00080064 CITY OFCUPERTINO - ' PERNIUNO.
BUILDING DIVISION PERMIT CONT'RAGTOR INFORMATIONi./-;,
BUILDING ADDRESS:
SANITARYNO. APPLICATION SUBMfITAL GATE
10590 N TANTAU AV MAI INDUSTRIES INC011080054
OWNER'SNAME:
NIC CONTROLp
HONL.. LIFORCE 105 BONAVENTURR OR E] 08/09/2000
ARCHITECT/ENGINEER (408) 434-9880 BULIANG'PERMU INR)
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LICENSED CONTRACTOR'S DECLARATION Job Description
1 hembY aRmt suet 1 an licensed under Provisions of Chapter 9(comnercin. p
O Z t-u�i with Section 7")ofDivision 3 of Ne Business m Totinoy liftf{p.,ya�3k
<' i full force sed effect. /, TIt NJ
y cw<Clau�'L BATHROOM REMODEL
W�LL N COO
F
u0< ARCHITECT'S DECLARATION
-1 I undcnud my plans xM1dl h umd m public mwds
w6p0
z
Licensed Rnfesaional
n ^y
OWNER-BUILDER DECLARATION
C Z nI thereby affirm Inn I as exempt from Inc Contr cmh e:MY C Law for the
d ^ following Raw..(Schon 1031.5,Business.a., W Profeuiom Cud=:Ana city 1 county
3 which RQwRs.promo w comuua,dm,,impww,hper iit s w repair ed tavcufe Sy Floor Area Valuation
Prior its iasunnce.dw negvims the nppbcam for such permit w fie a.igned statement
trot he is licenaetl pursuant to Ne provisions of she Conuwlofa Licm.R law(Chaprer 9
that
exempt Sctiromand)orbasisofrofthe Businmadon,Any nsCses)w OCCU anC
Nat o is exempt therefrom and foe basis for the subjects
ON exe cart to Any v;o)niw of P y
not none then five
anydred amt for•permiuublecs Ise epplicmno a civil pemlry of
pW mote Ines five moths dollar(5300).
La.n,work.dlepmpeny,wmrotinuma.,wimWawn nwl(Sec.7044. m.Ew. 31.E].BIr7L'eq'�uif Inspections
will drLhawork.Co ere he Conti,tor,Ldedwoffadfroor WY 0014,Bmineu
and Ary who
Codec:The Contractor,Land w law sten not apply s lf owner M
his
wnkones.a;mpw di theRhw,wwrsum, tours imemmwv t,Nwagn Art _�OUND, IO~N,'
M1is own employees,pmvidd Nu such improv<menu ert not inadd a oReRd for
Off.If.however.the building or improvemml is sold withinnne ycarofeompletiw,de 1.02 IEA �f
owner-builder will have the buNcn of proving Nat he did not build or improve for par-
1 03 — UFE
I,u owner of the properry,as,exclusively convecting with licensed contractors to
comuucl the pwircl(S..10..,Buaaess and Pnefcniom Code:)The Cwmanno:U. 104 — RE BA R
ceme law does not apply to an owner of property who bailds or improves thence.W 105 — ANCHOR BOL
who connects for such projects with a contractor(.)l;Leoad punaem w the Conuscmes
Uam.law. 105 — SEWER K WATER
1 am exempt under Sc. .B&P C for Nis reason
202 — UNDERFLOOR PI_UMBI T
Owner WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL_
I thereby affi,no ude,pammyref perjury,one of Ne following ee=I�hknn: 204 — UNDERFLOOR FRAME
1 have ad will mdmdp acewifleaR m
o.Coml to self-insune for Worker's Comm
pe
tNo..rpwvidfor byySection 37WofNeLabor Ckdc,for Neperformance ofthe 205 — UNDERFLOOR INSULATION
prk for which this Permit is issued.
1 have and will mdnuio water.Compensation msurace.as required by Section 301 — ROUGH PLUMBING
POO-Dy"Ubor Code,fro of she wort fro wnich Nis pc it is isw
1' MyWone�,C�pe�.; n`. er.m`R.neror nam f�' .��( 302 — TUB 8 OR SHOWER
II`y Camcc Policy N
CERTIFlT CAIEOFEXEMPfIONFROMWORKERS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
is section nenot be complesd ifthe permit is fhummer dd
ohuhelars(1100)
or lest.)(Thd 305 — FRAME
Loy my Net inthe my omtml of the wwkfor whichtW pemdions mound,CoI.hdl
nn employ my person in my manner wasrobcwtne subject Ne Woncn'Compem 306 — HOEDOWNS
AA,,Ii N',k California.D,R 307 — INSULATION
NOTICE TO APPLICANT:If,eta malting thia Certificate of Exemption,you should 308 — SHEETROCK
bcomc subject to Ne Won.l.Compensation provision.of the labor Code.you must
forthwith comply with such provision,w this permit shall be demand revoked. 309 — EXTERIOR LATH
CONSTRUCTION LENDING AGENCY 310 — INTERIOR LATH
I hereby ulrum Nn Nem is a construction lerding.gency forth.pedomwce of
z m
the wacm,wmmthis pamIisissued(Son.3097,Cil C.) 311 — SCRATCH COAT
Lecke.None 313 C _ ROOF NAIL> Led.(,Addreaa
ii a IcamfythnIhaveredthis avpucatithat ,501
boveinformationis FINAL ELECTRICAL ENERGY
demseur l agree a comply with nil city and county tdimnea ad chaff laws mining m —
7 'Z, buildmit,omtraion,mshe,enyamewriRRp.senutivesof'his arywa--'mon Ban 502 FINAL PLUMBING ENERGY
V C above-menlonm property for inspection purpme,.
w P (We)aace,toaave.indemnify adkeephermlasthe City ofCatalan awimt 503 — FINAL MECHANICAL ENERGY
0 V nebilides,jdgnenu,toss and apenwa which may in my way accrue agaimt said City —
y minet.equeec.ofNegrmd,ofthisMr . 504 FINAL BUILDING ENERGY
NAPPLICANT UNDI?RSTANDSAND WILL COMPIYWITHALL NON-MINT 505 — FINAL ELECTRICAL
V ^ RI.GUTA 1D 50E — GAS TEST
(rav Jwf /"� l.
ISig mofAWlicza to cls D. 507 — FINAL PLUMBING
HAZA )OUS MATERIALS DISCLOSURE
Will Ne applicmwrfvuniipal Cgwcupapt smmor handle hmWovsmamdd Re-roofs 508 — FINAL_ MECHANICAL
as defined by the Cupcwino Municipal Cdc.Chaps.9.13,and the HWN and Safny Type of Roof 509 — FINAL G RADE
li Cde,Sctiwt255]3(.)1 YP
El Yer
Will the applicwtwfO N building wcupml use equipment wdevices which All roofs shall be s eetekygCl1 Ty�[J�g1Js�Y'{Jfk�k5{l t1Ar�P+, rg, terial being
emit harasdose eu wnum;nO so defined by Ne Ray Area Air Quality Menagernent installed. If a rot s�a11eU W thVl� o 'tslilii�t'g an inspection
'auictl
❑Ya ❑No I a ree to remove all new materials for inspection. Applicant
- Lha eRadNe1R>ars«tort,�idaRgtimmenwadncbaprati.95kiNecai�
unclerstands and will comply with all non point source regulations.
Nana HmLN&Satiny Code.Sections;]5505,25533 and 2553x.1 uldvarad that if Ne
bu xta cuwentlyh camnant,Not is is MY respomibiloy to notify the ccupmt
la whicr s t pnono.nuance ofaC fn fOcca y.
men s '^ Signature of Applicant Date
r or eutMwzd f Dam
All roof coverings to be Class"B"or better
OFFICE