05070177CITY OF CUPERTINO7777
BUILDING DIVISION PEST
CONTRACTOR 1NF0RMATI(7!N
Bu1LDIN()ADDR AVV.
no
HILLHOUSE CONSTRUCTION
PERMRND.05070177
0 NEWS NAME:
PERMIT ISSUE DATE
CUPERTINO CITY CENTER ASSOC
1670A ZANKFR Rn
0 - 7 2 -7 -/2005
NE:
SANITARY NO, CONTROL NO.
408 467-1000
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSEDCONTRACTOR'SDECLARATION
lob Description
voes of Chapter 9 (commencing
1 hmsby storm that 1 am licensed under pmkl
P
with Secuan 70110) of Division 3 of the Business and Timfossimat Code, and my It.. Is
in fullfmaandeffect.,
REVISION -PLUMBING FOR'SINK/BREAKRM
Lkense lass Lie. g'
Contraction_
3 OFFCS/FRAMING/SHEETROCK/ELECTRICAL
ARCHITECT'S DECLARATION
I undersand my plana thi useduseen
IN HOUSE ONLY -NO NEW PERMIT ORIG 05010066 '
Licensed Professional
OWNER- UIL.DER DECLARATION
I hemby affirm that I em exempt from the Committers License Law for the
following mason. (Session 7(13 1.5, Business and Professions Code: Any city or county
which requires a Permit to consumer. alter, imPron. demolish, or mpair any swcture
prior at its issuance, also musu es; IM applicant for such permit to file a signed moment
dam he is licensed pursuant to the provisions of she Conuacmr's Limme Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) or Division 7 or the Business and Professions Code) or
$ 0
at he la expt theom and the basis for the alleged exemption. Any violeuon of
Nemmlr
APN Number
Occupancy T
P y yPe
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penauy of
not mom than fin hundred dolls s ($50T,
❑ I, as owner of the property. or my employees with wages as Nem sole compensation,
3690t028.00Required Inspections
ener
will do the work. and the structure a not intended or offered for side (Sm. 7814, Business
imis code: The Contractors License Law dnet apply M an owter
and Pmreasoes
q P
propeny who bui Ids or im prow themon, a nd who doessuch work himself or thmugh his
Own employees, provided that such improvements ate not interstices orortemd fmaale. If,
however, the building or Improvement is sold within one your of completion. the owner-
builder will hen she tuNm of proving Wt he did not Mid or known for purpme of
\
sea.).
❑ i, as owner of the property. am exclusively contracting with licensed contractor, to
consumer the project (See. 7014, Business and Professions Code:) The Contractors U.
cense Law does not apply he an owner of property who Wilde or Impmw Netcom and
\
who contracts for such pmJCca with a contrNmf(e) licensed pursuant in Ne Contractors
License Law. ..
..
❑ I am wimp, under Sec.--,B&PC for this reason
net Dow
WORKER'S COMPENSATIONDECLARATION
1 hereby affirm under penalty of perjury one of the following declantiou:
1 ham and will council. a Certi icate ofC.mcm. to alf-insure for Worker's Compen-
sation, as provided for by Semon 7700 of she [Aber Code, for the performance of the
.- -
work for which this peimit is issued. - -
❑ 1 hon and will maintain Workers Compensation Insurance, as required by Section370001
Ne LeWr Code, rmr the penf encomee ofth, work forwhich this permit is fund.
My Workers Compensation lnmrance carder and Policy number an:
v�s
Cartier. ".�]Pit1f. )aIOFMl1217soHey N.,1LIri D,l zcga
CERTIFICATE OF E% EM ON FROM WORKERS'
COMPENSATION INSURANCE
(Thi commit need nolbecompleed lithe Permit a foronc hen&ed dollsn ($100)
or len)
1 certify that in the p efmmance of she work for which this permit is issued. I shall not
employ any person In any manner an as to become subject to the Worters' Compemaafion
.
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject to the Wmko'm Compensation provisions of the Libor Cade, you most
forthwith comply wish such Provisioas or this Permit shell be decmW consists.
CONSTRUCTION LENDING AGENCY
I hereby efltrm Nm there a a construction lending agency for the rerfermmu<uf
the work for which this permit is issued (Sec. 7197, Co, C.)
lenders Name
'
Lender's Adams
I cenify that I ham read this application and sum that the above infornadun is
Contest. l agme W comply with all city and county ordinances and mm Iew missing a
Wilding construction. and hereby m holm representatives of this city to enter upon she
above-mentioned property for Inspection purposes.
(We) agme to an, indemnify and keep harmless the City of Cupertino against
'
liabilities, Judgments. costs and expense which may In my my seeme against aid City
in consequence or the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGy�LAMONS.
Re -roofs
Roof
lJ/tM6,* '7—z7
Signature of pplicenVConusel f Dem
HAZARDOUS MATERIALS DISCLOSURE
Type Of
Will the applicmt ter future Wilding.,Ount Am or handle huardou material
as &flncd by she Cognition Municipal Cade, Chapter 9.13, and fix Hou1N and Safety
mc. Section 35373(&)?
All roofs shall be inspected prior to any roofing material being installed.
❑ YFu
If a roof is installed without first obtaining an inspection, I agree to remove
Will Nc applicant or forum Wilding occupant sea equipment m devices which
Pithanrdnu sit contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
trict7
❑Yes f11�
1 have mW the hasurdous materials mquimmenu under Chapter 6.95 of the Califoo-
nia Health & Safely Cade, Sections 25505, 35533 and 27574.1 undersand that if Ne Wilding
dog not curmntly ham a enal Nm it a m PoaslNllty W notify the occupant of the
mquimmenu kh,Qm�umjbem or ' ante of a cmtiricam of Occupatmy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
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