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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PALISADE BUILDERS INC
PERMIT N®4090184
OWNER'S NAME:
PERMIT ISSUE DATE
CUPERTINO ROUSING PARTNERS
909 -,TRFFT
2�2 005
NE:
-ALMA
SANITARY NO. CONTROL NO.
(650)470-4700
ARCHITELTIENGINEER:
BUILDING PERMIT INFO
BO EO PLUMB MICH
O
LICENSED CONTRACTOR'S DECLARATION
oerP
lb Description
I Mreby affirm Nat 1 am licensed under provisions of Chapter 9 (commencing
-
with Section 7000) of Division 3 of the Business and Profession Cade. and my licence is
L,1I�ra'aiee°Act.
$3f�6�[
NEW CONDO - 1589 SQ.. FT.
Lit.,
Dam Contractor s AO•r
ARCHITECTS DECLARATION
1 understand my plmo,�V>udad u public records
Licensed Professional
OWNS Rift DECLARATION
I hcmhy aflrm that I am nempt from the Contractors License law for the
following mason. (Sectiun 7(D 1.5, Business and Profession Cade: My city or county
which requires • permit to construct alar. improve, demoted, or repair any stractum
priorto is issuance, also requireu 1M applicant forsuch permit n Oa a signed statement
thalha is licensed pmseantntie provision ofthe ConuactoM1 Ucene law(Chapur9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Businessand Profcuiom Code) tar
$183942
Nat ha a aumpi therefrom and the basis for the alleged exemption. My violation of
APN Number
Occupancy Type
SeNon 7031.5 by say applicant for • permit subjects tits applicant in a ciMl penalty of
Amt cone Nan five hundred dollars (113000.
❑ I. n awmu of die property. m my employees with segs u tieir sea eompenudmn.
Required Inspections
will & the sed. and Ne structure a mtinlWed mORerad for We (Sec. 7044, Business
Code: The Connrs License law don not apply to an owner of
and Profession use
properly who buildsorimprotes dereon, andwho doessuchwmk himsetfor through his
o mamployces. provided that such improvements are trot intended mattered for tale If,
however, the building or improvement is said within man year of completion. the awmr.
builder will have the burden of proving that he did nm build or Improve for purpose of
sale.).
❑ 1. as Owner of the prnpeny. am exclusively canuamdng with licensed connotations in
construct tie pmjca (Sec. 7044. Business and Profession Cade) The Conracnra LI -
cone law data am apply on an ouster of prapcny who boil& or improves Herron. and,
who contracts for such projects with a comracmr(s) licensed Pursuant to tie Contractors
License Law.
❑Iamuemptundm Sm .B&PCforthhreson
Owner Dame
WORKERS COMPENSATION DECLARATION
1 battery drum under prosily of perjury arc of tie following declantiorte
i have and will maintain Acenifinte of consent nselfdnurt fm workers Cmnpe
udon. as provided for by Section 3700 of the Labor Cede, for the performance of ft
work for which this permit is issued.
O 1 have and will maintain Wormes Compensation Iwnnce, As required by Section
3700 of the labor Cade. for tie performance of the work for which this Permit m issued.
My Worker. Compensation Insurance carrier and Policy number tie:
Cartier. aMA(%S%iii Tkf Polity No.:�2'" fA
CERTIFICATE OF EXEMPT10N FROM WORKERS
'
COMPENSATION INSURANCE
(Tbls section need rot be eampletid if tie permit Is forme handreddoBars ($I00)
or leu.)
1 certify that in the performance of the work Ire which this permit is issued. I shall am
employ any person in any manner An As In become mbjWI to the Woken Compensation
'
Laws of Califomia. Data
Applicant
NOTICE TO APPLICANT. If, arm, making Na CeniRcaa of Eecmption, you should
became subjmt in the Workers Compcnutian provision of the Labor Code, you muss
fafmwith comply with such polwhinn or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby aRmm that Nem is a ronuruNon lending agency for tie Performance of
the work for which this permit is issued (Sec. 3097. Co. C.)
Tenders Name
Under. Address
1 certify that 1 have mad Nis application and sum that the above informal. h
'
corom I agree to comply with all city and county ordinances and sou laws relating to
building construction, and hereby auNorirm representatives of this city n nim upas the
abovcmentioned pmpcny for Impec9on purposes
(Wc) agree in love, indemnify And keep harmless the City of Cupertino against
limilitin,judgmenu. costs and eapensm which may in any way acme against said City
In of the granting of s rmit.
APPLIICCANTeUNDERSTANDS AAND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
`2 /
Signuum of ApplicanVCrIn—RDan
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or (Mute building =opal tore or handle haurdous material
as deRned by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
'
Code, Section 25531(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yuen
,building
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Tutu\re occupant use equipment or kvicest which
It hazardous air contaminants As dcrined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes o
I have reed the huardnnmateriab requirements underChapter6,95 ofthe Califon
ria Health&Safety Cao, Secuon23505,25533 and 23534. I understand thatiftie Wilding
does Amt currently hoc a Inthat it is my rcaponibiill n nodi' tbAtiax ant of Na
requirements which must be met poor n issuance of. 0Occupancy.
Signature of Applicant Date
" O
All roof coverings to be Class "B" or better
Owner or antharized agent Date