00060015 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: `
flUILDINO - PERM1IIT N .
OWNER'S 1 GREUU 1214 RUPPEL-r- Pr_ APPLIC.\ ?�
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ONE. G — .•� SANITARY No, CON'IRo.NO
❑re/ ARCHITEMENGINEER: BUILDING PERMIT INFO
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h Z LICfiNSIiD CON"1'RAG'mR'S OECLARAOUN
Z Z�z 1 hereby affmn IbnFl Ilm liculwd soder pmvlaiore 1 Chapter 9(mmnmming t 1 h pe5Cr1 lion
Gnt� W'ufrScnlanmlg»alTrvi.ianioldn,I,ine..anIP"d ' Cala.and
TEMPORARY
F�I�ER p .
II
i.in lull farce and catch7•�/
z au a Lmcnaa clm.a lJe a
w Dam canwaor
tr 3 u y ARCIII I ECr'S DECLARATION
g 1 understand Icy plane shall be uaal as public mount,Y
,tea o O Licemcd P,ob,"i...I
a. OWNER-BUILDER DECLARATION
mI hereby rifrm that 1 aerne,from the Connsawre Licenac Law for the
Z following real wn.(Section 7031.5.lmsinecs and Pnde.%hus Code:Any city or county
S x d which mquims a donot t ammt,dom, p c.de cF' y sminere -
��� an,( I - 'I. pda,I Ip nits II '. g Jamcamn -
- Ihathaalea,%W pt a�tt,tblhel. % nl c taor%1 I fchmma9 Sq. Ft. Floor Area valuat
(con0 oaaa.gwith Section 7hXI)of Division 3 of the Itusine,,and P,or—lons Code)
or that he is exempt merel'out and the base,cattle alleged exemption.Any violmia.
of Section 7031.5 by any ap,li.a,far a pem,il sobjeaa the aPPlicunl to it civil penalty
of sol more than Bac hundred dollars(5500). A159 if IB05. 00 Occupancy Type
01,us owner of the properly',or my employee,with rages as their will compensation,
will do the work,and the sBamum i,not intended lir offered for sale(Sec.vuM. 103 — UFE R Re uircd Inspections
aurins.and Pmfeeeiom CmIe The Contmnm'a License].am deals no,apply u,an
q p
orfor propari Who buddhar trial therean,and he doe,oah work himFelf 304 — ROUGH ELECTRICAL
through h1a own employees provided that such impasio cats am all,intended or
offered far wale.It,howe.ca the naildiag at timprowe nem I,Id within ana year,of
mo,dian,Inc awncrbuildc,will Lave the burden of craving that ha did not bo11d o, -
pnne far purpose of s'le.l.
caner of the properly.am excwsivcly contracting with licen.sd canuanan n,
a,rotma me projecl(Sec.]IIID.13.6io,, ad Produne,Cudc:)The Convumal
License faw rice,not apply'a mol of properly who builds or impose%rhercon.
and who contracts for such projects with a carol licensed Familiar It,the
ennwnarw Licany�
t 0lum'�ex�cm�p�.tuC{/�rS c._ _l— .H&PC far this remo -
I owmr l" ate OBJ /
OR i 1 iNS DIF
111, 1
I hereby off rn,underlsnallyufperju mol the l ollowingdecloulacto
J I base and will muinium a Cenificsm of Cement to sdl-insure for Workch
Compensation, to, pmvlded lar by Section 3700 of the Lbor CNet far ,he
perfonnmee of,he work for which this permit is issued.
❑1 base and will maintain Worker's Compensation Insurance,as required by Section
3700 of the LaMar Cale,for the performance of,he work for which,his permit is
Issued.My Worker's Compensation monomer,carrier and Policy number are
Carrion Fill,No,:
CEIlI'IFICAI'ION Oil 12XIINIII DON FROM WOKKERS'
COMPENSATION INSURANCE
rfhis section need not he completed,f he pem,i,is for one hundred dollars
(51(X)ar less)
1 certify that in the perli,rmance of,I�wvr frn_ ttcl.this permit is Isaall.I
,null no,employ any p on in any man m hoc m <uli t f the N•arAen'
Ap i, set L Doc r so
AO 1 7.t
NOI'ICF,T AP I.. '1':ILsol
of o' ?xcmptlom .,oaleuld
borunm anbjccun the st a In v,or this
pmvisiue of a decreed Cuol,tal mixt
0 . fnrlbwhh mmPly with each era iaonw or th'e,Fermi,altlll bu AmmcJ rooked,
FCONSTRUCTION LENDING AGENCY
' I hereby f.,,,fl at share is a construction lending upon,for the perfonnmee
of the weak for which,his Fermi,is issued(Sec.Sol Civ.C.)
L Q I.cOrat Name
Z I,cdal Address
C.) Q 1 certify,hat I have call this uFFli.tion and flute that the'More infatuation is
carton.1 agree to comply with all city and county ordinances and store laws editing
Q U to huild'mg mmwcdon,,md hcrchylnuhnrizc core andmivcs of thirdly order area
�y ;4 the nhnve.mcadoncd prupcdy lnr lnxpe l Pumuws,
F W t Wq agree to save. ndmnnlly and keep han,des%the City at Cuponln)ngairs,
V1 liahilllics.jud'ama...cod#d"
hit tiny in any way accrue al%aid
U z �Fd
inrnneequc wtfthe ,.
Can DERST . .OMPLY WIT({q1.L NO Po (� Date
BCF LATI NIssued by:
Ap Re-roofs
r lAIALS DISCIASUREesn me:,F cam li
car ,at
sore m nanale a,amaa,material Type of Roof
m defncd by the Coperlinn Municlp:J Gdc,Chapter 9.12,:uW the Ilcahn and Snfely
Code,Seclioo 25572(')'1 -
0Ye% 0N All roofs shall be inspected prior to any rooting material being installed.
Will the appncun or future building occupant use alolanalt or devices which If a roof is installed without first obtaining an inspection, I agree to remove
-air hmaodou%air communicant,lie ddined by the Bay Are'n Air Quality Ma,agnmmrt
)(.trier+ - all new materials for inspection. Applicant understands and will comply with
Ove, 11No all non-point source regulations.
I Ill mad the hvurdous materials myuiremmriu under Chapter 6.95 f the
California Health&Safety CNc.Sections 25505.255)3and 25534.1 unit % nJ that
file building does no,currently h:oc a lenmt.that h is n,y re,;.s.'llhy I Iifythc
mupam of the ncnls an. maw, me,prior to hsnunee c, theme it
0, Fit re � d Signature of Applicant . Dale
I nn.cd a, ate All roof coverings to be Class "B" or better
OFFICE