02050058 Y OF C
CIBu LIVING nrvESONNDFERMII CONTRACTOR INFORMATJW:
BUILDING ADDRESS: PERMIT NO.
20610 STEVENS CREEK BLVD NORTHWEST SIGNS 02050058
cmbROPERTIES, L. P. 325 WASHINGTON ST 'p5f T��sy1'02
PHONE: SANITARY NO./ CONTROL NO.
qq. (831) 469-8208
Lu
00 ARCHITECTIENGINEER: BUILDING PERMIT INFO
<6 BLDG ELECT PLUMB MECH
D LICENSED CONTRACTOR'S DECLARATION P.--....,1 Job Description
z 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing S GN' >
4 k whis Section 7000)ofaivision 7 of the B.1mas e d Professions Code.and my license T
Sloin full f 'e en ff. �p ( �'y
Licc As Lia: p t
a �n s RCS—CT'S DEC TIO /`'1'' `
3 im1 understand my pl...hall be used as public records
Su�
7 6 o Licenced Pm(euional
�a OWNER-BUILDER DECLARATION
•uvi— I hereby affirm on I oro exempt from the Condom o a:Any c Lew for the `
Z following reran, er it t 7031.5,construct.alt e. endo roe,de o li Code:Any city or counry yti'16 O
G which rtquirca n Fennel re re.IMWer,improve,demolish,m repair any structure
>�
poor uiucensed pursuant
provision of for Contrauch rminoaleaslaw(Ch statementdial ..
(commecingwitpunuamtithep f Division
the ContractorsLicenseand Pr law(Chapttt9 .3 w��- I;�a: � � r Valuation
(commencing wird Station 7000)of Division 3 of Na Business ci and PmfAny vi Code)
or Natio is 31.5 b therefrom end the basis tits the alleged Applicant
to Any l Malin
of Sm..7031 S by airy applicant fora permit subjects the applicauo a civil penalty p y�p
of not more than five hundred hulloes(5500). 1 O]AP'Al 1']n'QI�AT I ON � � OCCu araC e
°I,u owner of the property.or my employees with wages As their sole compensation, 103 — UFER
will do the work.and the structure is not intended or offered for tele(See.7044, 104 — REBAR
Business,and Professions Cade:The Connectors License Law does not apply to an Required Inspections
owner of property Who builds or improves thereon,and who does such work himal( 10 5 - ANCHOR BOLTS
or thunh his own employ..provided that such improvements au gut intended ser
ca "P y 304 - ROUGH -ELECTRICAL :
offered or sale.If,however.the building rim roament n sold he did one ser or
completion,the owner-builder will have the burden o(pmvini that he did esti build or
improve mr paryoa rn.la). .505 - FINAL ELECTRICAL
0 I�As owner of the property,em exclusively d Profession,
si withone:)The
Comrson'.
514 - FINAL -PUBLIC 'WORKS'
roeswd the does
(Sec.]044,Business and Profmiom Code)The Co demsrs
Lt..Lew does rut rapplysuch
loan owner of property who Wilds m improve Nereus, '
ad.wW.comrens for such project wird a ronuamrts)licewed pursuant a dm .. _ . -. ..
Crnsrm pt under
Law.
°
- Ism exempt under Sec. "' - - BkPCfor this reason
owner Dome
WORKER'S COMPENSATION DECLARATION
1 hereby affirm underpenalty of perjury one of the following declarations:
_I 01 have and will maintain a Cenificou of Consent m self-insure far Worker's,
Compensation, a provided for by Section 3700 of the Labor Code, for the
. - perfonnann of the work foe which this Permit u issued.
°1 have sod will maintain Worker.Compensation Ins...'i required by Section
37M of the Labor Cuda for the perfomunm of the work for which this Most is
Issued.�My.tW.7eo.rsk%e�r's Compensation Insurance carrier and policy number are:
OERTIFICATIONOEEENIF N FRLOSM�W1ORKERS'
,COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars
($100)orlas.)
i'emify Num the peAomienee of me work for which Nis permit is iauea I -
shall one employ my Peron in any mannersa ai to become subjm to Ne Workers'
Comiamsetion laws of Colifomia:Dau
Applicant .. - _...
NOTICE TO APPLICANT.If.after making this CmiOcmeof Exemption.you should -
Z become subject to the Worker's Compensation previsions of the labor Code,you must
Q 0 forhwith comply with such provisions or his permit shall W domed revoked
.
rr of Ne work forwh CONSTRUCTION LENDING AGENCY -
a y that there Is aoeed(See lending aiencY for Ne peRonneece
W 1 hartb affirm this permit is issued(gee.3097,Civ.C.) ' "
A which
Ladder's Name .,, . .. ..... _: -.� ..� .......... .. .. ..
� Z Lemoar.Address _ .. ... .. .
1 cndfy Net I love with Nis city
and on and eau thc Ilia above laws efion is
tar [ti toWilding
I ayes u comply with all city and county ordinances and some laws wining
� W 1k.boingmmiumel n,and y forhereby Impact.irposes. roof this city menttt upon
0. theaW(We)Aree property AdiImpImandA
py eWe)ague ts save,indemnify and kap hmay in m City accom nino 4eim
f4
liabilities,judgments,cwt and expenses which may in any way accme arynst said V v
V CITY In conteqquence of the mining of this permit.
APP no. ST bN MIPLYWITHALL'N N-P NT ` I'
ss74 or':. 6 Issued by: Date
igmaNu of ApplieanUC.mosch r ' - Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
WWII Ne'Applicant w(mule Wilding rscupom ware or handle hamed s.mumtl Type of Roof -
so defined by the Cupertino?."'!iq
ode Chapter 9.11 W the Health and Safety - -
Cade Section 255321x)
°Y" All roofs shall be inspected prior to any roofing material being installed.
Willthe:ppueontorocenpat..equipmemordeviceswhich If a roof is installed without first obtaining an inspeetion,,I agree to remove
emit mamdous au canumi...is as Mired by the Bay Arca Air Quality Management
District] all new materials for inspection. Applicant understands and will comply_with
Cdifo I have road
he hAzA, mum,.lis requirements. under all non-point source regulations.
Ely" „
CMpur 6.95 0(hm
Y J end 25530.1 undeuund Nat
'if the W tiding drew not meats Y hove a utast Net o is mY manc.of A ernotify the
occupant of Ne requirements which mast W met prior to Wuance of 4Cmi care of '
y' Signature of Applicant Date
,
l5w
nesm mthmiad agent - Doti I All roof coverings to be Class"B"or better
.._ -. OFFICE