04120091 CITY OF CUPERTINO,, „ " 'w•* -{.� aai�f _ "�
...
.BUILDING DIVI910N ' PERMIT - CfSNTTtA NOT.i T1VA'UAT4;> ,-� r •- - -
v{ tine ihlf qt,:r VY,.�.'3,P R,5
BUILDING ADDRESS: HALLMARK CONSTRUCTION INC PERMITN004120091
20807 STEVENS CREEK RMin
OWNER'S NAME:, PERMITISSUBDATB
J. VOLCKMANN ASSOC. 3360 DE LAO, _
SANITARY N '- - CONTROL N0.
(408) 727-4422
ARCHITECDPllGINEER: BUILDING PERMIT INFO r•
_ - BLDG ELECT PLUMB MECH
LOO - - + LICENSEDCONTRACTOR'S DECLARATION - - Job.Description
1 Immby affirm the i eco licensed under Provisions of Chapter 9(ammmcming
i Section? 1 f Dw,09 ctilp Bbsinenan essimu Code.AM my Save it . .. .. _ . . -.
<z is ane G 0 u :` IN-HOUSE ONLY
D`te aex TGass
TS D u AT e G REVISION FOR PERMIT 04070197 < jf
I Ueda d .h'0 Licensed
all C._.
OWNAR.BUIL ED RDECLARATION
iI I hereby art that I am exempt from Ute Coninstass License law for use
O O following mason.(Section 7031.5,Business and Professions Code:Any cityser county
$tai which requirus a Permit In common,alter.Imprnw,demolbb,nr repair my structure _ -
t-�i prim in its issuance,also minima site applicant for Inch permit to file aaigadstaunamn ,, ..
�< Net he is licensed purvelt te the Provfaimuof the Conuman's Lkide Law(Chapter 9 Sq.Ft. Floor Area __ Valuation .$0
3 (mmmemmngwith S=don7(DD)o(Divbion3nf IMBLWm ndR fmion Code)m
that he Is exempt therefrom and the bub far the elleW exemption.Any violation of
Section 7031.5 by arty applicant fm a permit subjecm the applicant m a civil penalty of APN Number Occupancy Type '
Cant mom than rim hundmd dollen(SM.: -
0Luawteraftlepmperty'ar my employea with xgesuthebsod tompcmdm, 32632051 . 00
will do the work.and the sonxime Is not intended ca.0med for sale(Sec.70/1,Business ,
• . . RequiredIDSPCCtiODS
aha Profeedan Cade:The Canmsemh Lice.law does not apply m an owner ser • '
property who builds m improves thercondnd who does inch work himselrm through his
Own employees,provided thmmch improvements arc eco tmameA orartered for sad.If.
Wilder will
the
that he
yam or Improve
Wilder will hew Ne burden of proving Nn he did not build m imProw fm purpose of
Yd.).
❑1.As
Most
of the property am exclusively contracting with licensed mntnmon m
- cmamuct the project(Sec.70x.Business and Professions Cede:)The Conmemr.U-
done law does not Apply to an owner of property who builds or improv thereon,and
whoconmmfmevahpmjecuwiNacmuactm(gliavedptumantwa Conuenoes - -
License Law. •.t _
❑I an exempt under Sec. .R h P C far this
- nu
Data
WORKERSCOMPENSATIONDECLARATION
I hereby same under penalty of perjury am or the following declandov: -
0Iham and will maintain aCeNficateorconsentmaelr-Ivute forWaheb Compen- -
- - .Adan,As provided for by Section 37M of the labor Code,for de part....of the _-
workfmwhichthisPermitisinead.
❑I low and will maintain Workees Compensation Imwnce.an required by Satire .. ,•. .:. c r.:. ..
37000fthcl4borCM ,fwr perf r nceofthewmkfmwhich Oispemitisinued.
My Workee,Compensadonlnsunn canimmd Pnlirynumberam:
Carrier. J Policy No.:
CERTIFCATE OF E%EMPrI RKERS'
COMPENSATION IN CE -
(This am reed mattocampleted ifs permit is fortune,hundaqddallan(SI00)
or les.) 1
1 certify that in the performance of the work far which this permit is entad,I Nall am
employ any person in any manner an an to become subject o the Workers'Campewtion -
LawsofCalifomia.Dam '• '
Applicant
NOTICE TO APPLICANH If,after making this Certificate of Exemption.you should
become iub)em in the Woheta Compensation proAdhas of on tabor Code,you most
,JO forhwith comply with such provisions or this Permit&hallm deemed revoked. ,
„Za"' CONSTRUCTION LENDING AGENCY
F+��+ lhareby.IRme that them i..convmtinn kadingagmey car the perrarmence of -
a> the work car which this permit Is issued(Sm.3097,Cb.C.)
W Lender's Name G•
Q z lender's Address x -
t.7 Q I=try mut I haw mad this city
and c un aha sate that the show information is
D.;-'• amen.I spa tu comply with all city and county ntativ sor and cute laws r upon t e
Q building construction,and hembyauNadarposesentallves of Nb city to color upon the
W aMvmmeMmtdproperty finemnify anporoma..
r
(We)spm to caw,indemnify and keep harmless he City of Cupertino idem
UTA incamseq Judgment.do;and espenmwhich may in my way accrue galvt said City
C.1 7 A cmleq can Nc g ling of Nie permit.
G APPLIC UN D STAN AND WILL COMPLY WITfLL NON-POINT Issued by: Date
SOUR REGUL ON /'
z Re-roofs.'
beaA ion nioctor Dem
HAZARDOUS MATERIALS DISCLOSUR Type of Roof
Will appllant or future Wilding omupmtnom arlundie haardous material
an corned by the Cupertino Municipal Code,Chapter 9.13,and the Health and Seery
rodOyer ❑No,genian 25537(.)? mAll roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building au"ou use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cm it Wandous air contaminanta u deeded by the Bey Area Air Quality Management all new materials for inspection.
D"' et?
❑Yen ON.
I hevc mad the hv4tdnms materials mquircmenu under Chapter 6.95 of the Califon.
nb HcalthASsety Cad.,Smdm25505,25533as25531,lundr=W wird¢building
does not dead, y ha a tmaa Nm i b responsibility m notify the,oceopent of the
myvimme which sibc miManaal.Cerbflc.zafGe pency Signature of Applicant Date
44
2 o All roof coverings to be Class"B"or better
115 r th Mage ate