08030168 CITY OF CUPERTINO
BUILDING DIVISION PEPAUT ° CONTRACTOR`INFORMAT
BUILgirIeffa`NELLY DR FOREST BUILDING 08030168
NEWS NAME:
PERMIT ISSUE DAM
HO JEAN C AND GILBERT D PO BOX 183 03/28/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 862-0742
ARCHI EC AINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTORS DECLARATION I Job Description
1 March, from that I am teemed under provisions of Chapter 91...ench, p
z wiNsection 7000)of Diviumn 3 of the Busious,and Professions Code,and my liceaux,is RPLC EXSTNG WINDOWS 1 LVRM 8 'X4 ' 1KTCH 4 'X3 '
^< in full form ant tttect. '
'�.z DW Clue Lie.It 1FM RM3 'X3 ' 6"
' Dam ARCHITECTS
TS DECLARATION
I undenuml my plans shall
M used a public RcoNs
i u
Licensed Professional
u, OWNER-mount E0.as denCA710N
<1 1 Mushy anion that I sus mampt from Wa Contra Cr's od :Any c Lew for the
0 o following Roan.(Sevum 71131.5,"alum. and ve. ons demolish.ac:Any city or mumy
$ which its iss s a Permit ru ennmsun, alley,improve, Permit nr e.sir ed awctuR
pdorbiu iouenro,ela requlrm lM applicant(onuch permitm file uigned summate
FF< that he Is licensed puraeni to the provisions of the Connector's License aw(Chapter9 Sq.Ft.Floor Area 1500 Valuation
Sg (commencing wit Schon 7000)of Division 3 of the Business and Prorewona Code)at
tat he an attempt therefrom and the Wain for the alleged assumption.Any violation of
Section 7031.5 by arty applicant far a permit subjects We appimanl to a civil penalty ofNumber Occupancy Type
rot roue tion five hundred dollars(SM 35911021 .Aff
❑L o awlc of and
property ar my employer,wit wage u lheu acme mnpuuaao^,
will da the dmk,end tite h.Cort re tor's Lt..
or offered Tanta(Sm.7044,M..of
and property
W Code:The ous der on.acme law darn act appy 1f an mage or - Required Inspections
progeny who h,prooricethaws thereon,andwbo amsotmhwart himeelrar Image his
awn employ=,provided Nanswo improvements am not intended oroRemd(mule.if,
bull&'Itonarver,the building u t.of MA.Ia sold within one year o(completion.the owner-
builtler will Nva the burden of proving that M did not build or Improv^for purpose of
ulc.).
1.as on.of the property me exclusively contracting with licensed contractors m
Utnawasca IM project(Sec.7044.Business and professions Cade)The Conuacmfo U.
caress Law does not apply m an owner of property who Milds or impreves thereon,and,
who mmraaa for such prof m s with a mnuacmr(0 licensed ponunt to We Contractors
License ave.
❑I am exempt under 5/¢ B a P C for tis moan
nu / '7.- Data
W� COMPENSATION
I hereby acro under penalty of perjury am of the following decelerations:
❑Ihavemd will munWn•CeWOmm of CamemmulFinsumforworkers Compen-
salian,as provided for by Recover,3'1110 or the Labor Cod,for We performance of IM
work ran which Wu permit is ivuecL _ -
za I lave orb will maintain Workers Compensation Issuance.u rryvia d by Section '
700 of the Labor Cade.for the performaace or the work fro mich this permit is iawea
My Workers Cam woven Inannce mmicr and Policy numbersen:
Cartier. Policy N I.:
EPTIR TE OF EKEMPIION FROM WORKERS'
COMPENSATION INSURANCE
(Than section nod not he canpleted If the permit Is for once hundrtd dollen 1$100)
nr leu)
I certify tat in the perfermaux of IM work for which this pmmi,a Wmd.I shall nm
employ any pence in my mmncra become subject be the Workers'Compensation
Laws of Gliromi Dale
Applicant
NOTICE
TO AP UCAraniking this Comm )e of FxamplIorf,you ihodittl
become subject Ip eta C6mpenti0on provisions of the"Wr Cod,you am
O forthwith comply fxu tt26 prevision or this posmit mail M dammed revoked.
z CONSTRUCTION LENDING AGENCY
y
[-r I hembY elfin that tem is a consuuctinn lending agency for the Portmanteaux of
a> the wort for which this permit an Wised(Sec.3097,Civ.C.)
W�Q Landers Name ,
7 z Landefs AddRa
U O I certify that I have mad this application and state that Ilene antro Information is
U.^ cormtt I.S.In comply with all city and county aNinancu and about lam mmling to
buildingmioned neaten,
Manby wthon p RpmexnuuwsertudmYmentuupnn We
Gs1 aMve-(Whi st d property far inspection purposes
O, caju
(Whist.Ix cave,indemnity and Peep harmless IM City re Cupenino agmvt
fq ll.blacoitieijudg offlue mu and expemcamit. may in any bony attme gmnstuid City �]
(„)7 APPLICANT
ofteEN
S tlapermit.
�7 APPLICANT U EDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date !�
SOUR REG AT
3 a 1e9 Re-roofs j
sine
uR "can
llCmf Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WiOy ,Cupentu fmuni demC dc,Cpantnomuharble hats Health
and
m defend DY the Cupertino Municipal Cadc.Oupter 9.12.me the HealW ad Safety -
.
Section 255324)? f',5g
❑yen T\AA.1O All roofs shall be inspected prior to any roofing material being installed.
%R the applicant or future building occupant nse equipment of dcvicm which If a roof is installed without first obtaining an inspection,I agree to remove
emit bumptious air contaminants as donned by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yen �l J�10
1 have read ave houdous mLt:riau M uiremenu undo CMpur i95 of the Cslifoa
nu Health d:SafelY Code,Secaiom U.505,15533 am125534.1 undcrusnd that iftc building
does rot cmently have a tartar uham it u my penitentially to modify duce omupuu of We
mquimme u Which m M(me//// m Wmnm afaccmnmRafacepsm . ignature of Applicant Date
owmr rano gent Data All roof coverings to be Class'Jr{.a'or better