04120115CITY OF CUPERTWO n�7a,�a
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BUILDING. DIVISION'. PERMIT . •
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BmLDINGADDRESS:
SOUTH BAY CONSTRUCTION CO
ITN004120115
OWNER'S NAME:
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PERMIT ISSUE DA'Z'E '
HUNTER PROPERTIES
SANITARY 10, CONTROL NO.
408)j79-0400
'ARCHTIRC AENGINEER:' -
BUILDING PERMIT INFO
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13LM ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
,wlNW7�O),ol,Dlvn
'' v lob Description
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1 M y affirm that I Am licensed under provim Ioyq`Clnpmr 9 (commencing
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SofNOBummas lassTdnsCmh end ylicenaeiammi'
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REVISION --IN HOUSE -USE ONLYLiceN'..
NO'NEW.PERMIT ISSUED/ORIG. #04080178
arcContractor
CHITECTSDEC
shell W used u TmNi n
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Licensed Pmf
' OWNER -BUILDER DECLARATION
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I Lcmby, affirm thatd em eecrepl from the Camrecror's Licenu Law far the
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following moron. (Section 7031.3, BuAmas end Profusions Cade: My city or county
which acquires A Permit to construct. Alun improv. demolish, ar mpir Any nmcium
prior an its issuenec. also requires the applicant for each Permit W RIe ¢signed maumam
weW talicomed pumaant to tal prov'ialom of Necontrseuu'sucaase taw (CAApur9
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- Sq. Ft. Floor Area
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- Valuation$43
(mmmencing With Smllon7 W)of Diviaiob3afthe Buainesaand Profwiam CWc)w
that he is exempt the sfrom. and Ne basis far the alleged exemption. My vloladon of
_. APN Number .'
Occupancy Type .
section 7031.5 by AM Applicant for a permit subjects the applicant to. civil penalty of
int name Nen live hundred dollars (8500).
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36940017.00
owner oftM wu property, army ploycwith wage, es duUsole caeopvuedon,
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Required Inspections "
win do the watt. And inamorata LL notimanded aro@red fnmale(Sm. 7044, Butlaras
and Professions, Code: The Commences Limn¢ raw does not apply he an owner of
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propenywho build,orimpraw utereon, andwho doeseuchworkhimselforNrough his
ownemployees, provided that each improvmenu K notinunled oroQered formle.If.-
however, the building or improvement is ¢old within am: year of completion. the owner.,
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builder will haw the burden of proving that he did Act Wild or Improve farpurpose of
❑ I, As owrur of the property, ,A. Business oand caniM)nt with named cantrsemn .
IS u Codei The U.
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m daemon.
who Wires or improv Comm. Ana
teamcommL wit es not ly roan wnerofAnd property who
came law coca not apply m ts owner of pm
tarty
who contracts for ouch projects with econuacmr(q licensed pursuant rothe Contrsemea
Licenut _....
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❑lam uempl undo See. .BB PC far this naeon
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Owmr Data
WORKERS COMPENSATION DECLARATION,_�
I Wmby affl m muter penury of perjury one of Ne following dm ism:
I haw and will maintain a CeniRuu of Conammselhlmum for WorkersCompen--
asdon, as provided (a, by Section 3700 of be labor Code, for the performance of the
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wart for which this permit is issued.
❑ 1 have end will maintain Warkee, Compcmwon I.., as mgtared by Section
3700oftW tabor Code, for Ne perfarrnanea of Ne work for which this permit is issued.
My We Canape a Ion 1 nor carder Policyn
Ce •f ' No.: �/
CERTIFICA > PQK 1 FROM WORKERS'
COMPENS i0 SURANCE
(nds W. ad notal completed if the permit 1, far ane hundred dollam(8100)
orf s)
I eerily, that in Ne performance of Ne work for which this Permit tai Wesel, I Ahall not
employ any person in any mannerm as in become subject o CU Worker'Compensation-
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LawaafCWfamia,Dart-
Appliesnt
NOTICE TO APPLICANT: If. after making this Certiftcau of Exemption, you should
become subject to the Wallace, Compensation provisions of the labor Coed, you more
faMwith careply with such provulom or Nu permit mull W deemed revoke¢.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Nem las construction lending agency 1'nr the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lendces Normo
Le.dee, Address
I certify that 1 haw need this application And,ute fast the show information is
correct. l agora to comply with all city and county omioeacus and a= laws muting u
Wilding conatmctlon, and hereby auNotim mpacumuliw of this city u enter upon Co
show-mcnduned property far inspection purposes
(We) agree to saw, inacnnlfy, and keep beanies, the City of Cupertino Against
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liabilities, Judgments. costs and expenses which may in any way Accrue against old City
in comnce of Nc Lrenting of this permit,
APP I NT UNDERSTANDS AND WILL COMPLY WITH ALL INT
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Issued by: Date' 6
$ Il ,al
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Re -roofs
Type of Roof
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WU a Applie Conlnctor �� au
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupam more orhandle harsmaes maudai
as denmd by the Cupertino Municipal Cade, Chapter 9.13, and the Health and Safety
Cade, Section 255324)? y
All roofs shall be inspected prior to any roofing material being installed.
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If a roof is installed without first obtaining an inspection, I agree to remove
Will the Applicant or future building occupant use equipment or devices which
It hvamnus Air contaminants es dcflncd by that Bay Arca Air Quality Management
all new materials for inspection.
District?
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I have mad Ne hasammu mmcdala requimmcnu under Chimer 495 o(Ne Cal t far
nu IN@Safcty Codc,3 aAM50 35577 and 255N.IurNessuM thmBNC Wilding
c ntly haw An, Nm' u my mspauibility m mdfy do pant fine
math emet a,wuanmoracemneateafaa c.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner orauthadudsml