05070067 7
CITY OF CUPERTINO
vUnO
BUILDING DIVISION 0 FRA ORANFID ATTOM ,
PERMIT
CITY
ADDRESS: TAIJ AVE D A POPE INC PERMIT"°'0 5070067
OWNER'S NAME: PERMIT ISSUE DATE
PACIFIC
RESOURCES 1160 CHESS DRIVE. #1i 09/01/2005
E: SANITARY NO. CONTROL NO.
(650) 349-5086
ARCHTDISCUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm dart I sm licensed under musicians of Chapter 9 weammencing Job Description
;1H coloandrey1werassi.
W2 ,
/7---; LOBBY UPGRADE, INCL, NREW WALL AT STAIR AND NEW
se- F.wasm, FINISHES
iol- ARCHITIECTS DEC An
I V plans mail be used as public recoms
,to
3s;� Licensed Prufassai...I
I OWNER-BUILDER DECLARATION FWALED
��z I hereby effort that I am cacmirl from the Contractites License Law for duce
0 0 following ammon.(Section]ID Id,Bounteous,and Peallmsionat Code:Any city ar county
which requires a Permit to coomme4 altar.reprove.demolish.or repair my common v"R
prior In its Issuance,also requires the applicant forsuch womit to file a signed statement
thaw andel pursuant as line provisions Of the Condricum's License Law(Chapter 9 Sq.Ft.Floor Area Valu
(Coromandel With Section 7000)of Division 3 of the Business and Profession&Cork)or
But he is exempt dominate and the buts for the alleged exemption.My violation of fl$,19569
Section 7031.5 by any applicant for a permit subjecto the applicant to a civil penalty of APN Number LQqcqpt4&yjy�e
not am than fin hundred dollars($500). 31618025 . 00
0 1,as owner of the property.or my employees with wages w their arle compensation,
will do the work.and the strut
Is not Intended or offered for sale(Sec.7044,Business
and Profession.Crew:Th.Ounceeme,License Low d.act apply in an comer of Required Inspections.
property who hatildsorimpeaves,theaccon.and who doessuch warkhmuselforthesuil,his
own emploces,provided that such Improvements am,Out intended croffered ficafle.If,
however,the building or Improvement Is sold within we year ofcamplodon,the Owner.
builder will haw ft burden of proving that M did at Wild or finp.far purpose of
sets.).
0 1,as Owner of thme property.am asclusively contracting with licensed containment to
consumer the project(Sec.7W.Students,and Noulemosions Cade:)This Contractor's U.
come Law it=not apply at an owner of progeny who Wilds or limprommer thermon,and
who contracts for such parejects with R conumscron,)licensed pursuant to the Contractor's
License Law.
0 larne.mapatmatersec. _.B&PCItawl.ressom
Owner Dow
WORKER'S COMPENSATION DECLARATION
I hameby affirm under watalty,of priory One of the following declarations:
I Inw and will natfirmin.Cermificausid Curacao,to self-imam for Workimes Compete.
dow,as pronominal for by Section 3700 of the Lidsm Cow.far we itaffmamemen of the
work for which this permit is means.
0 1 have and will maintain Workers Compensation houncenewc,as,required by Section
3Morthc labor Grow.for the Performance of the out for which this permit is acted.
My We y 8 rawaro:.7arric,and Policy
MMAZ Policy No.:IM r_/1 0 0
CERTIFICATE OF 70NPROM WORKERS'
COMPENSATION INSURANCE
(This weaken necull an,he completed 1111he Permit is formuchurnermaj amilm;($IW)
or Ion)
I certify that In the performmum of the work for which this permit Is ismaid.I shall not
employ anypcwn In any summer so a be temore subject to the Workers'Compensation
Laws of California.Dow
Applicant
NOTICE To APPLICANT:If,after making this Cendicesta of Exemption.you should
leavereve subject to the Worker's Compensation provisions of Me labor Crew,you mum
Z roarthwids comply with such lenwasia.Or this Permit shall W decreed onaked.
z 0
CONSTRUCTION LENDING AGENCY
1 hereby afflon tat them is aconsuructlim lending agency for the Perforation"of
iYi> the work rat which this permit is Issued(Sec.3097,Civ,C.)
Lender's Name
D z
LanderesAddres,
U 0 1 certify that I have mad this application and slow that the show information is
".E crommem.I agree to comply with all city and county Ordinances and slow laws retailing to
0 WildingIII dh th tharize,representatives Of this city to order upon the
"an y
on n as U
have. ....4 In
above-
I -to caw, aadMp,hIrmhus,the City Of Cupenino against
cn Ii.bit I I u t enal'COSIS and expenses which may In any way accratc.gainsomid City
Uz C, file growing of this permit. Date
L NO STANDS AND WILL COMPLY WITH A NON-POINT Issued by:
R E L Ns.
Signalum OrAppicantlComractor Dow Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dow applicant or future building occupant swee or handle haccandous material
ET
C'XLDSTANDS AND WILL COMPLY WITH A
a NS
"is
as dallned by this Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
ode.
an.Swoon 25532(a)?
0 Yea ON. All roofs shall be inspected prior to any roofing material being installed.
Will Lima applicant or future building Occupant use equipment or denim which If a roof is installed without first obtaining an inspection,I agree to remove
a himardams it concomitants U deflead by the Bay Area Air Quality Management all new materials for inspection.
Yes ❑Nt
c4lifer-
data cryC .Secdmu 0303.29577 and]Ssl/.lwbemval than Rale Wilding
d.
pace Signature of Applicant Date
owner ar,nmariree.gem _� Date All roof coverings to be Class"B"or better