00080090 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DArh
10362 TANTAIJ AVENUE 00080090
PHONE: SANITARY NO CONI ROL NO.
08/1.4./2000
O O ARCIII'I I:CDIiNGINEER: BUILDING PERMIT INFO
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BLDG FLIECIPLUMB MECH
L-1 L__!I C=1
�,x.,i, LICENSED CONTRACIOR'SDECLARATION Job Description
L"�,' 1 hrnMy allium than 1 am licensed under pmvi,ions of Chapter 9 Econ.... g
Sectioreby of r Bar is m of the d under and Prom,of Chapter
ant my lira ng
a in full Burs nnJ effect.
s re 6 Licence Clan. Lic,so
O a O Dam Contractor
3 u h ARCHI'I I'.C'1"S DECLARATION
t�a.°3 1 vile amt n,y plan.I'all be novel public ocelot,
DEMOLITION
le
x Q Liccnncd Pofle"ionnl
e.°• OW'NER-EUILDHR DECLARATION
w m I hemny a1Rrm aha,1.,is exempt Iran, he Contraemr'o Licah,c Law far the
r z a following reason.(Section 9031.5.Business and Profc,sions Cute:Any city or county
a x D which requires a permit to construct,alter,improve demolish or repair any structure
u t-m
prior III its vvierme.also requires the applicant for such permit o file a signed statement
d3_
has hei,rcen.edpnt.nammmepm.;.bmanftheConnnem.aLicense lawtCIv,uaq - Sy. Ft. Floor Area Valuation
(commencing w'into Season 7")of Division 3 of The Business and Professions Cook)
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
III Section 7031.5 by any applicant for it prison subjects the applicant m)a civil penalty
of no more than five hundred damn South, APN Number Occupancy Type
01,as owner of the p,I,,ry.or my employees wire wage.,a,their ode emh.pemmian.
win do the work.sad,he artmism i, a..Intended tri offend for sal,(See 7144,
Dox and Profc. ,Coda:'1'11,Con rims',].'teen„e Law does nor apply ,,an Required Inspections
rv0m11a,�' ,,,,uy Whor'build............or,a hercmn.mod who one,.ah»look hlma"li —`75080'3
ugh hh own employee,,nn,,rdrdsnor,Duch improvnmc,ns tiro con intended or 3 3 . 00
offered Is,,sale.If,however,Nm notion or isupmwamen,i,sold wmdn tine Year til' .
nmplction,the owner milder will have the burden of proving that he did not build or
p
for paq.oaofale.). NO ASSIGNED INSPECTIONS
/
owner of the property.am,tcIu%ivcIy enntrecting with licensed contract e,
ntuY no user the project(Sec.7044•Rosiness and Pmfe,siom CtNeq The Contractor s
License Law does not apply to an owner of properly Who Wilds or improves thereon,
and who contracts for ch is n with a wntrector(,)licensed presume m the
Cunamon.o Lceme
El IOw con cxcntpt unJc(y/ as .N k I'C for rano
Owner Duct
WORKER" UMPIINSATI(lN DECLARATION ,
I hereby atllnm under penalty of In'jury one of the following declarations,
❑ 1 have and will maintain a Castilian,of Can.00,to self-insure for Work,,'s
Cunhrynatinn, as p.,idad for by Sears 1 3700 of the Ulm, Cudc• for the
perfnrm:mm of the work for which this permit i,issued.
01 have and will mainmin Worker's Compemation Insurance.as rcgrireJ by Section
3710 of the Labor Code,for the performance of the work for Which this permit in
.sued My W'orker's Compemmion In,rrunec carrier and Policy madder me:
Caricr: Policy Nn.:
CER'fI FICATION OF HXRM PITON FROM WOR KERS'
COM PHNSAI'[ON INSURANCE '
Cl his redo,nava out tie aumplcrvf iI he pernit Is hoe"tic flmdred dnllms . -
fS IIIO)or Ic,,e.l
1 certify that in the permeative of the work for which this permit is issued,1
shall not employ any person in any summer so as to became subject to the Worsen'
Cumpen,ation Laws of Calimsrms.Dae
Applicant
NOTICE TO APPLICAaO:.IL after making this Certificate of Esesuption,you should
bcr eonsubject no the Worker's Cumpcn,stion provisions of the Labor Curie.you mux,
Q Q fimhwith comply with such provisions or this Paul.hall he deemed revoked.
FZ^• ti CONSTRUCT ION LENDING AGENCY
Qct 1 herby affirm that there is a consmtctitn lending agency for the pedortrunce
W of the work for which this pernit Is issued(Sec.3097.Civ.C.) ,
QIx let's Name
7 z Leader's AJJms .
U 0 1certify,bar l have read th his ap,heedon and sine,hat,he all ovc fdomatin i is
U. [.. correct.1 agree,o comply with all city and county ordinances and late law, closing
Q foot n,builJingcomarnion,and hereby authorize representatives ofthis city former spun
} y ,he aWvomenroneJ pmpcny for in%ecdon pu psor, _
(•' !L (We)agree to save.indemnify and keep hamdcss the City of Cupertino a"ainx,
W liabilities,judgnrnts,costs and expcna,which may in any way accrue against aid
U Z City inn qucnce done
gmmi "oft is permit.
^ APPLONDE STANDS, ILLCOMPLYWITHALLNON-IY)INT Issued by: Date
5."nature lot A tcmatcoulmetor Dae - Re-roofs
HAZARDOUS MST HRIALS DISCLOSURE
Will a haapphcamnrmmmm.udir"ocvpamsmmmhandle hazardous,normal Type of Roof'
;Is defined by the Cupenino Mnuioryal Cn le.Chnpm,9.12,and fuc llc"Ith and Safety
Cade,Scalnn 25532(a)" ,
❑Ye, El . - All roofs shall be inspected prior to any roofing material being installed.
Will the applicnm or future Wilding occrpart use equipment or devices is hich If a roof is installed without first obtaining an inspection, I agree to remove
mit
emcontaminants lir laminana,JefincJ by the Bay Arca Air Quality Management
Di'it hazardous
all new materials for inspection. Applicant understands and will comply with
0 Yet, 0N all non-point Source regulations.
1 have read,he hazardous materials requirements under Chapter 6.95 of the
Califomi"Health&Safety Code,Sections 35505.25533 and 35534.1 un iculand that
i f,hv he Idia,does nm austart ty have a four,Jha it is my resp,sespid,y to notify the
cnpart of then ternichnt. n pr
s whtibe ior m issuance of a Certificate(It
O n
°Cujuniy Signature of Applicant Date
Dwne,,unaunrlaedm it Don All roof coverings to be Class"B" or better
OFFICE