05060154CITY OF CUPERTINO
BUILDING DIVISION PERMIT
TQ"�NFOrRMAT O
,CrQNTIU
BUILDING ADDRESS:
METRO MECHANICAL, INC
PERMIT NO. 05060154
OWNER'S NAME:
PERMIT ISSUE DATE
-JO ANNE'S FABRICS
5807 WINFIET.n RT,vn
n7/2S/2009
E;
SANITARY NO. CONTROL NO.
(408)227-7276
ARCHITEcrMNGINEER:
BUILDING PERMIT INFO
BO EO PLO MEOCH
LICENSED CONTRACTOR'S DECLARATION
Job Description
o
n 1 licensed ardor provisions of Chapter 9 (Commencing
1 hereby aBirthat m
with Section 7M) of Divislon laf the Busimu and Profasium Code. and my license is
imm�mxe,ndert r �j
J 71��.� / r��"j7"'is'
Tpp}}77(( i7p7 T pp{{ 777777 ORCEMENT @ A/C UNITS
Liana cl
Dau Canuanor�:J7
RCHTIECTS DECLARATION
un d m Inns shall be stand as public records
2005
Iced Pmfasional
OWNER-BUILDER DECON
I h.nce n I a.C.Copl Pram the CoraronLicense Law for the
name. (Section 7031.5, Business and o, Code: Any city Or county
which requlroa apermitt 1re Construct,alter. improve. demolish, or mash estructure$20000
0 0 ]
prior w its issuance, also requires the applicant for such permit w Glc a signed statement
Valuation
that he Is licensed pursuant w the provisions of the Contractor's License IoW (Chapter 9
DUMP
(Commencing with Section 7") of Division 7 of the Businm and Proma,ions Code) or
that he is exempt therefrom and the basis for the alleged exemption. My violation of
3 A019 Mer 0 0
Occupancy Type
Section 7031.5 by my applicant for a permit subjects the applianl w a Civil Penalty of
ON mon Nan Ow hundred dollars (5500).
0 1, u owrter of the pmpmy, m my mploym wlth napes u tietr wle mmpcmdw.
Required Inspections
will do Newark. and the new. is act amended portend fosae(Sec. 701x, Business
and Pr lfe rima, Code: The Conunsmfs Liam Law does ml apply w an owner of
9 P
property Who Wlidso, dmprovesthenan,andwhodoesaoh wok himselfothwagh his
Own employ=, provided that such imp owme usan mtlnende d OroRered fursala If.
however, the building Or improvement i, veld within arc year orcampletim. the ewner-
builder will have the burden of proving that M did an, Wild o Improve for purpose of
ask.).
0 I, u owner of the properly am exclusively contracting with licensed contractors In
construct the project (See. 7044. Business and Professions Code:) The Conoacmfs Li-
cense Law dao not pply to an owner of proWny.who Wilds or Improves thereon, and
who Conncts for such projects with acommear(s) licensed pursuant to the ConnCWe$
License Law.
0 1 am exempt under Sec. . B & P C far this reAwn
Owner Dau
WORKERS COMPENSATION DECLARATION
1 herby afRm ander peulry o(perjury aro of tie following dmlaratiotac
I ham and will maintain a CeniftauafComnt to self-Insure for Workel,Compen-
nn ,, u provided far by Section 77W of the labor Code, far the perfand— Of Ne
work for which this pomp is insect
0 1 haw and will maintain Worker's Compensation Insurance. as inquired by Sectio'
77W of the Labor Cade, for the perfarmmm of de woh for which this Permit is issued.
My Workefa nm ensadm lesson o cetrier and Policy number am:
C,rder. x Policy No.:C^�o
CERTIFICATE F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu seclim nexa no kcamplced If the Karol Isforane hundred dollan41M)
or less)
1 ¢reify that In the performance or the work for which this permit is issued. I Nall not
employ any person in my manmrm as m become subject in OC Wcoxha Conpemtim
Laws of C,lifomie. Dow
Applicant
NOTICE TO APPLICANT: If, afar making this Ccnifnau of Exemption, you shmld
became subject to the Worker's Compensation provisions of the labor Code, you man
forthwith comply with such provision or Nis Permit shall the domed revoked.
CONSTRUCTION LENDING AGENCY
I hereby arms Net there is a consncdn t lending agency for the performance of
the work for which this permit is issued (Sea 5097, Civ. C.)
Lender's Name
Lendefs Address
I certify that 1 haw read Nu application and was that the above information is
correct. I,gne to comply with all city and county ordinances and vex laws alalias m
Wilding convection. and hereby authorin mpmsenu lm of this tiny in endo upon the
akvomendoned property for impecdan purporen
(We) agree In taw, indemnify and hep harmless the CITY of Cupertino against
liabilities, judgments, coats and espenses Which may In any way a. against said City
in COnsmCC Of am aniffling Of thonk.
APPLIC NT UNDERSTANDS AnND WILL COMPLY WITH ALL NON-POINT
Issued by: Date -7- 2, ps-'
—
SOURCE CULA N
Re-roofs
Type of Roof
ZS"O
S1 atom al ApplicanUConuwmr Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant slam or handle huardous material
u dOOncd by Ne Cupertino Municipal Code, Chapter 9.13. and the Health and Safely
Code. dde.Seclwn25552(U7
All roofs shall be inspected prior to any roofing material being installed.
0 Ye, ;RNs
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant o, Wood Wilding acupant use equipment m devices which
o hmardow, el, cmtamirunu u defined by the Bay Ams Air Quality Man,gemcm
all new materials for inspection.
District?
0 Yes ANu
. I hew read the hsnAmsmauriau mqubcmenu underChapur&95 of the Califor-
nia Health &SafdyCok,Somow;nS05,25533 and 25534. l undcarand thuiflM Wilding
draw not Carmodykw , ora Nat In is my mspoesllnllty m ratify ft occupant of the
nqm nuwh et Prior toannonceof, cctdnam^faDpattey,
Signature of Applicant Date
All roof coverings to be Class "B" or better
mer arwtharixdaseo Data