05110008CITY OF CUPERTINO
t 'r '" ,r �.t'=`�"'' baa '"' `
CONTRACTROR INFO,,RMACION �KK
BUILDING DIVISION PERMIT
BUIL DING ADDRESS:
PACIFIC GENERAL CONSTRUCT
W "D' 05110008
1 638 STEVENS CRK it 990
O ER'S NAME:
PERMIT ISSUE DA'Z'E
KCR DEVELOPMENT
43050 CHRISTY ST
11/01/200r,
E:
SANITARY NO. CONTROL NO.
(510).824-0490
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
mcing
al 1 won under provisioof Chapmr 9 (comen
1 kmby affirm Nm Ivun
with Section ]ODu)of DiNsl n3o(dm BusinessaM Profusion Code,aM mylkenmu
in fmlromcmil if L �j -7�
TI --ELECT. /PLUMB/MECH/PARTIONS
Licenm Class Lk. p
LicICmah
Dam Sur
ARCHITECTS DECLARATION
1 uMcriumd my plans shall Ec wed as public RroNs
Lkenmprofessional
OWNER -BUILDER DECLARATION
li
I kmby alum 1 am ucmpt from the Contractors Law for tk
Any
tG/,'A•�`,'`a
: c county
following mnnn. (Sttuon ]IDsom Business; and Pma(cainu moor: Any oily
on
a
which mquims a pcmit m,ui svuel alcor. impmK, demolish, or mpoir any amamnu
$135943
!priIon I,lissuaac.alsamc 1. the ftapplicantof for Such conufammitlofikasigsw(Chap=m
oR Contravasand malaw T.
cdpurmt..
Sq. }�,,;tt; Area
rFI
Valuation
(flun axormoar, 70D) of Dwioosaf
Coda r
Divisionr or Busimssana Professions Code? of
ommip, Sichum
/-
7nnr
duAL M fisc
On, A
Nal k u exempt ihcmfmm and the buil for use alleged exemption. Any violation Of
and the
r•(n
Occupancy Type
Section, by any applicant for a pemis Subjects um applicant m a mil pmulry of
than
for maRNanRKnnnamaamlan(ssm):
Oil Pik
0l,uownuoftimpmperty,urmyemployemwiowaguu Neirmkeam don,
l�.. i {l a
"
U fy R``CLI�UIred Inspections
will do the wark.and theswnum is not internal or offered Tommie(S..]uCa, B,mums
License Law
and Pmfesuon Cade Tk Conlrclors class not apply m an owner of
pmpcny wW Wildsor impmws Ammon. and whoaaessuchworkhimselforthrough hk
awo employ's, provided Nal Such improwsmenu art notinmrWed oroRemd for sale If.
bowevem, Ne Wilding or improvement is said within one yev of completion, Ne owmr-
Wilder will han the Wrdrn of proving Nark did am baiW Or improve for purpose of
uln.).
0 I, as owncm of tk property. an uclusivcly contracting with licined conforms k
convect the Mica (Sec. ]Duca, Business; and professions Cade:) The Com alors Li.
cease law dots not apply m eco. of pmputy'wbo builds or improves Neuron. am .
who contracts for such projects with a contractor(s) Iicenmd punum to Ne Convectors
Licentse law.
❑ I am uMpl undm See ,B k PC for this Ruon
Date
If WORKER'S COMPENSATION DECLARATION
1 hcmby aB'um under Xnalty of perjury one of the following declamtiou:
I haw and will mainuin acumiRom of Common un xif-insurc for wurkeYs eompen.
Rinu pmvided for by Secuon 77M of the labor Codc, fm Ne performan¢ of Ne
work for which this pmnit is Wood.
0 1 haK and will mAmm. Workers Campewdon Inurao¢, u required by Section
7yBDof Ne Labor Code, for Ne pcdo... of dR wads for which thu permit is luted.
'
My Wm1oc Compeuauonl and Poll, numkm am: /
's ) sTa�myeLccaaniv
D5
Grticr. —/1li %VIVL Poli, 140 313D5
FRO
CERTIFlC TE OF EXEMPTION FROM ORK S'
COMPENSATION INSURANCE
(ITIS sevum maul mmkcomplaod if the permit is Imam mommd dollars (SIM)
or less.)
1 certify thm in dm perfume ac of tk wart for which Nis permit If issued, l shall not
employ any person in any mannerm as m become subject to the Warken' Canpuuadm
Laws of Cxlifomia. Dam
Applicant
-
NOTICE TO APPLICANT: If. Amr making Nu Comfium of Exemption• you should
become aubjecs m Ne Woftes Compcuasion provisions of the Labor Code, you mma
forthwith comply with such provision m Nu permit shall W decmal mwkcd.
I
j CONSTRUCTION LENDING AGENCY
T hcmby afnm than the. is. constrvon kining S,S, for the pedurmaan of
the work for which vin permit If issued (See. 7097, Civ. C.)
landcrs Name
Lenders Add.
1 unify Net I haw mead Nie applicuion and sum Nat the aWw mfomadun is
coot I g. to comply with all city and caunty, ordirusu and suk laws m Wing to
building construction, and hcmby mmurine mpruenuuws of Nis city in cnmr upon tlm
above-mcnduned property for inpmoon purposes.
(We) agme m LK. indamnify and keep harmless the City of G'uperhna agArm
liebilidu,judgmcnu,custs and expenses which may in my way aecrue against said City
c the irmunt of it
NDS N ILL COMPLY WI7H ALL N N- INT
Issued by: DateUil
Re-roofsonuContnckr
mstan,,Type
of Roof
rAP1
e applicant m (uuR Wilding oavpant ROR a hndle harallow mamal
Ne Cupertino Municipal Cade. Chapmr 9.11, and the HeaIN and Safety
us7z(a)?
Na
All roofs shall be ins ected nor to an roofin material bein
P P Y g g installed.
e applicant or futum building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
us air conuminanu as d by Nc Bay Asea Air Quality Management
all new materials for inspection.
District?
Dy.
I have maJ Ne MaaAtas mamllab mquimmenu under Chapkr 6.95 afuse Califar-
nuHcalN L55U5.2ySl7 anJ 1573a.lundmaaM NmifNc Wilding
ak,52pnorwismaruccofaCcaulfcalcor
Wety
Joss s ntl q'c aNas itumymsPanihilitybntilYdo a up tof Ne/oRp
,
Signature of Applicant Date
nz 14Ng
All roof coverings to be Class "B" or better
O or aushorim agent ala' '