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00120142 CI'T'Y OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: ©O 1 2�0` YL BUILDING ADDRESS: PERMIT No. tv v oat OWNER'S NA! APPLICAHON SUIT DAPI? GLcAl dole- Vc� r PHONE: SANITARY NO. CONTROL NO. ❑e[Z ARC]II'I'ECT/ENGIN@iR: BUILDING PERMIT INTO O O BLI ELECT PLUMB MECH m `6 H LICENSED cosuRACIOR'S DECLARATION Job Desci ipti n 1 hereby Brenn that 1 an licanwd antler provisions or Chapter 9(Commencing ca with Sexton 70ID(Bof Dr,mon.3ofthc Bu.vincs and Prof..kao C,de,andnhy license ¢ tarn full fortt umJfltc dC 6 lieen.L clay `= N o u Dale[ Co." ARCHITECTrhuw DECLARATION F�0� I undersuuhd nnY Plans.boll M1e useA ax Puhio reconh � C,p p Lic...Cd Prcm,,innal _ OWNER-BUILDER DECLARATION I hereby uffnh than 1 am cxeropl from the Contractor's License Law for the billowing reason.seclion 7031.5.business d Professions Code,Any City or County ` O whi b y R,it... t t II J I:ll,la.cpda. any luau um ou poor ho im1 arequiaws Re applicantf h pronia I file a signedl.t t neat C. fia,he is1renoed pursuant l„,[a,s000iaomorat CourCluar's License Law(Chapter 9 Sq. Ft. Floor Area Valuation ' (commeacmy all Sxu...h 7(kR)of D'viao I i orla,Ruane,,h u11 mlu:Ins Code) or that he is ecanM themrnrnh and the basis for the alleged exemption.Any violation of Semen 70315 by Illy applkanl Earn permit subject,the applicmn it,it civil Inraly ,it ratio Cthanfee handrail dollars u5bb. APN Number Occupancy Type ❑I,as nwncr of the property,or my employees with wages as their,nle co.npensaliah. will do the work,and the structure is not intended or altered fart sale(Sec.7144, nu,irm” a,]prorm.aon,Cade:'Me Cnntrctnr.license law does our apply In an Required Inspections nov r alpmperty Who nada.m in vex thereon,asu nd who does ch walk himself r through his own enlplayecs.prrvided than such aro Bol intended ar offered for sane.If.however,the building or impmvc..nl is slid within one year of nnplednn.Ibc ownarhulWcr will hane The broaden(it that he did ren mild or - impmve far par sox of vale.). ❑h as awncr or the prop ' ,..it exclusively contracting with licensed cunuachas to Istria the project(See.TW.Ilu, and Rodes w Csdc)The Contractor's License Law does not apply to an owner of progeny who builds or improves thereon, aid who m..,a., or such project,with a contracurbs) Ilcunsed permant m the 01 ton usta license law. ❑lent exempt under Sec. .HkI'C fur this rcasu Owner Date �{ WORKER'S Q)MPDate DON DEChARA'nON �rVy I hereby affnn under penally of perjury one of she(allowing Jhelaralilao: . O 1 have and will mainmin a Cendmithe of C'nncnnt ha self-insure lin Wnrkcr', ' Compensation, m provided for by Section 37W el the Inbar Cade. for the pelkn nance of tau work for which Ihix pcmlit Is issued. ❑1 have and will mainmin Worker's Conhpcnsation Insurance,as mquiacd by Section 3700 ol'the Latin Coda,fonthe perfnrnrenw of IIle work in which this N....il i, recd.My Worker's Compensation Insurance carrier and Policy number am: Carrier: Polley No.. CER1'IIICAIION OF EKIMIllION FROM WORKERS' COMPENSATION INSURANCE Ipris section need not Ir ennplcled it the pe.oil is far one hundred dollars o 1l111)art Ins.) 1 certify that in the performance of the work for which this permit is isuad,1 shall not employ any parson in May mm act;eu as t{ ria: s,,e bre the Workers' Comprnum �.a� �.Cut{y yy Uutc1 LL C• ! (l - Applicant g�A.{;�.T/'�/C_/�eyy`�`I/�� NO['ICE',)APPI.ICAN'I1 IL uimr nnaAmg Ihix Ccruf roof lixcmptiun,ynnxhould ben..m ebjeet as IIle N'orAcr,t]nnpcn,al a provision,art the Edna Code.youmust Q 0 fonhw,hcn.nply with such provisions or this permit shall be deemed revoked. H = CONS'IRUCI'ION LENDING AGENCY I hemhy of it l that there is it consbmelion lending agency 4n the peRonmance male walk lar which this per Ix ixsnca tau:.3097.Civ.C,) Q' Lender',None 7 Z Lender's Address V Q I cenifv that 1 have mad this upplication and state that the above infonnalion is W. E. current.L agree in comply with all any tad county ordinances and ,are laws redwing Q U as baidding mn,uucu i.and rarely ambmixc mpnescidaivesol't his 1-11lo call,upon the aNna-mcationN pn,,rIy fnr impaction purposes. (We)agree"',:nc,ademnifvnnd kcop lmmdess the City of Cupertino against Ur h liuhi lilies.judgmenl,,and uad aspenIn,, ch may In any way accrue again.,said 7 Cay in consequence none granting of thus pariah. APPLICANT UNDERSTANDS ANDWILL COMPLY WITUALL NON-POINT Issued by: Date ` SOURCE REGULATIONS. y' Signnnmol Applicarl/Canlraaor Uma Re-roofs HAZARDOUS MAIFRIAI S DISCLOSURE Will the appllcunt or future bvildlng,ccupant sham or handle hvmd,ws material Type of Roof o auhned by the Curynin i Mnnirprl Codc.chiller,).12,and the[Icahn and Safety Gdc.Section ❑Yee 35321x):' 0N All roofs Shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant ase equipmem or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit armrlous air c Courainams as JeGned by nhc Hay Area Air Quality Management District _ all new materials for inspection. Applicant understands and will comply with ❑Ye, [I No all non-point source regulations. 1 have read the hat of mumrix6 rcyuimarenls under Chuptar 695 nt the California Ilcalnh K Safety Coda Smion,25505.25533 and 25534.1 understand that / _ `V 1 If the huild tag does nal v',Irmally have a retrain,that 1n la try rcipanxlbll'lly in noury the V ,tcupam of r ai,cumals Mach Brest Iw mat prior to izwnnce nl a Ccrtiticac nl' �� — occu /2-27_ 0o Si n• ureal pplicant Date Clot; i.edageht Date All roof coverings to be Class`B" or better OFFICE