08040195CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUIL 1
DLW9"TEVENS CREEK BLVD
PERMIT NO.
ABLE MAINTENANCE 08040195
R'S NAME:
PERMUT ISSUE DATE
SIIEC,I, OIL PRODUCTS US
3224 REGIONAL PKWY 07/14/2008
NE:
SANITARY NO. CONTROL NO.
ARCHITEC"VENGiNEER:
BUILDING PERMIT INTO
INSTALL VAPOR RECOVERY BLDG ELECT PLUMB MECH
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LICENSED CONMACIDRS DECLARATION
Job Description '
I nacby alarm that I son li.nmd under provisions of Chapter 9 morn mencing
with Scedon 7OIIW) ofDiOa on 3 of the Bndneusnd Profetttons Code.and my liccne u
in mu Lane, erc GD pqz 312By U
Dew E MAtN7"E"Nr1NCE
rS DECr
DECLARATION
As
man man
[understand my plans Snell he used u public rtcnrd,
Lkerhtts Professional
OatNSR-BUILDER DECLARATION
I ncrtbY (Bm that 1 from don GOntr.ls taw far th
Any rity.,aunty
I.S.uoad Po. Coast: A"
. (Satan ]831.Buaircssand
followinguion
or repair any mono.,
dcomi k,o
souse altar, impmat do
a permit on r
a
which rots
pti cOmil t
on. Njo do, drovish i[ml(a AKn scuri1 mimorml. ata W1[m[nl
pnolwiw itnad
Sq. Ft. Floor Area
Valuation
purso
thatOncoticgwithswion 7000)9Division 3fthe Business ProclawlC odc)or
ing Division 3 of she Buaihmss and Professions
Section ]Ond
(cat
the ladw of
that nd u exempt tbmefrom and the beau for the ilkgd eaempaou Any violuion of
an I, ipt
APN Number
Occupancy e
P Y ZYP
Section 7031.5 by my Applicant for • pemtit subj.0 the applicant to A Civil Penalty of
not.,ort than me hundmd d.form ISM
❑ 1. u owrcr of the propmry, a my wplayea with wagn u Ne'v mk.mpcnuta,
Required Inspections
will do the work. and she slrvctum u notinwMed me ffaed for We (Sc:. 7061, Businctt
and Professions Coen The Contractors Lim•« law dans Out apply 0 an oval or
property who ban lids or improves thalon. and who doa such wort alma el f a through his
own employees. provided that such improw:mants son not mounted oroRemd foruk. If.
W,wwr. Ne building or improvement is mid within one ycu of completion• the owner.
builder win burn the burs. of pvvin6 that he did nm eilld or improv far Purpose of
uk.).
1. as mma of the property am exclusively contracting with IiaMed Ca110aetOrs w
construct the i my.t (See. 7W. BLLVnefa and Pfoicasions Code:) ran Contractors U.
tome law dos not apply to an own., of propa'rty, who builds or improves therton. and.
who contracts for Inch projects wish a conuaaor(s) honied primal to the contractors
Lions Law.
ammaopturWm See .B&PCfmdua me
Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pemlty of perjury, one of the following declarstans:
1 haw and will maintain a Cottonton, of Comoros to sl(--iuum for Workers Compcn-
out, ns provided for by Section 3700 of the labor Code• for she Per(orm.. of she
work (or which than permit u issued
0 1 hive and will maintain Workers Compensation Imurmae, u mquirtd by Satan
3700 ofd., Labor Cosa. for the perfarmanca often work for which Nu permit u issued
'
My Workers Compensation Insurance cannot .4 Policy numhcr am:
Cartie FeesLuoan RQz Policy No.: cA.�A3�S0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thumion onto nation eanplewd nihe pewit is forone hund d do1Wa (SIM)
or leu)
I cannily not in the para merce of the work ror which this prom, u uahed. I shill ma
cmpkcy, any person in any manoran u to Wwmc subject to tM Wm4cn' Compensation
Laws of California. Dam
Applicant
NOnCE TO APPLICAN . IL after making this Ccnirtcaw of Exemption, you should
b.ome subject to the Workers Compensation provisions of the Labor Code, you most
forthwith comply with such previsions or Nu permit shall h[ domed rtmtcd.
LENDING AGENCY
1 la mby,n on d. f. u a couvuaian lending agency for the performaax of
0c work for which than permit i, issued (Sec. 309], Civ. C.)
L e Ones Name
L<ndera Aadma,
I .rtd(y that I IUK and this application and soon than the above information u
conal I agree to comply with all city and county ordinances and sun laws mlaung to
building conswctia, and hewby authorim mposommves of this city to cher upon me
shove-m.ummd property los pectis
(We) agree to save• indemnify and Wasp noddles the City of Cupertino against
.
whichpurposm.
osuang e, peamwhich may in my way CO.aagilnst said City
incoiscquo of
A consequence of the granting of than permit
APPLIQANT UNQQQERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU�y�yJy,RFGUt�71QNS.
Re -roofs
Type of Roof
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Sitnumin, of ApplicanuConuacmr Data
HAZARDOUS MATERIALS DISCLOSURE
Will tc spplicam or future Wilding occupant start orhandle havallom matorial
0ned by f Cupenino Municipal Calc. Chapmr 9.13. and the Health and Safety
. Section 25532(,)?
❑res a
All roofs shall be inspected prior to any roofing material being installed.
will the fumrt
If a roof is installed without first obtainingan inspection, I agree to remove
Pe
TPlkant a buildi aeupant heti ordMana
it navaAnns air [aummants m d by Ne Bay Ama Air Quality Managcmem
a Air Qu Management
all new materials for inspection.
atrnt?
0y. o
1 have rtd the lumadaumatcrials.,quimm[nn uakr Chapnrb.95 of the calif. -
ow NO. Safctycadc. drat 25585.25533and25534.1udersundthuifdcboiking
Mea ....5.y? lava ani that it u my ouponsinility to notify tic occupant of the
rtqubt n tprior toCruuneofaCcrurcawofOccupancy,
Signature of Applicant Date
All roof coverings to be Class'%r♦.' or better
ownmo mora ed.gem Acetr, P AMA Dam