01020083 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
IIUILDING AIIDBills �G . PERMIT NO.
r.
1113
.1.0978 SYCQMORE DRIVE
(IWNER'S WANE:: APPLICATION SUB DAO.
l7/ �n/isf62Gif/t Si _
j/PL 711
IIONE: - SANITARY NO, CONTROL NO.
0 p ZO ARCDITECnENG1N'EF.R: BUILDING PERAII'IINFO
u_ BLDG ELECT PLUMB MECH
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LICENSED CONT RACrOR'SDECLARATION lob Description
SSw 1 hen'by urGfinarm aha.I am icunvcJ unJ9r pnrvieiunx ul Cbapm.'9 fcmmnmn9mg
:C w with Sect n 7IXXB of Diviyyyyyyyyyyyy 3 of the Businee.and Pmfcssinn,C.de,end my license
z x < m in full lass and cOc
z 2 I.icenne Class_ hie.M
3 uW0..H Dac Comm....
nitcpunx-rsDrl,l ATo SOLAR PANELS
C °'S 1and..rinnd Plans shall •nu-: Inr reenN..
�r
.25 p O LiccnscJ I'm- u — .
OWNER-BUILDER.eantDECLARATION
e¢1 hereby alarm on 1 1 1, axmnpl from he Contrprofession,
Ca L An,c Law forbe
F Z> (allowing¢axle.sta for
7U3L5.Busincs and oc.dcsin li h,,,,Any city or county
7=D which rcyuircx a pct.nit m anuauua,alter,inlpn,ve,denu,li,M1,fir roprir any srvmure
ceprior to in requires the also ruithe applicant fle such fiction it)file a.signed statenwon
Ihnl he i.renlmdpurxuina to lire pnw.,ane ofthe Conaacml,hittnsu l.uw(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Social 701)(1)of Division 3 of the Business and professions C.dq
of the bels exe.gn n.erelo nt..tld fire nods Inr rhe alleged cncmptino Any violation .
of Section 703 1.5 by any applicant for a ire mil.objects the applicant to a civil penalty
nfnarrac0ar,five Ill.abeddolmo1551Xn. APN Number Occupanst-' y b0
❑I,is loner or the prnpry,or my umpleyeus with wages as their sole enmpensaann.
will d9 the work,and the awemre is not intended or offered for.sale(Sec.7(W,
Bueintx+and prvrs.ioa,Cna:,neC....meto.,L.icenw Law doss nal apply m an 34"560-1k dInspections
saner of progeny Who builds fir narcoses therena.and who does such work himself
m brnugl.Irl,own r.npbryce,.powalyd her such impnammm�e are not blended fir
offamd for ole.11:however.the Will or improvement is sold within one year of
.....rpIcti theowmer-builder will havcroehaderofplivingthat hedill athdl`dor 304 — ROUGH ELECTRICAL
impm.e forpurpnxofsalc.). -
01.a%owner of the rrnpny cur e,clu,i,ely contracting with licensed cnaacmr.to 501 — FINAL ELECTRICAL ENERGY
Lnaru.a.he project(See.70,14.Bu...lco,and Prnr„ina,Cade:)The ennrracmc. 505 — FINAL ELECT R I CAL
icenm Lew dos not app?to an owner of pn,peny who holm,or Improves hereon,
and who emtmels for snub prejoct,with a contaaogs)treated pursuant to the
Contra lois Liccmc Irw.
❑Ium exempt under See. ,B&P C for lhis¢ason
Owner [)at-
WORKER'S COMPENSATION DECLARATION
I herchy afino under icnulty of perjury one ul'the following dedatallons:
RI rr e J II ..,,,Win C ri 1 Is n 1 C n m II n Worker's /,•/ `
p n-r n provided for by Section 3711(1 f tht Lari C,dc, far he
pfd lith I the ark for whichthis Iscroal is issued.
DIhave d will jusialain Worker'sConificintannan Insurance. 'y '-dby Scclur
37x1 of the Labor Cade for the prinnnane,of the work for which this attain is
i.cvucd.,Myy Worse.Fenmp£ yr,2prl..acneet o poliiccyl bcrjJ'j Q
Carri/nH/r,v✓�— /V Policy No.:j /f O G 9 10 .2—
CER,IPICA'NON OI;ENV 1PTI1IN ITUIbf WORKERS'
COMPENSAI ION INSURANCE
I'I'hi,rection nwN nm he co.npldcd if rhe IK...it is ILr nue hundred dolhax
IS I(Xn ur less.)
1 real fy that in the crfmmance of the work for which this count is issued.1
'hall not mnpll”airy"'on Ia any.na to w u.19 hc.onle.able,,to Inc Wod.ers'
Compnsarion Lnw,or California.[)are
APPficlua
NOTICE TO APPLICAN'C II;diet making this CeaiOcm of Exemption.you should
beconm subject m the Worker's Cun.penoo providons fit'ale I.alxa Gado,you nm.l
O O (oath llh comply with such provisions fir this penial shall he deemed revoked.
zit ttil CONSTRUCTION LENDING AOCNCY
a 71 hcmhIinae.p
y at that there ix a colraetlan lend l ng ugcocy Tor the announce '
far of the work far which thin panni is issued(Sec.3W7,Cie C.) ,
L Q 1<ndcr's Nuts
7 z I.endcrN Address
U O I certify than I have card this application and time hrn the eM,v a information is
bee E;,. "novel.I agree to cn.nply our all city not anumy anlirmnae';,,it .tum saw'relating
O U hlwdding c,maucaon,and hereby authorize representatives ofthiscM1y,[center a
O.e n f d 01 1try .pal i alrts,.
y
U Nz (WeB toIF,s c 'bnmdac nJfipaafy�land!
sfihd keep
t1 �Iy sy,nyuh.ery City
SOutt"yy'f C pnUd gu�aln n/a".bt iani,dn
-
Date
la Ib,Lynn h
IIIOfPA � Issued by:omRe-roofs
a /
AZAR DO11S b1AI1i121ALS DISChOSURIi
Will the applicamnr furore huildingpcuparce re or handle hoonnhasamerial Type of Roof
as defiled by the Cupaina M1lunidpal Coda Chapter 9.12,and.he Ilcaltb and Safety
Cada Section 2553201'I
ore, t7 No All roofs shall be inspected prior to any roofing material being installed.
Wiuheahpaeenornone,bdlda,oc,u,auuseeydp.tenter devices which If a roof is installed without first obtaining an inspection, I agree to remove
hrnWest,air canlarninant,le defined by the Bay Area Air Quality Managrnte ll
S"'i"'r all new materials for inspection. Applicant understands and will comply with
oyes El No all non-point source regulations.
I have had flat hvallous materiel,arlanre sans under Chnmcr 6.95 0l the
California IB,Ilb&S .ty Cade,Sections 25505,255))and 25533.1 understand that
iflhc building Js cuucntly laveur t.teat it in my respumihllit}I.,nmily rhe
rup; I of r remelt, hien n n p for m iooanee ora cenirea of
its,
""°ivy" yy, Z �r Signature of Applicant Date
uwlern .n..rn.,ri>aI agent DateAll roof coverings to be Class"B" or better
OFFICE