03100217 (2) ray rvin,
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CITY OF CUPERTINO ` "I'l an"
BUILDING DIVISION . PERMIT ( ONTRATbR INk l7ILMATiON
r
BUILDING ADDRESS: ALL BAY CONTRACTORS, INC, PER NO.O 31002I7
QWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY NO. a� CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT , PLUMB MECH
:oa LICENSED CONTRACT'OR'S DECLARATION'
Z I hereby affirm mm
at T am Bnsed un cr provisions of Chapter 9(commencing Job Description `
< with Section )of Division 3 ofthe Busies nd PoidessionsC Ic.andmyliecoacis .y
m ,o m roll forte fleet.
;qZi? I`'cen,e look- Lk.p / TENANT IMPROVEMENT
C v Dave cum '
e g ARCHITECT'S DE RATION vs
1 understand my plans shall he trod ae public records .soli"
JyU
O Licensed Prorded.ml
OWNER-BUILDER DECLARATION -
,2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the - ar
i O O following reason.(Section 7I131g Business and Professions Code:Any city ser county
$ff which requires a permit to construct,alcor,improve,demolish,or repair any structure
as prior to its issuance.also requires the applicant for such permit to file a signed sukmenl
X50 That he is licensed pursuant n the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Va}I ion
at 1- (commencing with Section 7")of Division 3 of the Business and Professions Code)or
mat he is exempt therefrom and the basis for out alleged exemption.Any violation of
Section 7031.5 by any applicant for a penult subjects the applicant to a civil penalty of 3��jyi'pQyi(gi�er00' O- uane
not more man five hundred dollars($500). - p y'ryese
❑Las owner of the p e someone
is employees wire wages r ales(sok eW,Business
will do Prme work,and the rte,Com intended Liceneoraw do snot sale(Sec.too 44,Business q�..
and property
soh obu Code:The Contractor's License Law docs not apply ff an owner of 1te(I 7rC In peCtlOn$r
own enywho builds i id roves that such improvements
who it esauchwork ttimselor nedthrough his
own employees,provided that such improvements are not our of tl mpleerctl for ole.B,
however.me building or improvement is sold within one year of completion.to owner.
builder will have mmm
e burden of proving he did not build or improve for,purposeoseof of
We.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to s
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense law does not apply to an owner of property who builds or improves thereon,and 00
who contracts for such projects with a cmnmcmr(s)licensed pursuant to the Contractors.
ticanse Law,
❑I am exempt under See. ,B&P C for this reomn Ift�6 r
Owner Data /IV `-'I�1-4'&)'f �
WORKER'S COMPENSATION DECLARATION Tf
.r I hereby aRrre under penally of perjury one of the following declarations: " isles
0hw and will maintain a Ccnificate of Consent to of Nature for Workers Cornier-
Scion,as provided for by Section 3700 of the Labor Code,for me performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for one performance of the work for which this permit is issued.
My Workers Compensation IInmona cattier and red C mMIr r am:
r:� TIFICATE OF EXEMI'1' IkY O WO/KE S��
COMPENSATION INSURANCE 101,(-
mosscdinn neednoth edeadaekdifthe permitisformichundreddiillas(SI00)
ser leas.)
1 eeniry that in the performance of me work for which this permit is ismed,1 shall nut
employ any person in any manner so as in become subject to the Worknf Compensation
Laws of California.Data _
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,JZ forthwith comply with such provisions or this permit shall he loomed revoked.
'Z O CONSTRUCTION LENDING AGENCY
F
I herebyffrrm mat mere iso comtrvctinn lending g ascne forme Y Performance of
C La work for whir this permit is issued(See.7097,Co,CJ
WQ Lender's Name
)
�z Lender's Address
V Q 1 certify mat 1 have read this application and sure that me above information is
1U F correct.I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby nuthodae opoosentatives of this city to enter upon the
mod
CIL,
or
W shove-ms,judgment,costs
fidexpenses
pees purposes.
pli (We)agree to Ove,indemnify and keep harmless the City mf Cupcnino against
Z lieConsequenc Of
gratsing of this cswhich they in anyway eccme against mid City
V Z A APPLICANT
of LW granting tar This permit. i
^' APPLICANT UNDERSTAN SAND WILL COMPLY WIT ALL NON-POINT Issued by: Date
SOURCE)J�GUL ION ,
—12 12' s Re-roofs
Signature of canUCmnt mor Date HAZ ii O, MATERIALS DISCLOSURE Type of Roof
Will a applicant or future building Occupant store or handle hazardous material,
defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(n)?)] All roofs shall be inspected prior to any roofing material being installed.
Y
Will the applicant or lora bmldiag mcempam ti=c equipment ser devices which If a roof is installed without first obtaining an inspection,I agree to remove -
harardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
evict]
❑Yea po - -
1 have mail the harardmus materials requirements under Chapter 6.95 of the Califmr-
.is Health it,Safety Code,Sections 25505.25533 and 25534.1 unJcrs and that if me building
does not curtemly have a tenant that Ir.my reireme dilly re notily the mcupanl nr me
req Ifemco hmua meltrees5u emfaCemreatemr oeetrp,acy. Signature of Applicant Date
er or im tmr)fgal agent Date All roof coverings to be Class "B" or better