04090011 CITY OF CUPERTINO �'^°'� '" *" "�� ` "
BulkDmc ornsloN PERMIT iz CQ.NrTRk1.C'CQR INF®1ZMA.T;I�
It DINGADDRUS; ALL BAY CONTRACTORS, INC. PEaMrrNo04090011
OWNER'S NAME: PBRMITLSSUEDATE
liftE; SANITARY OL NO.
ARCHITECTlENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p 0 0 0 0
Yeo LICENSED CONTRACTOR'S DECLARATION Job Description
�i I art,.N
hereby afal 1 and immune de
ine unr provision of Chapmm
r 9(camouing
mm with Section 7nlKp of Diviaion]olthe Basin vantl Profcuiou Code,andmylicenuia
^=a in fun lone anaafleetr
Liz Lt....Class Lic.« REVISION--IN HOUSE USE ONLY
c Dam Cumractdr NO NEW PERMIT ISSUED/ ORIG. #04060255
ARCH=CI•S DECLARATION
1 i ndaraund my plans shell he it ea public rccnNs \
; U
u� Licensed Professional
5 OWNER BUILDER DECLARATION
E n f 1 naso .(firm on 11. exempt from the Conten Co e:Any c Lew for Nc �rr
OO which
reason. ermit U 71131.5, t,alter. and w.doiou Cade:Any city or county \V
,limo which rtqui s a n e.also re cane the aloe improv,demolish,m repair any awcturc
Fiy that he its isswnce,a6orc to the Neappin of for such Contractors
aangered sutemem
PP < (commencingudruection7")
th)ofDivisuofNcCamrumesndProrLaw(Chap¢r9 Sq. Ft.Floor Area - Valuation
m€�
out
Is
with Section 701 it
had,ton 3o,
or Glnc eed ess exemption.
An vicCoder)or
Not he V exunpt Nerclrom and Ne buts for the alleged eamption.Any violation of
Section 703M by any appliwntfor a permit subjects We applicant to a civil Penalty of AIYN Number OccupancyT e
not mane Nan five hundred dollen($500). YP
0 1,u owner of the property,or my employees with wages a their mile compensation,
will do the work and Nesm un.isnot intendedornlremd fornm(Sec.7061,Business 32632050
and Profession Code:The Commodes LIceue law don not apply in an Owner of 0 0 Required Inspections
progeny w ho bui lds or improves thermn.en d who does suc h work himul f or through his
own employees,provided that such impro droo,am not Intended Oroffercl foradc If,
however.We building or improvement is Bold within one you of completion,the owner.
Wilder will have the burden of proving that he did not build in Impmse for puryoae of
am).
I,as Owner of the property,am escluively contracting with licensed eonuacua to
to duct the project(Sec.7044,Business and Profeuiou Code:)The Con racmrs Li.
ane law don not apply u an amino of property who hamlet or improves Nitron,and,
who canme4 for each projeau with neonuacmr(s)licensed purswm m Use,Conmaoes
License
01 esempl no .B k P C f thi noun
Date 04
WOR ERS COMPENSATI N DECLA
1 hereby affirm under penalty of perjury ane Of Ne(oI Ing declinations:
have and will maintains CeniRnu ofCOnum m set nsurc for WorkeM1Compen
scion,u provided for by Section NMI a!Ne labor Cade.for the perfannaned of the
work for which this permit is issued.
0 1 hive and will maintain Workers Compensation Insurance,as required by Section
3700 of Ne Labor Code.for We performance of tha work for which this permit is issued.
My Workees Compensation Insurance carrier and Policy number au:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE
(Tbb arotlon maul not becdmpicmd If the permh infer...hundred dnllus(51011)
or less.)
1 unify Nu in We performance of We work for which this permit is issued.l shell not
employ any person in any muneru as an become subject to the Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificau of Exemption,you should
become subject in Ne Workers Compenadan provisions of the labor Cede.you mtw
.JO forthwith comply with such provisions or this permit shall he deemed revoked.
z'••' CONSTRUCTION LENDING AGENCY
P:M IMrcby aRian Nat Neu is a conmucdnn lending agency for the rerformence of
C4 ? dm work for which this permit u muco(Sere.3097,Civ.C.)
W�A Lender's Name
z tondos Address
D,Q I certify Nn 1 hoe read this city
and
oun and tum Nn the show information is
0 f" butrc0.1 agnea m comply with all airy and county nNinutta and cum lawn r upon
to
U moving construction,and hereby amhodae purpose. tiws of Nia city m enter upon tM
` IT7 about-mcntiun re in saw,for inspection purposes.
!M^y (Woe)agree m ave,indemnify and tech may
in ss Ne City n Cogent s id City 42
I„h Iiabilitiea,judgmenu.eom ode cines which mryin any way accrue against said City `
)7 in crena min isperon
r�77 APP ANT UN A AND WILL COMPLY WITH ALL NOP Nr Issued by: Dale
s E A 'NS
Ggnat of APPlican mi ter
Z Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or future Wilding Occupanurore or bandit,h1YWaw material
as defined by Ne Cupertino Municipal Cade,Chapter 9.13.and the Health and Safety
Code,Section 35532(a)7 All roofs shall be inspected riot to an roofing material beim
❑Yn Na P P Y g g installed.
Will the applicant or(mm building acupam tea eyuirmam or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
t hanNou air contaminants u defined by the gay Amo Air Quality Management all new materials for inspection.
O
r
0Yw
I base mw Naha emaurialarcquimmcnuunderCMpur6.9 Of lift,.
HulN&SafctyC dao 250115,25533 eW 23534.1 undcawd if building
umn C •untie than h la 55 3 m,125i534.1 mr madly an(oIthe
Ian con h/rest etpoor missuanceOfaCcnifueucup c Signature of Applicant Date
owns cram ueaagmI �te All roof coverings to be Class"B"or better