03110148 (3) CITY OF CUPERTINO ' rC'TMTT __'a � o`
BmLmrvc mvlsloN PERMIT COO 1vTRACTOR INFQRMATION
at .1.,4.
BUILDING ADDRESS:
PERMIT NLb 3 110 14 8
E40 STEVENS CREEK RT."IM
W NER'S NAME: PERMIT I SUE DATE
ININSULA BEAUTY 11/25/2003
ONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CM 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby Art,.B.,1 am licensed under previsions P
ions of Chapter 9(Commencing
with Socchop 79II0)of Division J of the BusinCsynd Pm(cssiuns Cade,and my license is
In full fore d affect.GSI V`- 7 e;t 4& SIGN
�nZ Dalamc C116s S Ce.g Coli r t
J crib cLARATION CONTRACTOR: CALIFORNIA NEON
y
f �1to A I ryM b,used as public records
s o G Licensed Pm cssmF-- �\
g 5 B - U Copt from
DECLARATION
POC I hereby Maso ,(firm on l ore exempt from Ne Contractor's o License Lew for the
3 00 following area, emit t 8013,Business and ft.decum Code:Any oily nr courtly
$� whish mqulres•Permit m cnnnma,a1¢r,Improve,JcmnlL h,or mpair'eny nmctum
iy prior to its Issuance.also,equima the applicant for such le,milto Ric a signed rammcm 000 ,
2 G that he isliecowdpummntlathe pmvisiomorthe Contractors License Law(Charles 9 Sq. Ft. Floor Area Valva fg
3 $ (Commeocing with Section 7")of Division 3 of the Business and Professiou Code)or
s, Nn he l.exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by.,applicant far A permit subjects the applicant m A civil Penalty of APN Number Occupancy Type
not more Nan five hundred della.($50)). 359080180 0
0 1,As owner of the pmpeny,on my employees with wages As their sole compenad.n,
will do the work,and Ne structure is not intended or offered for sale(See.70414,Business Required Inspections
and Profession&Code:The Consmecoor's License law does not Apply to An owner of q P
pmpeny who builds or improves thereon,and who dma such work himrelfor through his
own employees,provided that such improvements are not incurred or offered for Asia,If.
however.the building or improvement is sold within am year of completion.the owner.
Wilder will have the burden of pmving thr he did not build or Improve for purpose of
sale,).
❑1.as owner of the property,am exclusively convecting with licenced convectors to
consbuct Ne projat(Sm.7044,Business and Profession Code:)The C.ThommM1 Li-
cense law does not apply to an owner of property who builds or improves themon,and.
who contracts for such pmjcca with a conuaaor(O licensed pursuant to de Contorcoes
se Law.
ra
Am exempt under Sec. .B d:P C far thH eaon
Owner Dale
WORKER'S COMPENSATION DECLARATION
affirm 1 hereby arm under Nulty of perjury can of the following declaration:
0 thaw and will maintain A Ceni6cam of Consent a&elf-insure for Wallace,Compen-
sation,As provided for by Section.7100 of the labor Code,for the performance of the
work for which this Permit is issued.
❑1 haw and will maintain Worker's Compensation Inseam,As mgvited by Section
3100 of the labor Code,for to performance of the work for which this Permit is Wind.
My Worker'.Compensation Insurance artier and Policy number am:
CdnlCr. Policy No.: ,
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Crass seetim need native completed If the permit Is(mom humdraddnlla.($100)
or I..)
1 certify that in the partyy,,nnAnce of the work f r which Nis Permit is issued,I shell net
replay any pe.go yes TIM Iv hcc spas bjcclmlheworkeri ComPensatloo '
LIm NC& mi LS
A
b
CET APP CA ore king his Cc7RAtcaf Exemption.youshould
.,Obamme auh)c0 to the Wotl.es r this p,.i&iom'ABA,IaMr Code,you must
forthwith comply whit such provisions or odes&permiuhell be deemed revoked.
Z:'--' CONSTRUCTION LENDING AGENCY
r I herby Affirm that them is comwction lending egcnry for Ne perftxman¢of
the work fm which this permit is issued(Sec.1091,Ci,C.)
4 Q Landee.Name
.7. z Lenders Add.e,
V U 1 cenify Net 1 havand reed this ammo
application pr and sum that the above informationt e
coned.I agora to comply with all city and county ordinances and state laws minting to
V Wilding caIf.wction,end hereby authorbe representatives of this city menmr uPnn odea
W aMw-mcntioncd property for inspection ortmcs.
gyp
(Wo)agree to save,indemnify and keep harmless the City of Cupertino against
p) liabilities,judgments.costs and cepenscs which may in any way aceroc against said City 1 f
U in consequence of the granting of this permit. 111r/
" APPL)C N RS WILL COMPLY WITH ALL ON-POINT Issued by:9 Date
yyssG7P R(R(( E U
ll—ZS•oS Re-roofs
Signature o(ApplicantlQu, 11 Dam
Hnzkit US M,fTBRIAL DISCLOSURE Type of Roof
Will the applicant or home ullding occupant store or handle haardous material
As defined by the Cupertino Municipal Code.Chepmr 9.12,and the Health and Safety
Coda.Section 35571(A)1 All roofs shall be inspected prior to any roofing material being installed.
C YnNo
win the applicant or future building occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree IO remove
emit hara,dous air contaminants As defined by the Bay Area Air Quality Management all new materials for Inspection.
Yes off
1 have mad the huarthes mamdats requirements under Chapter 6.95 o(the Califor-
nia Health S Safely Calc,Scents.25505,255E and 25534.1 underawnd that if the building
dna
no cu c no Bar to is my reammu ility to notify tM occupant orma
mqulm ich'mvs N.,onisauaace ora cemnataefOccupancy. Signature of Applicant Date
2A U All roof coverings to be Class "B" or better
O Cur autgorind ag Data