06010137 CITY OF CUPERTINO `9x z
BUILDING DIVISIONPERMIT CONTRAC ORINFORMA'CIO
BUILDING ADDRESS: 'INTERIOR ENTERPRISE INC PERMIT N0.06010137
10495 SCEN
ER'S NAME: PERMIT UEDATE
GREG RICHMOND 855 AZURE ST 01/25/2006
NE: SANITARY NO. CONTROL NO.
(408) 245-5500
ARCHI'IECYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION O O O
raniF I hereby affirm that I an licensed under provisions of Chapter 9(commencing Job Description
�Zj rL with Sccrian]fkt0)af Division 3af me Businnxand Pm(cssionx Code,.antl myliccnu is
o` inmRmrreandefren. REVISION - ADDING 5 SKYLIGHTS
License,ClassLic.0
=moo Dam Cwhimsor NO NEW PERMIT ISSUED/ORIG. #05030011
ARCHnELTS DECLARATION
rjks I undconand my plans shall W used as public records
JiU
g O h
Licensed Pmfcssional
OWNER BUILDER DECLARATION
.�<2 1 u"cby alarm o n I am exempt from lu Contractors :A License Law for to
p o which coq mann.(Section]tons.0 Business and Professions Code,:Any city or county
`e m vi which tits as.a permit re construct.Jmr,improve,demolish,fi repair any ewcmas
�z i Our hnore its i eased pursuant
a requites the appliema for such ro fm se Law stammers
ESGmathclmungwlpursuantmthe provivimmofof ftBComment'ssinessLittnwlaonsCodmr9 Sq. Ft. Floor Area Valuation O
YI- Our(conso
incingiiNSecuoon and O Division]WN CBusircssmton.Anynvilaton or
Nat he u exempt therefrom and Ne basis for rte alleged exemption.Any violation of
Section 7031.5 by any applicant for a parmit subjects the applicant in a civil penally of APN Number Occupancy
not roam man BK hundred dale, s(s50d). 35706015 , 00
P y Type
1,u owner of the property,or my employers with wages as thou role compensation,
will dome wart,and the swnum is not intended or offered for sale(Sec.7W,Business
and Professions Code:The Conuacmr's License Law does wr apply in an owner of _ Required Inspections
Property who Wilds or improves thereon.and who dos such work himself or through his
own employees,provided Out such improvements are not intended croffercd for sale.If.
however,the Wilding or improvement is sold within on year of completion,the owner-
builder ,will have Be burden of proving Our he did nm Wild or improve for purpose of
sale.).
1,as Owner of to property,am exclusively contracting with licensed contractors to
onstrua me project(Sec.1011,Business and ProGssions Cade:)The Contractor's U. \
cease Law docs not apply 0 an caner of property who Wilds or improves Burma,and S
who contracts for such projects with a contrwtor(s)licensed pursuant to to Contractors a.
License Law. �^
El Lon exempt ,B k P C far anis
u a ec. rcazan /\
er Date
WORKE 'S PENSATION DECLARATION
1 hereby aRmt under penalty of perjury we of dm following declarations:
rl 1 ham and will maintain a Canifream of Coment to self-insure for WorkcrS Compen-
sation,is provided for by Section 37W of the LaWr Cade,far the performs.of the
work for which anis permit is issued. _
1 have and will maintain Workers Compensation Ituu ..ss mquimd by Section
3700 of me laWr Cade,for me performance of the work for which this permit is issad.
My Worker's Compensation Insurance earner and Policy number rre:
Carrier: Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sector wed not u completed if to permit is for ane hundred dollars($100)
or less.)
1 cemfv mat in me perfunnanee of the work for which this Permit is issued.I shall not
cmployany Powan Misty manners mWcom ubjcn mthe Worker'C,,m satin
Laws of California. O
Applicant 4 r / `� 4k. I .
NOTICE TO APPLICANT.If,a akasB lh s Cenrficate or Exemption,you should
Wcome subject to the Worker's Compensation provisions of to Labor Code,you mats
.JO foMwirh comply win such provision or anis Permit shall W doornail revoked.
Z y CONSTRUCTION LENDING AGENCY
I-a I bunchy affirm Out mem is a construction lending agency or me Performance of
C'
the work fur which this permit is issued(Sec.3097.Civ.C.)
U]Q Lender's Name
Z Leader',Add.
U 0 I unify that I ban mad mice application and sate Our the aWve information is
!!. F correct.I agree to comply with all city and county ordinances and tam laws relating to
0 building commuctian,and hereby suthodre asp"ewntxtives of this city to rnmr upon the
0. auvc-mentioned property for inspection whichpromises,
(We,)agree to save,indemnify and keep harmless lu City of Cupertino against
y liabilitiu.ludgmcn¢cosa mdexpcnws which may in MY way accmc against said City
U Z in CoLco nuc of cgnminggLlhis. "mit.
'-" APPLICANT U STAN19 N WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R_GU
IONS.
Re-roofs
Signature afAPplinnVCon��aett / Date,
HAZARbD MATERIALS DISCLOSURE Type of Roof
Will do applicant or rutum Wilding occupant srome orhandle hazardous material
az defined by the Cupertino Municipal Code.Chapter 9.12.and Oc Health and Safmy
C.Section25snz(a)?
Oyesxa .a All roofs shall be inspected prior to any roofing material being installed.
Will mea heanl Or future Within oaa nt awe If a roof is installed without first obtainingan inspection,I agree to remove
Tan B W a Air Qm err Yana which P
cash hazardous air comaminanu az defined by me Bay Arca Air Quality Management all new materials TOC inspection.
District? �� //
❑Yrs 'AIN.
I have mal the haudoluss mverials mquircmcnts under Chapter 6.95 of me Califon
ria Hcalm&wth
de,Secu 05,25533 125534.1 undcrslandnatifthe Wilding
1aG not cuM,a LL'n 4 mdt 1 Ice my! "lily b notify IIIc occupant of me
regmremenuts Wme 'mu an or.Ce fi am Or Occupancy. Signature of Applicant Date
Ownermi,edagmt Date All roof coverings to be Class "B"or better