04080208INO .
BUILDING DIVISION VEXM1'I'.'
BUILDINGADDRUS: HOWARD WRIGHT CONSTRUCTION) 66 "04080208
n (11 -] n CTDVDTT❑ (iM7717i J nT NM _.
OWNER'S NAME:
1 hereby affirm that 1 sur limned under provisions of Chapter 9 (commencing
with Smrice ndo ofDivlsion3ofNc eudness end Profcuinns Code, entl mylicenm is
Lerase lass cBact (J - ic.
License CIm3 /7 Lk.
5y a :� 1 understand my plans shall ba used as p dirt records -
;�O.... _ .. ...
Licensed Pmfcasional
q S OWNER -BUILDER DECLARATION
qyy 1 hereby aso affirm on 11. exempt from the Contractor's License Law for the
S00 which re reason. etch I,]1131,5,Buineri and Improve,
demolish.
Code! Any city or county
$ fii which its es a permit re uires n alma nt for
h penlish, or repair any twment
_ZQ cture
pnonoiscensedaalso equines on of the Contractor's
Lieom Lo signed statement
pp
flat he is licensed pursuant the provisions of Ne Commcros and ProLaw (C Code)
rr
(cat he is
(commencing Serefourn ad the
Division] of the al eged Business end Profession Cnde)tar
that io is exempt thertfrom and the bur for the subjects
the
tl exemption. Any violation of
Section by any applicant for 'Permit subject the epplicanuo 'civil penalty of
not mors Be.Nen five hundred dollars ($500). ,
❑ I, as owner of Ne property, or my employees with wages as their sale compenwdon,
will do the work, and the structure, is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Comracmfs License law tices not apply in an owner of
propenywho builds criterions thereon, and who doessuch work hime iforthrough his
own employees, provided Nm such improvements arc out intended or offered (resale. If,
however, the building or improvement is sold within one year of completion, the owner -
.builder will have the burden of proving that W did not build or improve for purpose of
mlcJ.
❑ 1, as owner of the property. am exclusively contracting with licensed contractors to
construct he project (Sec. 7044. Business and Profeasions Code:) The Comtracure Li.
+ ceme law does not apply to an owner of property who Wilds or improver Nemort and
who contracts for such projects with aeon uslor(s) licensed pursuant to the Convenor's
License Law.
0 l am exempt under Sea ,B&P C for this season
Owner Data
WORKER'S COMPENSATION DECLARATION
I hem"''frmn under penalty of perjury one of Ne following declarations:
1 nave and will maintain a Certificate of Cement to sell -intim for WorkefsCompen-
sation, as provided for by Secure 3700 of the labor Cade. for, the performance of the
work for which this permit is issued.
I have and will maintain Worker's Comrso mlion Insurance, as acquired by SCcfion
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compenatron Insurance curler and Polity numberpp:� 00�
c
Cartier. JTY/G/ Mc+//aN✓✓/ Policy No.: 3
CERTIFICATE OP EMPDON FROM WORKERS'
COMPENSATION INSURANCE
(This secure need not Wcompleed liter pelmet ialnronc hundred dollars (SI W)
tar less)
1 certify that in the performance of the work for which this permit is issued, l shell not
employ any person in any mannersm ax to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If. after making Nis Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of the labor Code, you must
z foMwith comply with such previsions or this permit shall be deemed revoked.
„z„ O CONSTRUCTION LENDING AGENCY
[r I hereby olfon Nat thcrt iso cmsunctinn Iminingagney for Ne performance of
Q'.
use work for which this permit is issued (Sec. 3091, Civ. C.)
W� Q Loathe's Name
z Lcminos Address
U 0 1 comfy that I have read this application and sum that the above infotmauun is
correct. I agree to comply with all city and county ordinances and sate laws misting to
�U building concoction, and hereby auNome representatives of this city to enter upon the
Lt7 above-mentioned property for inspection purpose.
Lia (We) agree to save, indemnify and keep harmless the City of Cupertino against
to liabilities, judgments, costs and expenses which may In any way accrue against mid City
U in consequence of the granting of this permit
APPLICANT,UNQERSTANDS AND WILL COMPLY WITH ALL NON -POINT
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or run= building occupant store or handle munitions ma erial
as defined by tie Cupertino Municipal Code, Chapter 9.13, and the Health and Safely
PERMIT ISSUE DATE
'I/ r1 C /l1 G /
R ITARY 46u7 - --r
BUILDING
romn ELP.
'•lob Description.
HVAC (LOBBY)
I
Issued by:
Re -roofs
Type of Roof
Required Inspections —
Date
cmlc. Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ra44r _
Will the applicant or future building ocmpant use equipment or dcvic. which If a roof is installed without first obtaining an inspection, I agree to remove
.d havardous air co muninams as defined by the Bay Arca Air Quality Managemcm all new materials for inspection.
'terrier? —��/
❑YCS IN#0
I have mad the haradoes materials requiem ns under Chapter 6.95 of the C41m,
mefkolth&S coy otic. Section 25505.25533 and 25534.1 understood thadde, building
docs not c •ndy Is Nat it is n spg it, m notify be mcupam of On
rcyuiem ta 3 Lich tit d m d��i INOcam of Oc panry�
Signature of Applicant Date
All roof coverings to be Class "B" or better