00070074CITY OF CUPP'RTINO
CONTRACTOR INFORMATION:
_
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
74
OWNER'S NI EVENS CREEK BLIVID
APPLICAI'1N SUB DATIi
E, E;
SANILARY O, O. NO.
A (C.HITECrlIfNGINBER
BUILDING TERMS INTO
-
BLDGI?1.14:1' PLUMB MITCII
LICICNSITDCON'IRACIOR'SI)FC1,ARATION
Job Description
1 hemM1Y a1Rnn Olt I am liccmcd under provininns nI Chapter 9 wouunencing
lith lotion 7roh) ofD vioion J of the Business and Pmfico%in�ns Col andel my license
in full iisrcc and Lit. N_5MISI
DeeDaUna cl"�� T-�
ILLUMNATED CHANNEL LETTER SIGN
DECLAHAcION
As
shall use
I undnn.;md my )bets Jwll Ire used as public nvnrJ'
Licensed Poutssional
OWNER-BUILDITR DECLARATION
I hereby v0irm that I ant exempt fn,m the Contmaoh Licetne Law for the
following loosen. (Section 7031.5, business and Prous.'ionx Code: Any city a county
which requires a penult to contortion. altar, improve, demolish. or repair any structure
prierm it':swamies 91so'Pars, We applicant be,uch pent... to his d eignedswwnant
Sq. Ft. Floor Area
Valuation
that he is Greased persoanuo,he provnions of the Contractual' License Law (Classic, 9
Ounmcndng with Suction 91100) of Divlsinn 3 of the Shoals,, and Prafebin I, Cate)
or that he is exempt therefrom and the !osis for the alleged exemption. Any violation
of Secaun 71131.5 by any a,plicnm Gn a permit s.thjcns .he x,ph ... I to a civil penalty
APN Number
Occu aft pe
.floor ntamthan fit Ihundred dollars (5511U).
❑ 1. as owner of the property. or my employees with wages as mcir.a,le cnmietwntion.
36906009. quired Inspections
will do the walk, and the structure is not intended (it ofrered for sale (sec. nue''
Pon Case: rhe Conman License Law does apply .o
Business and eWma, ar, I., an
of prapcny Who builds or imp rl thereon, and who dues such work himself
through his awn employees. provided than such impmvtanwas are ren :mended or
orr
rumored for sole. IL however, the building no impuremoo, is sold within one Year of
304 — ROUGH ELECTRICAL
m,plotion, ,Iso owner-hander will have thc haulm O. proving thw he did no, mold or
imporosm"."'mfs.le.).
501. — FINAL ELECTRICAL ENERGY
❑LasownernnheproperlymnexGlutivalycontracting nithliceoedeantrzmors,a
505 — FINAL ELECTRICAL
n.atusa .he is ..woo Sec. 9M1. Bos and Pm&se s C def The Contrcmh
can
who builds I.npmv thcreun.
unit ,h Law dict not apply total rwnwith
a cony
se a
and who contracts for such projats with a nm,remr(s) licensed pursuant n, the
Contractors Liccmu passu.
O 1 vat Germ)! under Scc. . B & P C fur this reason
01 mesu
Owner Dao
WOR K SIR'S QOM PENS ATION DHCLARA'I'[ON
I hurcby mlir.n realer penalty of perjury one of ,he following dcdvrtioro:
have and will maintain a Certificate of Consent m se for WoiA
Lallm ths,
as presided lir by Sccomit 39)0 of ,hc Lubar Code, fn: the
Col reid
Comrmanc
`
\/
o
performance of the wnrA lar which ,his permit in :'.reed.
D/
❑ 1 have and will mainmin Worker's Compensation Insurance. us normal by Section
non of,he Labor Code for do pertmon.nce of due work for which .hi' peri, is
:.wed My Worker Compenweon nw,mnce carrier and policy n ,ber am:
Cardec � Policy/1%1l
Cr:R"I IPICA t )N OI li%ITb11TON PROM1 WOR F,HS
COMPENSATION INSURANCE
(I has welion need no, be cnmple,ed If it, permit Ix for one Inualmd dollar,
IS H00 or less,I
I certify that in the perfunnznce, of ,he work bar which ,his pone:, i' issued. 1
-
,hall , ma"4" . stype y 1� l/ Get t ,1, Worker'
Compo .!
i In . I f D WF
Appl ,
,
NOTICE loan
.IC NI f 1 C ff . ol'I P.' yshould
len, tb a tbu W A
1'rrthwuh comply with sncb p Irv'sass nr this pcn d,'boll he theories] waked.
CONSTRuC'I'ION LITNDING, AGENCY
I family affirm that them is a constral lending agency for the pwom,ance
oI he work lin which 0,i' pain:, Is:-weal (Scc. 31 Cic C]
Lender's Name
Irolcr's AAdreas
I Gamily the, I have read this application and state that the aMrve information is
,ma. I.gree a, comply with all city and county ordinances and sate laws Wiling
m building construction, and hereby authorize representatives of this city u, enter upon
the above-mmrtioned property for inspenlnn purposes.
(We) agree to save. indemnify and keep homeless he City of Capon.. against
Ilabili,ies, judgments,eiss and exienw, which piny in any wvy'necruc against sail
City in consequence of the granting of this permit.
APPLICANT UNDrANOS UWILL COMPLY WITH �A7LL; NPQI�
SOURC.Y/[[p�iy('jpi—.Uri T )NS. I`i/
Issued by: D te�
y'
Re-roofs
Signals a nppi.eanu ,town r 1 ate
HA RDOUS MATERIALS DISCLOSURE
Will the npplicmn or(marc budding occupot elm nr hnche bazanlous ammdnl
'type of Roof
as defined by the Cupertino Municipal Curie, Chapter 9.12, and the Health and Safety
Curie. Section 255321.)?
"
❑Yes '.vat
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant or future building occupant use equlpntent or diwhfah
If a roof is installed without first obtaining an inspection, I agree to remove
mi, hu amhms as connnnin:one as droned by the Bay Area Air Quulny Mnnagcmrn.
:Trell
all new nmterials for inspection. Applicant understands and will comply with
❑yea iva
all non-point source regulations.
1 have read the hlia doth materials mquirtmems under Chapter 6.95 of the
California Health & Solely Code, Sections 2550.5, 25537 and 25534. 1 und,o,I; I,hat
if the building does not currently have a tenant, that it is my rcspansihility m notify the
u¢cupum or he mqulrn cots whid, mm, be .,a, poor to :.sconce „ a Cool "I'll of
onoTare
Signature of Applicant Date
All roof coverings to be Class `B" of better
Owner ar.,r lornc age
—" Note
OFFICE