03120092 CITY OF CUPERTINO " 41
BUILDING DIVISION PERMIT ONTRACTOR INFORMATION
BUILDING ADDRESS: HOWARD WRIGHT CONSTRUCTION pCdITND03120092
OWNER'S NAME: PERMIT ISSUE DATE
YMANTRC
NE: - SANITARY N0. CONTROL NO.
(206) 447-7672
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
E 0 (�
:Oa LICENSED CONTRACTOR'S DECLARATION
'u❑ 1 hereby affirm that I am licenead under provisions or Chapter 9(commencing Job Des ��
ZW with Section )of Division 3 ofthe Business and Profeseimsff.�,eod in, is Er)
^ infulifome errea'A �b 7,r TI'--DEMISING WALL ��l�1Itt
n;�; Li.n Gl ARCHITEC1 JUN 1 5 2004
e,O Detc Cu racbr _ _
qq /Ir tan my plana shat Museda pubHc=
W
it0 Lic studPm(essional BUILDING
g OatNER-BUILDER DECLARATION
9 M 0 I hereby.Sm ar 1 am exempt from the pr professions
C's :Any c Law for the
O O which
reason.Permit
1 ]1131.5,Business and Professions Code:Any city s county
k$ which its s Issuance.proton re cnasuun,pftar,plic improve,h Permit t m e pair any n,udum
per heor isuersedpearaMequiree preisionof forthe sucContractors
License ned Law(Chapter
Ftp (commencingsithSetantmthcofDivinion3of cBusinessanicenuLpw(Code)or Sq. Ft.Floor Area � Valuation
z l— (commencing he is xempth therefroon m
and th Division the al eged exempt Professions Code)or
y $ Net io is exempt rang applicant
li and dm aper for the alleged camphors.Any violation of rnr��i�1.r� ,p
Section]Oh n five
any applicant for a permit subjects me applicant to a civil penalty of 3(N 0T WIP!bgr0 0 Occupancy Type
not mare man Eve hundred dolma($500). P Y YP
❑1,u owner .tae 0.summum,I. emntendedwith f..dfu.1.(m.compen sins,
will Pr fework,endure he Co is notintendedorofferedforme(See.]B an,Business
and Profusions Code:The Common,License Lew ares not apply lf an owner of Required Inspections
ownenywhobuildsorimprovesthereon,padwho does such work or
redthrough his
howwn ever,thecs,ping or imet rnchimprovements within
not intendedof
for maraif,
builder ,will
the
of ementrsold the did not year or completion,the owner-
auilder will have the burden of proving Nal he aid not build or improve for purpose of
sale.). -
❑1,as owner of the properly,am exclusively convecting with licensed convectors to _
consumer the pmject(Sec.]Ona,Business and Professions Code:)The Canlncmrb Lb
cease Law does not apply to an owner of property who Wilds or improves lhemon.end
who contracts for such projecei with a emaractor(s)licensed pursuant to the Contractor's
License Lew.
❑I am exempt under Sec. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a C.niRcate of Conunuo ael Dinsu ,for Workers Compen-
sation,m provided for by Section 37W of the Labor Code,for me performance of the
work for which this permit is issued. _
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for the performance of me work for which this permit is issued.
My W rker's Cnmponsatio Insurance cam.at and Policy neither am:
Cartier. Poiic -aa"aV lip 7�'ai
CERTIFICATEOFEXE Fn ON MWORKERS/'
COMPENSATION ANCE (J/pr�Os]
(this action need n.thecomplmed if the pertnit is for.nc a an a11ars If XB
or less.)
1 cenify mat in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compcnsatlon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.after making this Ceniflcam of Exemption,you should
become subject 10 the Workers Compensation provisions of be Labor Cnde,you must
,J O fonhwilh comply with such provisions or this Permit shall he dimmed revoked.
z V7 CONSTRUCTION LENDING AGENCY
fw IWmhy aR,m that there is a conauuninn lending agency for the performance of
(Yi > the work for which this permit is issued(Sec.3097,Civ,C.)
1x3 Q Lender's Nam.
Q z Lender's Address
U Q 1 cenify met 1 have read this application and suite that the above infmmatiu t is
ly Hcorrect.l agree to comply Withall city and county ordinances and sure laws relating to
C) building construction,and hereby authorim N
representatives of is city to enter upon the
G above-mentioned properly for inspection purposes.
We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities.judgments.costs and expenses which may In any way accm9 against mid City
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTAittQ§AND WILL COMPLY WITH ALL N N.POINT Issued by: Dat
SOZE REG -
G �L Re-roofs
" asurc ofApplicaData
HAZARDOUS MATERIALS DISCLOSURE _ Type of Roof
Will the applicant or future building(=UPanumrc or handle hamBlous material
as defined by the Cupenino Municipal,Code,Chapter 9.12,and the Health and Safety -
Code, r Itina255R(a)? All roofs shall be ins ected prior to an roofing material being❑Yea ❑nom P P Y g g installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
han dour air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
Ouict?
❑Yes [�Nu
I have mad the torturous materials Ixquiroments under Chapter 6.95 of the Califon
nia Health&Safely Code,Sections 25505.25533 and 25534.1 undersand lhu if the building
deer not currently have a tenant,that it is my respmuihili y b nod I rhe uecup I or Be
require ntswhich Must mel aane.nftceniE.a nrOccuu n . Signature ofApplicaot Date
ver u,nmen,ed reg I D All roof coverings to be Class "B" or better