08030039 CITY OF CUPERTINO ;i _�p,a�/� ppap �'7�=' "p
BUILDING DIVISION
P];1T CQlu'fl: A�jt�RQLLLY �Vt ,
BUILDING ADDRESS: PERMIT NO.
10300 N TANTAU SOUTH BAY CONSTRUCTION CO 08030039
NER'S NAME: FER1,11T ISSUE DATE
.APPLE 170 KNOWLES DR 04/24/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHITEC IENCINEER: BUILDING PERMIT INFO
NEW GENERATOR IN (E)RM, T. I BILDO O O O O
rl 00G LICENSED CONTRACTOR'S DECLARATION Job Description
hereby SIT.that I me I4emndp
ed note, mviaimu m
of Clrspte,9(cemeneug
i with Section 7")of Division 7 of dm Southeast and Pmfeuimu Code,and my license
^<� in full Is and efreaL
�'�3 ucenSo IY.g
0 Da¢ Can DELL ria,
ARCHRECse OFpublic 1 e
1 untlenunJ my plane Nall he used u public reenNa '
y Licensed Pmfcan...l
OWNER-BUILDER DECORATION
CaO S 1 Iteroby aRmm that i 1. eusin from the Contractors License law far Bea
1 o O followhich re reason.(Sauon 7rnsm5.Business and rve.da o ll Cade:Any city at county
$ which mqussu.permit re onnswcL aien improv,m,molW,fi repair any ammum
�Sn that he isususna,aiSont W the daeapplialof for Sochpermit', RleaSigned
Law
mem
�< (co he islicensedwt Section
f0M)of Division
ivimu3 oOut f
urines Lieema law(C ode)9 Sq.Ft.Floor Area Valuation
B
(commencing he I.
Wth Smtioss,andth D osis fel of dam Bvainwand Professions Code)at
dao k s exempt daereRom and de bass for We ailege0 nsvnpuon Any violNun of
Section 70713 by any aced ant rte.permit Sobjecu don applicant W.civil pmulty of APN Number Occupancy Type
nu Some duo Rw hundred dollars(5700}
❑1,u awaer of the property,army employer with waW u dteh Soktompensation,
MlidD wak"NeatmaumlarwtimmndedwaReredfar..In(Sec.7041.Business Required Inspections
and?mica rs;Cede:The Conuecwrs License law dons ant apply W u e momer of q P
prope y,wM builds or irm.dammer,endwhoaaa erredworkhimseum through his
awe mnpkyen,povided don Such Improvements art rat intended moBerW for We V.
bowew,don building or improvement IS Sold within arc year ofswopladon.the owmr-
builder will here the border of proHng that he did Mt fluid or improve fur purpose of
sale.).
❑I.as owner of du pmperry.am ea4uaively conuaning with Barred mnu.nom in
construct the ounce(See 70th,Business end Fmfn.mOs Cotler)The constSomes U.
cause Law doer not apply m an owns of papmty,who builds De Musen s Merton.and.
who cote—for Such prejecu with a rnnu.mm(s)Ii.d pmmum M the Connoisseurs ,
,.canis Law.
❑I am aempt under See ,B l P C fon this mason
Dam
4 Was WORKER'S COMPENSATION DECLARATION
1 hereby,affirm ounce pmWty of perjury am of the folkwing hclarWoes
❑IluwamW Wil mainuina CeNRate or Camemwself-Wore for WarkefSCampem
urian,at provided for by Section 7700 of Be Labor Code,for the perfomuna of the
work for which We Permit is usual
❑1 have and will maintain Workers Comi emWon Inmernce,as required by Section
7700 of the Latest,CoM.for the Rrformence ofte work for whieh this Perth is Issued. '
My Workers Compensation Insurance atria and Policy,number mc;
C,der:t�'Iht/5 itf ^/kwsv`2- Policy No.: C ¢413 —0 1
CE0.71� FlG7E OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
rrun emla rend sot he completed ifthe peen0IS frearohummed dollars(5100)
or kat)
I anify them in the performance N the work rte which this Permit is issued.I awl not
employ any person in any Sma crto u w became Subjectto de WorkerCompensation
Laws of Cellfomia Data
Applicant
NO77CE TO APPLICANT:If,.(ror making this Cer lRc.m of Exemption,you Should
baome Subject in dam Workers Compewua pmvishr s of thst IAW Code.you mum
Oforthwith amply with Such provisos or this Permit Nail be deemed revel
CONSTRUCTION LENDING AGENCY
�'✓ Thereby aRimr this dem s a cmmrvctinn lending apwa for the lerformatu¢of
ai the work for which this;permit s Issued(Sec.ID90,Civ.C-)
W Landers Name
D Z Landers Amtaat
U O 1 certify that I have real this mitliwion and Sone that de above odcarm,uon is
Ind. Contest.1 agree W comply with all city and county ordinances anti am IS"milling in
IS SU^ Wildingconstruction,and hemby amhoeirs mPruenstiws al this city we mor upon du
L17 •hove-mendened property for inspect¢purposes
(We)agree to save,indemnify and kap bermleas that City of Cupertino agaiml
f/1 liabilidm,u menu.casLL and eepema which mar in any way amus.let.,said City , Q
U rZ rate of IM NDERSTAN Df das iL Issued by: Date `'112,q/
APP CA NDERSTANDS AN 11 COMP Y WITH ALL N-PO 17fl 0
SO
err Re-roofs
sign APPIian lc= our Das
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future buidal oauFAM Same Of h Chaatmtlom essential
as deRnetl by de CYSam.M icip.l Cade.Chapter 9.17.W the Health and Safety
seedier 25672(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya Na
will the applicant or fuwm building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emd hsallons air conumimns u defined by the Bay Area Air Quality Management all new materials for inspection.
Disc cR
❑yet
1 have read de,hvaNm ametrias re,fiemcns umler chapter 6.95 of the,Califm- Y
ria Hcalthks myCod%Seeuom25S0 25577and2553.I.crsundthalfft b WWl
dila not c nt hew•Murry t I my mm omibility u notify eau t of the
mquim Cmurl I a Signature of Applicant Date
owns a mdageol Date All roof coverings to be Class'%Q"or better