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CITY OF CUPERTINOE'7777,m`�
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BUILDING DIVISION PERNIITCrONTRACTgIiI1VFQRNIATIQ.N
BU ILlTbCG
PERMIT NO.
8TEsTORRE AVE
TBD - TO BE DETERMINED
08090038
W NER'S NAME:
PEEMR ISSUEDATE
TICO CONSTRUCTION CO
09/08/2008
PNONE:
SANITARY NO. CONTROL NO.
ARCHITECIfENGINEER:
BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Chapter 9
Job Description
of (A meminj
I Weeby affim that 1 sm lived under provisionsm
with Session 7011)) of Division 3 oftho Business an�daPprofession Code. and my license u
3RD FLR REPLACE 116 LIGHT FIXTURES
infullfomeande _/a Lle.♦ O /I2r7
Lleewc Claes
RC POWER INC. PD FOR BUS LIC 9/5/8 #30423
Dau Contractor
ECL
DECLARATION
As
Shall Ate
I understand my plans shall ho ItSd as Public raorN
'
Licensed Professional
OWNER -BUILDER DECLARATION
I bemby affirm that I m exempt from IW ConomoYs License Law for rho
following mason. (section 70 1.5, Business and Profession Cade: Any city or count
which mqulrn a permit w cnn9ruel. alter. Improw, demolish. or epi, any wuclum
prior to its issuanec. also requires An applicant forsuch Permit to file a signed natemcm
Contractor's Uccom Law 9
Sq. Ft. Floor Area
Valuation
that ho is licensed pursuant to the provision of the (Chapter
40000
(commencing with Sation 7000) of Division J of tW Business Doti Profession Cade) or
that he is wempt therefrom and We bases for the alleged atempUoa Any vblaut of
36941005
Occupancy
Pane Y Type
Sadao 7031.5 by airy applicant for a permit subjects the applicant IS a civil penally ofNumber
set mom than fin hundred dollars (1131)(B.
(] 1, u owner of 0e propctty. ar roy wpleycn with wages u Neo sele oompenution,
Required IDSpeCIIODs
hofewodt and thesmmm userintendedoroRe
Boer
of
and Profession Code- The Commetor'sdencere. License taw dun nosapply lf an of
and dos, apply
_
Wildsorimpromdh told donst umak ough his
offiforNrwgh
onmenywho
mounted
semm0teenotamended oroBered for sale Ir.
impronemmus
Nal such ire
ewnctePbyeWiping
is yearofcompletion.theowner-
the Wilding orimpromnatissulciwithin
or
Ali
W alder will tun rho Wren of proving WI he did tl build or improv for puryese of
Wilder
sale.).
0 1, as owner of the property am esclui only contracting with licensed contractors to
construct she project (sec 7044, Bnineu and Profession Code:) The Conbahers Ll.
.
corse law don set &W, to an owner of property who Wilds or barroom themon. ad.
who contracts for such projects with a conmenat(s) licensed pursuant to use Gnlrateh
Lim. taw.
❑Iweawpt seder Sec ,B3PCforth3caws
,
Mf Date
WORKER'S COMPENSATION DECLARATION
1 homby afftm under petWty of perjury ane of the following dalaradon:
❑ Thaw Snd"lmainWn•Cenif=mof Canenlwself.iusvmfa Weekers Compen.
smon, as provided for by Scetian 3700 of the tabor Code. for can perfnrmtce of the
work for which Nis Permit is issued
0 1 han and will maintain Wor s Compensation Insurance, as Inquired by Section
37IXI of the labor Code, for the performana¢oftho work for which Nu permit is lutd.
'
My Workers omp cation Insurance carrier and Policy number am:
Gmier. iv Polley No.: /A/Fn/sri d 0'SZ / Z
J
CERTIRCATE •E?[EM LION FROM WORKERS'
COM ENSATION INSURANCE
m,h, aectiort need tthocempleted irde permit is ferone hundred del4n (SI W)
or s)
1 certify dant in the performuee of the work for which this Permit A issued. I "I In,
employ any Pence to my mamerw as to bccAA, subject to the Workers' Compensation
Laws of California. Date
Applicants
NOTICE TO APPLICANT: IL after making Nes Certificate of Exemption. yen should
become subjm w the Work s Compensation provisions of We labor Code, you most
forthwith comply with such provision or this permit shall Is, deemed rented.
CONSTRUCTION LENDING AGENCY
I heebY affirm dor Note is a co Watt,. lending Seery for the performsut of
the work for which Nes Permit is Wood (See. 309'f. Civ. C.)
,
Landers Nam:
Leader's Add.
I certify that I hart mad this application and stew that the Show iNomudun is
.
arrest 1 agate w amply with SII city and county mdinnces and sate laws relating to
Wilding cunsuoction, atW hereby authorise teprcserl of this cit to now upon the
ahow.matiened for inspection purposes
(Wc) agree to An. indemrdfy d kap hemlew the City or Cupertino against
'
lus
liebilitica.jedgmcnu and ex which may in any way acest aginatsiO Cily
espcmil.
in cortscgtluo e "ANO
APPLICA N A AND WILL COMPLY WITH ALL N N- NT
Issued by: Date
"tG A
Re -roofs
Type of Roof
Si of AL,l' alracler ate
' AZARDOUS MATERIALS DISCLOSURE
Will the Rcanl ter fauns Wilding oauputeue orhaMle hamdmu material
u de0ad by Cupeni Mur1lClPiI Code. Chapter 9.13, and site Bell and Safety
. Section 25532A)?All
❑Yrs No
roofs shall be inspected prior to any roofing material being installed.
Will Nc, iami or future Wilding occupant tm e w w devices which
pP eequipment
If a roof is installed without first obtainingan inspection, I agree to remove
P
emit Wsatdnw ter contaminants rs defined by Nc Bay Arca Air Quality Management
Qu
all new materials for inspection.
Disuicti ((
❑Yrs �jyo
I haw mal site hvaldoru matesiaesmquimmenu underOmpter6.95ofthe Califer-
niaHnl"SafnyCyd c5ion 25505.25533 and 25534.1undmtand Na ljsle Wilding
don tt cumnl yif tenant. Nat h it my rnpon;bIlly w notify dep6cu u'al of Ne
mquimmcn I sthemet prior WWeance.(aGnlOeaeo /fop
Signature of Applicant Date
All roof coverings to be Class')"
g or better
owner sen dagent D,m'