06060009 CITY OF CUPERTINO 'f -'�a ✓ 3 f"'" " '"¢ ' ' ' ""'
BUILDING DIVISION PERMIT ,0N'TRACT0R INFORMATION R.
BUILDING ADDRESS: FLUID INDUSTRIAL SYSTEMS PERMIT140.06060009
20325 STEVENS CREEK
GR'S NAME: PERMIT I5SUE DATE
W D V PROPERTIES 1545 BERGER DR. 06
PHONE: SANITARY NO. CONTROL N0.
(408) 947-7700
ARCHITECTIFNGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
t� 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION
mC 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description
�A, with Section 70011)of Division 3 of the Business and Pr ode,and. w.r.u;
to in full force and cffe
�„ SPLITSYSTEM
,qg Llcen.Cl Lie. MTECH�FLUID IND • TRIAL
F Dam Conuacmr t:r
ARCHITECTS DECLkcATION R �
I s� 1 undcrmanJ mmail plans all he used J public.cards
id0
G N Licensed ereby ioaal
3 OWNER-BUILDER DECLARATION
i 0 1 hMaso .(Sero on 1 am exempt from the GnnmmCc :Any c Law for rhe
.❑O following uiman.(Section 7W L3,Business and Profession Cole:Any city or county Ju
s m whim requires n pmmil re con.ucL alter.hWrove.demolW,fi repair any structure ,a
'_y prior m is issuance,pursuant
to res pre inions o for suchCon Permit l file m Law(.vammem
< that he is licensed purwant to 0th provisions of the ConvulurS License law(Chapter 9 Sq.Ft.Flo r Aiea..{'f} I VaIU Ib�D(1 0
e tt-a (commencing with Section 7000)of Division 3 of the Business and Professinns Cade)or (,.�,all .Irk �q
— that he u exempt memfrom.d me basis for the alleged esemptian.Any violation of U.IY 4/FJ Mw IN
Section 7031.5 by any applicant for a permit subjects an,applicant An a civil penalty of ppb][� loaf " ''a ' Occu ane T e
Amt mom mar five hundred dollars,ISwo 316261��0 . 00 P Y YP
0 1,u owner of the propmty,a my wployw with wages u the'v.ld compcnation,
will d0 me anuk.and me aWmuR 4 not intended or nDered for Silo(Sec.7044,Bushleia
and prolamines Coda:The Commences Licca.law dna act apply m an awn.or Required Inspections
Property who builds or im prove thmeon,and who does such work himself or du:ugh his
own amplaysca.provided Nat such improvements ae notimmnded oroQered for We.B,
however,the building or improvement is sold within one year of completion•the owner-
builder will have the When of proving that M did not build or improve for purpose of
.k.).
❑1,as owner of the property am exclusively contracting with licenmd contramara an
cosrmct the project(Sec.7(314.Bummems and Professions Cade:)The Coememes U. .
mere Law docs not apply to an owner of property who builds or Improves demur.and.
who contracts for such Projects wIN a convactar(s)licensed pmmunt m the Commences
Ise.law.
❑Iamuemptuadn See .B&PCforthumawn
Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty,of perjury one of the following declamtioac
1 have and will for by Se Certificate of the Labor
Codc.sura far Warkcr'a Ce of the
wtion,as which
this
for by saJae 3]00 a(the Labor code.for Jon peAonnan¢of me
wart far whim this pumil is iuAnri
1 have and will maintain Workers Compewuun I..As raptured by Section
3700 of theLa for the performance of tha wAak fon which ms permit Is issued
My Workers rams a 'm and Policynum
Grier. Policy No.: _
CERTIFICATE Pf10N FROM WOR ERS'
COMPENSATION INSURANCE
(This scrim need not be completed if the Permit isforme hundred doBam($100)
or less)
I certify that in the porfman.of me work for which this permit h issued.1 shall ns,
employ-AY Perron In any manner.aS m Ince me subject to dC Workers'Gmpmeestian
Laws of California Date
Appliaat
NOTICE TO APPLICANT:If,after making this Certirlease of Eaemption,you should
became subject a the Workeh Compensation provisions of me Labor Cede,you most
.J z forthwith comply with such pmvisioro or this permit shall be deemed muted.
z
pmCONSTRUCTION LENDING AGENCY
I Mrehy AM.dw daera :constructinn lending agency for the per(urmance u(
a i the.,it for which du.permit H issued(Sec.3097,Civ.C.)
6W. tondo's Name
0.zLanders Address
U C) I cesdfy mat 1 have read this applieadon and tram thm the:bass information h
Iy carccL I agree to comply with all city and county ordinances An
cute laws Mining As
C Wilding consuvcumn,and hembyaummm to,mantaivesafibS city to enter upon the
atAuvcs,udgmentioned property for a peNon purposes.
fr-A a (Wo)agree to ave,indemnify and keep harmless the City of Cupertino against
pj in
f the
uAd expenses which may in my way accmc against aid City
(„),'Z in conuqucnce of the granting of mu permit P
ICANT U ERSTANDS AND WILL OMPLY WITH ALL N N-POINT Issued by: �l
.-A SOU REGUL Date
Re-roofs
.ofAppl UConuacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will eCoantonfMuni Municipal
Cgeaup.tsmrear handle Health and meaty
fisted by the Cupertino Municipal Code.Chapter 9.12,and m<Health and Safety
. zss255324)?0y. Lt.No All roofs shall be inspected prior to any roofing material being installed.
�Yus p
Will the applicant or future Wilding=upon[use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haiardous air contaminants As defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes �u
I haveread the haardoes m=6ah mquimmeou undcrCMpmr6.95ofine Califor-
niaBuil &Safety Ca .SCCU=25505.25533am125534.lwldcrstand maif the Wilding
dory rot currently have a meant.that it h m nsihility m mtiry dm oaW.,or me
rcmcnta wh' mall w racwecamoraapanry. Signature of Applicant Date
Own r ra haaadagem Date All roof coverings to be Class"B"or better