went far which this penis la Issued.
My Wmius'.Cmmpmentin louse.carrier and Policy number am:
Carder: Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITIS sectio need net on completed if Ila permit Is form hundred dollars($100)
or ksa)
1 certify Nat In Ne perfona.x of the work for which Nin Permit Is issued.l shill ma
employ any person in my mosso as as become Vgllg W0rk21 Camxsneann
taws ofcatr rrcoe a-/ L /
NOTICE
NOTICE TO CANT.IL afar makfaj this ConiOalo of Eumpdan,you o am
wJ Obttane.Ulmer m is Wodero CampeoYOn pants mai of Ne Labor Cade.Yate am
fOMMIN esmpnY with such pcovidrtrts w Nu permit Nall k dxmed revalued.
ZN CONSTRUCTION LENDING AGENCY
1 kmby alRrm that them Is•consweinn lending agency far Ne Pi fananceof
Ne want for which Ild it h inued,(Sa6 B0g1,Civ '
W Q ft ere far w ,
� z LnndeM1Addw
U Q 1 certify that 1 haw mad this application roil shut that the above InfonnaWn B
LL !! coma.l agree in comply with al city and county ordinarun and sunt,laws totaling to
.O SV-: Wilding construction,and hereby swhorim mptasmatiw of Nis city in color upon the
W akw.mendaRM property far impaction Purposes.
a, (We)agme in Lw,indemnify and kCn hnakY she City of L•upe.n against
I/) liabilitka,)udgmemh.eors and nperhn which may to my My amTC against said City
U Z in consequence of the granting of Ihis permlL
APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date .yi C_r4_caV
SWRCS RECULATIO S.
Re-roofs
Signature Appliwnnumur Dau
H ARDOUS MATERIALS DISCLOSURE Type of Roof //v
Will y the
Cupertino
ar future Wilding occopant r 9. whandk hmNous material
u denan0 by Ila Cupenina MunicalPalode.Chapter 9.13,me tise HnIN and Safety _
Section 25932h)' 'PIAll roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future Wilding occupant=wmpmcnt in dwims which If a roof is installed without first obtaining an inspection,I agree to remove
amt,Waterton dr conhml.nu Y dinned by Ne Bay AmaAir Quality Management all new materials for inspection.
Dimict7
Y. No
I have mat W hsrardess materials mquimmnhumlef ChmW 6.95 of Ne Califor.
nh HeaWlk SdetyCodi,Saadome8305.25533w125534.ImWcrnandthalfde Wilding
dean not currently have a unanl dut It h my r.pumihility to redly the aauOml of W
mq whlchin=W=IPrior heIssuance ofaCertifu Ocun . � Signature of Applicant Date
Ow.rwau orveda Dain All roof coverings to be Class'%."or better