Loading...
0409010900 zN W Q 6 U UO O E W U i CITY OF CUPERTINO '^^: 'I,« r �•• �' :�: BUILDING DIVISION PERMIT CONrRACT4RRRRRNP©TION: Bu1LDING ADDRESS: PALISADE BUILDERS INC PER""Nb4090109 19503 STEVENS CRK 118 OWNER'S NAME: PERMIT ISSUE DATE CUPERTINO HOUSING PARTNERS 909 ALMA STREET 5 E; SANITARY NO, CONTROL NO. (650)470-4700 ARCHITECr(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH f� D LICENSED CONTRACTOR'S DECLARATION lob Description viof Chapter 9 (comencing 1 hares, affirm Nat 1 am licensed ander pmsiom m with Section 700D) of Division 3 of the Business and Professions Code, and my license is mfauf,romandellen.NEW CONDO -1195 SQ. FT. License Claw UU.g Da¢ Y Contractor ARCHTIEC'S DECLARATION 1 un rsunJ my p�sl � um u public recarJa Licensed Professional 4 OW NER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the conlrectors License Law far the following reason. (Section NO 1.5, Business and Pmfessians Cale: Any city or county which requires a permit In construct, elect. Improve, demolish, or repair any structum prior to its issuance. aim requites the applicant for such permit be Ole a signed statement Ft. Floor Area Valuation Met he is licensed pursuant to the provisions of the Contractors anse Law(Cbepter 9 Sq. (commencing with Section 7000) of Division 3 of the Business and Professions Coda) or $138333 that he Is exempt therefrom and the basis for the alleged exemption. My riolmfon of APN Number Occupancy Type Section 7031.5 by any appllcutt for a permit subjects the applicant to a cel penalty of not mart Ilan Ove hundred dollar. (5500). ❑ 1,u owner of the property, or my employees with wage as their into compensation, Required Inspections will do the work. and the "turn is not mated W offered far AM, (Sec. 7090. Bunircas and Professions Cods: Thor Comramors n wintere License law donot apply to an winter of q P property who build, or Improves thermm. and who don such work himself or through his own employes, provided Nu such Improvements are not intended or offered for Ws. IL however, the building or improvement I, to within arc Sem of wmpleuon, the.,. bullder will have the burden of pooping WM k did nm Mid or improve far purpose of sat ❑ 1, as awwr of the property, am exclusively em anesuz with licensed cantrictoa e common, the project (Sec. 7044, Braine d and profession, Code:) The Conummrs Li- cense law tion not apply to an owner or property who builds or improm therein. And. who contracts for such pmjcm with a conuactor(( licensed pursuant on de Contractors License law. ❑ I am exempt under Sec. ,B Alk P C for this reams ownm Data WORKER'S COMPENSATION DECLARATION I hereby opine under penalty of perjury arc of the fallowing declarations: I ham and will maintain • Cmnirima of Consent to self-Inmm for WorwsCampen- aation. u provided for by Section 3700 of the Labor Code, fid the performance of Ne work for which this permit Is Issued. 01ham and will maintain Worker's Compensation Insurance, as required by Section 1( of the Labor Code, far the performance o! the work for which this permit is Issued. My Workeer., Insomm carrier and Policy number are: �Caompensation Center.. T�3%rsL Policy No.: C-26 CERTIFICATE OF EXEMPTION FROM WORKERS ' COMPENSATION INSURANCE - (171*1 section need Amt w completed trust, permit U (Wont huedrcddallara ($100) or less.) 1 certify Nat in the performance of MM worst for which this permit as issued. I that nm employ anypermn in my manner an as to become abject to Newort, Compeosadw Law. of California. Daa Applicant NOTICE TO APPLICANT: If. after m lMol this Cenificaa of Emmption, you should become subject m the Worker's Compcmadon provluuns of the labor Code. you a= forthwith comply with such provisions W this permit shall he decreed revalued. CONSTRUCTION LENDING AGENCY I hereby affirm last them Is • c ... umunn lending agency for the performance of tite work for which this permit I, issued (Ste. 3097, Civ. CJ lander, Name Leaders Address I certify that I haus rad this application and rose Nm Me above information is correct 1 agme m comply with all city and county ordinances and sue law. relating to building construction, and hereby authodm representatives of this city or enterumn the above-menduned property for inspection purposes. (We) agroe to rove, indemnify and keep hamtleas lac City of Cupertino against liabilities, judgments. costs and expense, which may in my way accme against said Cay In consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCEREGULS. Re -roofs Type of Roof �— 14-2l^oS CoSigData nmurcof HAZARDOUS MATERIALS DISCLOSURE Will lac appllcant or fuam building oceupmtamm orhanded hasardom material u defend by Ne Cupenina Municipal Code, Chapter 9.12, and the Health and Safety Code, Section )!No]3332(,)7 ❑Ya All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant, or future building occupant um equipment or devices which III hazardous air contaminants a de0end by the Bay Arca Air Quality Management all new materials for inspection. Dimim7 1 DYn �Fo I hats road the haoudoa materials requimmenu under Clupter fi95 of the Califor- nix lleal 8 SarmyOxic. Semima25505.25333 am125534.1 understand MiliHhc Wilding does not currently haw a errant that it is my responsibility to notify 0e amupmt of lac r0rd.racots which mail metpriorn, umceofa CeauTicate ar(Xcupanry. Signature of Applicant Date �� o AS All roof coverings to be Class „Bra or better