04090108CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTI2AC OIis�INFF0 ,,, TION
BUILDING ADDRESS:
PALISADE BUILDERS INC
PERMIT N%4090108
1950
OWNER'S NAME:
PERMIT ISSUE DATE
CUPERTINO HOUSING PARTNERS
909 ALMA STREET
04/20/200S
E:
SANITARY NO. CONTROL NO.
(650)470-4700
ARCHITEC'VENGINBER:
BUILDING PERMIT INFO
BO ELECT PLUMB MOECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
o
Thal I licensed under provisions or Chapter 9 (commencing
I hereby a1Br M
with Section 70110) of Division 3of dm Businemi and Profc slo uCaleand my license is
m u, raroerotialias
NEW CONDO -1588 SQ. F.T.
License Cl - , Lit.
Dam Ca."nawr -Nle Sodom barb+
ARCHITECTS DECLARATION
1 uMeryend my pHy shall bo Y puh0c mcoNs
.2Ci��/JiLi- L w
Licensed Pmfeasioal
OW NFA -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Canaactors License Law for the
following reason. (Section 7031.5. Business and profegduns Cade: My city or county
which mqulms a Permit to construct. atter, Improve, demolish, or repair any aruetum
prior to its issuame, also requires the applicant fersuch permit to fiile.signed statement
that he is licensed pursuant to the provisions or the Contracmra License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Profesolons Code) or
$183826
that he I. exempt Ihertrmm and the basis for the alleged exemption, My vlolatien of
APN Number
Occupancy Type
Section 7031.5 by O9 applicant for a permit subjects ds, applicant w a civil penalty of
not ma¢ than fiat hundred dollars (5500).
0 Las owner of the property, or my employees with wages as their sole compengatien,
Re lured Inspections
will do thessrk, and theswcmrc W notmmnded oreRerrd formals (See. 7044, Business
and Professions Cade: The Conaattm not ars License Law data apply in Owner of
q P
property who Wilds orimproves thereon.m l whodressuch work himselforthrough his
own employee, provided Last such improvements art not Intended wallows for mic, If,
hmwevex, the building or Improvement Is sold within oro year of mmpledon, the owner.
builder will have the WroO of proving that he did let Wild or improve for purpose of
❑ 1, as Owner of the property. am exclusively contracting with licensed anrracwns e
construct the project (Sec. 7044, Business and Professions Code:) The Commoners LI-
ecnse Lew does not apply in an owner of property who Wilds or improver themon. and,
who convects for such pmjecu with a conuactWs) licensed pursuant to the Conaecmrs
License law.
D I am exempt under Sec , B,k P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby ellir under penalty of perjury onof tiro following declaetlons:
1 ham roti will maintain • Certiftam of Consent m self -insure forWorkes Compen.
sation, u provided Tor by Section 37W of the labor Code. for the perfmmarm of the
work for which this Permit is issued.
❑ 1 hats and will maintain Warkers Compensation Insurance. as requiring by Section
37011 of the labor Cade, for Ne performance of she work for which this permit is Wised.
My Workers Compensation Insurance artier and Policy number arc:
Cartier. Pfa1Uf5%e'G >C f,C policy N..:<a 4a ",26 �
CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
(Thal section need an, be completed If Lae Peron u foraw hundred deltas (5100)
or leu)
I certify that in me performance of the work for which Laos permit Is issued. I shall net
employ anyperaan in any mNner W as m became subject a the Warless' Compenaaddn
Laws of Csiifomis. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Ccrfil am of Exemption. you should
became subject to the Worker's Compensation provisions of the labor Code, you most
forthwith comply with such provisions or this Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby,ffrm that there is, construction lending agency for the performance of
the work far which this permit Is Wood (Sec. 3097, Cih, C.)
Lenders Name
Lenders Address
I a tify mat I have road this appllcaion and saw that we ahem information W
'
cora I agree to comply with all city and county ardiwxes and saw law rehting to
building cwavuerian. and hereby mol odae repnsentativa of this city w camor upon the
above-mendoned pmpeny for Inspection purposes
(We) agree to gave, indemnify and keep harness the City of Cupertino against
liabilities, judgments, casts and expenses which may in my coy accrue gaiml amid City
In consequence of the ganging of this perp.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:S Date
SOU�RCREGUI.ATIO
N'2 /'0
Re -roofs
Type of Roof
Soynaurt of App a o or Dam
A2ARDOUS MATERIALS DISCLOSURE
Will me applicant or future building occupmtawre or handle hanrdew material
as defined by the Cupedlao Municipal Code. Chapmr, 9.13, and the Health ad Safety
cad., S u.n 2553x(.)7 k
❑Yoe
All roofs shall be inspected prior to any roofing material being installed.
I.
IWill
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or future building Occupant use equipment Or devices which
II haaardnw sir contaminants as de0ncd by We Bay Arca Air Quality Management
all new materials for inspection.
DiWict7
OYcso
I haveread the henNoms mamrlalsmquimmcnmundcr Chepwr6.95of the Celifor.
nia Health @Safety Code, Seetions25505,35533 and 25534.1 undersand Laaifthe Wilding
docs rust currently have a WOOL that It a my responsibility w notify tis occupant of the
requinmcnswhich abemet ' rw Womaora CctWkaworOcapancy.
Signature of Applicant Date
^!-e
All roof coverings to be Class "B" or better
Owner
Or soubpa6mile em Dam