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BUILDING DIVISION PERMIT
CONTItAGOR INFORMA IQN6,
BURDINGADDRESS:
R-3 BUILDERSy
PERMITNI]a4050101
2 558 STEVENS rRT77.K BLVD
W IfNAME:
PERMIT SUB DAM
OAKVILLE MARKET
503 STONE
E:
SANITARY NO, CONTROL NO.
(707)748-2255
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
lb Description
o
ed under provisions; of Chapter 9 (commencing
1 thereby affirm Nu I am licensed
p
with&.1i ] of Divldon3oftho Basin� a fcssions Codc. and my mono is
in fell fane t
ecL_
L I -1 �(�?
NEW CMU SOUND WALL
Liecnw k�'
Dam Cunu
RCHnECI-SN A
in noSQl be use AsPubl a
LICC d C NI
OWNER -BUILDER DECLARATION
I hereby affirm that I Am exempt from the Contractor's License law for the
following mason. (Satrun 7031.5, Bur. and Profossions Code: My city m county
which requires a permit to cohsswc4 alter, improve, dimi or repair any structure
priorto its issuance. also requires du applicant forsuch permit b file a signed steument
that he is licensed purntm Wtheprevismuafft Conusum's Uccose law(Chapta9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70X) of Division 3 of the Businwand ProfesslmsCedc) ter
that he to exempt therefrom and dte bub for the alleged exemption. Any violation of
e
Occupancy Type
for A subjau to applicant l... ivil penally of
a" Appllhhundred
Nan
no,ome five dolsn (SSXrmtt
❑ 1. As owner of the propmy, or my employees with wagos As their sok compensation,
Required Inspections
will do the work erre Nosema a is not intended in offered for sole (Sec. 7014, Business
and Profession. Cade: The Contractors Llcuue Law does Am apply m an owner of
property who builds or impmws thereon. and who dote such wank hkue if or through his
even employees, provided that such impmwmen s tee not Intimated moQemd for ale. If.
however, the building or Improvement Is mid within an year of completion. We owner -
builder MR hew We burden of proving Wt he did =I build m Improve for purpose of
tele.).
/
❑ ss owner of the pro. .m cn with licensed conuanes u
6
ns Codi The Cmhecrors
construct the projm (Sec. toad, lessio t
s 7134 sucasivelynd
of and
I rad
ave law rima not apply to ts owner or uoutorty who belled or Improves Woman, and
wner property
who. kr such projects with •canuaclor(q licensed punwm to the Canuaclor'a
LaLv
Lkonse Taw.
❑Ion exempt under See ,Bd:PCfor this moon
DamWORKERS
COMPENSATION DECLARATION1
hereby a Erni under penalty of perjury oro of the following declarWou:hawand
will mathWna Cen,
a provided fm by Secuon 37W of Ne labor Code, Ire the peAommme of We
for which this permit is issuc6haw
1-r,k
ahN will mainWn Workers ComRnsWon Wurance, a reyuircd by Sa7ion
ofthe taborCade, forth performanttofthe workfarwhich Nispermitis issued.
kersCam nsadan Insurance carrier and Policy numberam: — ry Policy No.. C
CERTIFICA Up EXEMPTION FRO RS'
COMPENSATION INSURAN -
-1c;=iio need not ocamplC40d light, permit is for.. hundrodd.Rm ($IX)
or cast)
1 comfy that In the performance of the work for which this permit is issued, I Nell not
employ any person in Any maner an u At become subject o the Wmkcn' Compevetion
laws of CaliforoiA Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccnificam of Exemption, you should
become subject to the Workers Compensation provisions of the labor Code, you mute
0
roMwllh comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 WhAY A(Ibm hot them Is a connmcunn lending agency far the performance of
the work for which ods permit is issued (Sec. 3097. Civ. C.)
lenders Name
Lender'. Add..
I certify hat I hew mad this applicaim All sum thin the .bow information b
comm. I egme to comply with all city and county ordinances and $1440 laws ubting to
building consultion, and hereby moraine representatives of this city to enter upon the
shove -mentioned property for inspccuon puryoa .
(We) agree to naw, indemnify and kap hamless the City of Cupertino against
Ilabilita. judgments, cuts and expe 'ch may In any way aceruc against sold City
I
ocon uaccoflMgrantingofth' Poll
rT ND TyNS ND WI L MPLY WITH ALL NON -POINT
Issued by: Date
SO E LA f
Re -roofs
Type of Roof
`
Si of Applicam/Canumeor Dau
HAZARDOUS MATE A DISC SURE
Will d40 Applicant ter fuwm building cu Am hero m handle harndous material
As defined by the Cupertino Municipal Code, Apar 9.12, and dro Health and Safety
me, SCAten zss3zl.)]
All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the mpllCmh or future budding occupant use equipment or devices which
it hwArdmis air ammunitions; a de0ned by the Bay Area Air Quality Management
all new materials for inspection.
Doulal
❑Yes Nu
11 how dolou.rdousm 41srequi ms r wr695oftheCalifor-
,nt YC 'ore 25505.255 x12553 Ju and Wulftu Wilding
J trot cu ha a Lth mspoosihil y ul'y the meupant of Nc
m ire AA Tram tPrior Anwar C We pa;o+
Signature of Applicant Date
All roof coverings to be Class "B" or better
ow
arm �ct rm+,gent Date
u