02040098OFFICE_...._... _._ ._.. . :. _. ..: ...
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATIONS -
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BUIL�OQ$ES&
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PERMIT NO.
BLVD
02040098
ONT'ER'S NAME:
APPLICATION SUB DATE
NICK KOURETAS
04/18/2002'
PHONE:
SANITARY NO, CONTROL NO.
ARCHITECr/ENGINEER:
BUILD W O PERMIT WF'0
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S and DECLAAATJON
1 hereby aRnn that 1 om licensed underyyyyyyrovi :ions of GeP `, 9 ( commend.{
with SecuoW7 )of Division 3 the
Job Description
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of �rOR�ons Code. and rp iemse
. FIRE DAMAGE DEMO
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isia fxlClefs e0. C 3 "e. n I l.•
Contract
nn ARCHITECTS DECLA
DECL
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under t Pro lens shall W used u public rccmds
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Licensed Professional
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O\VNER- BUILDER DECLARATION
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1 hemby aRrm that I em exempt from the C...tar's Licene Law for the
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following reason. (Section 703115. Business and Professions Code: Any city or county
which requires a to construct. alter, imp demolish,
$4000
13$
pemtit n e, or repair any structure
- pri onoitsisruance. alsomquireuheapplic .oformchpenniuofle.aigned sutemem.
Va]UffiIOn
dr,he. Ieneed rant m the
Po pro)sons of the COnuxtols License law(G.p 9
(commencing- with Section )00D) ofD lion 3 o the Huyiness and Professions Code)
or he a e3h1em6 pt ,a Kcrtdfrrom and th e the
fiot
,- F�"1'i-3'�•D
AAny civil pen alty'
- of Section )B e fur c
,an m su bjects thee ' applicant to natty'
aiwtmn ethahhv ehunaedeollah ( sso).
NOppp7 � INSPEC IONS '"Occupancy Type
❑ 1,.s owner Of the property, ur my cmployces wuh.agcs as their sole compensation,
-.wilreotNO
wcrk--and the eonewriFis oat inmddN a erter.a fdrble )Dili.-
Husinds Arid Professions Code: The Contractor's License Lew does oat .,ply at on
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Required Inspeetiohs n'” -
Owner of propc ry Who Wilds or improve 0atrcon, and who does such work himself
-as' through his own employees . provided _ that such impm'e_menu are not intended or
. offered for sale: If, however. the building or irdprovcmeat is sold within one year of
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'completion,the owner - Wilder will have the WOCn of Proving that, he did.. Wild.,
.,...,AFYNO •7tb;'s.0._NO,
improve for purpose of uleJ.
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❑ I: m ownerof the property am exdusivdy convocting wid, licenud rontncton to
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construct the project (Sin. )614, Businco aril ions Cade:) The to
Liccvc Law doss am apply man o.'nar of eny w improver thereon,
pP Y propcny who Wilds or improves thereon.
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contractor(e1.HaruW . punu.nt.m.,W....
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License Lawuch.projau.wiN.a
Contractor.plu cIsw ..._c, " ":'r.to9;_r.:.L. >, -• ^•
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❑IUn atom [underSec. BAP,Cfar that re.mn
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Gwxl''I•.. .:Dire
0.KER'S COMPENSATION DECLARATION
- 'Ihertby aRrm under pewltyof perjury one ofthefollowingdeclarotioru;'-
❑ 1 M1eve unA will "moin'uin is CeniOcne of Conacni to eel(- insure far Workers
-
Compemation: arprovidcd- for-by-Secdon-3)OD'oP dte-Wbor Code: "for'the
performance of tho work fw which this permit is issues_
❑ I hev. and will maintn nWmQer CCompe sat b la uranoa, as required by Section
3700'6f th IoW CeQc, for the perfah anee of the woak f which dds pernut is
rs c,1Q My Worker C nsWon l sat a cm aM P.Hey nurhb rare
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if tY, s(. -' t t ♦\'
C N I.W. w RRS
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" 'COMPENSATION INSURANCE'
.`•e "(Ths scelon need hat be completed,( the is for one hundred dollars
_
Permit
fS100)o Iw) f s
certify, that ih � the perform ntt of the worts for which this',erout is issued 7
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$hall not empl y y pc o n any aner so s to become abject to thq Wor"'
Compemn o Ls f Cel f , Data '
.NOTICE TO APPLICANT If. Afar maL, $ this Cen f te of E e peon loushould
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Wco esub/ect to the Workers Gompenmto p ohs of th LsW Code y u u
fecithwith comply with s ch prorr s o s o this perm t shall be deemed revoked
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If. 3 �,- 'tCONSTRUCrtON LENDING AGENCY d' `'sc
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"' I hereby lllirm that the s a mriswct on lendm a`eneY for die per(ormarice`
of the wo k for hl[H th s pc h it issued f5ec:309), �iv. C.) ""•
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LenderaAdd s' '^^
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o,. - 1 ccn ft' thin I W d Ws.I:p,Iicauo e d u m that N eW mfonnation is
i Tree 1 e{ to romply ,hall c p and rot ty rdin.nces dip t laws
wWilding mnstr, inion. end tieieby euNOriie rcprcsenutives of @is city mentor , up.
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the aW a me tionetl property for inspection purpo,
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IVJ) epee to eve Indemnify and keep harmless the C ry of Cupen elainu
h
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liabjh0es• Ju enu. c u end pcnsu 1 h may a y way rtcry a {anus said
dons vet of the gmnun`[of Nisl n 01
°PLI ♦t` STIt 1. 7"}I
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A A\l� W, v L AiL P L\7
Issued by:
Date
s nee eetm n ' ",
Z D R I O S R
Re -roofs
I :'2 W11'the appl cant ry fum WUdin {amspw naiehwtdle m n u
nHY a
TY"p'` eo f R' oo'. fI . - � - •.
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th2e 7 5C`J, U2Hp(Aaerl uAnr oR# M Y nU eS , l CiOEd
aVnd thE e emalath aun'd safety
GIS a pD¢1r3y9CL1et 2
uCoddee f n S❑ eduYb,eoY n
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-in�g ,
NpMaa
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Instal.l._e_
p n_(o0 r .tS o1 .a- n
roofs shall _b_ e i` n s
p cl tet y roo f in g .m� aterial.be'
lh ". WJI tlrclpplidmt orf meWilding occupant use cquipmrnto devices which
emit haWdo bJ
If aroof is installed 'without fast
obtainin g an ins Action -Ia ree'toremove
sai c m mm nts udeMW Ne Bay ArzaA Q a1ryMm prom
all new materials for inS ctlon Appltcant understands and will comply with -,._ _ - -,
all non -point sourcereglations..:
.' }t 1 h e d'the h rdo matenas regmrtmeno- der Gapler 6.95 of the
CaliforNiHeal Safety, Cod.. Secdons lSSW.2]737 asW 257J4r1 vodusund than
-JihsW ld {d c -cur0 that tls
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Wu'CUe be 1.supons ofnyro ific.rthe
t of the eq u, enu_ h eh musi be pF [m ummce of Cemtleaa o/
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Signature of Applicant.. _ Date
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All roof coverings to be Class "B" or better''.
we o authorize'ages , I ?''8' � ;"`
OFFICE_...._... _._ ._.. . :. _. ..: ...