03030018CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CUN'-L12ACT,O.RINFOItMATQN^;
BDILDINDADDRESS:
ACME & SONS SANITATION/ELE
lMi"D.
R'S NAME:
- 3405 HILLCAP AVE
PeRA1R lssve °AT8
CITY OF'CUPERTINO LIBRARY
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NE:
(408)295-2263
SANITARY - C0MR01, NO,
ARCHITEC IENOINBER:
BUILDING PERMIT INFO .
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LICENSEDCONTRACURSDECLARATION
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JbDescription
o
I hereby affirm that I am Imemed under proviaom or Chapter9 (commencing
with Secdon7011D)orDiV1aoo3ofdm Buaineaand Erpfconce Code,mdmylicemois
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in full forardor, n g S ( /
Lt... Class C�—
TEMP POWER
Dau� 0 ,_CS'DWR
"AR�xr1Ec1's
CITY PROPERTY/NO FEES
�f DEcu A ON
1 understand my puna shall he sued As public reaneN
Licensed Professional
OWNER-BUILDER DECLARATION
I hemhy aRrm Nn 1 Am exempt from d u ConlnaoYs umme I.A. for the
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following means. (Section 7(013, Buainest and Profession Code: Any city or aunty
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which requires a p until to construct, AIR, Improv!, demolish. Or repair any arucmm
pt50r Ant its Issuance, also requires the applicant fnf such Permit to fde a Agned amu nlem
that he is licensed pursuant to the provlslona of the Contractor', Llmrse law(Chamerq
Sq. Ft. Floor Area
Valuation
(commencing with Section70M) of Divuibn3 of the Bminnr and Profeumns Cods) m
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$1000
mut he is exempt therefrom and mm basis for dm alleged cumpdon. Any violation of
APN Number
Occupancy Type
Section 7031.5 by arty applicant for A permit subjects On, applicant 10 A civil penally of
not mom than fire hundred dollen ($500).
36931033'00
01, As owner ofine property, or my employes with wages As their to eampensallon,
Required Inspections
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will do thewor4 and the suuctumis normended oroymcd for Aide (See. 7Da, Bmiws
and Professions; Cost The Oomncmo Liana Law does not apply m an owner of
103 - UFER
pmrnywh Wildsorimprawathcmon.andwhod iwhworkhlmselfat Woughhia
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own, employees, pruvlded that such impunmenu emnot Intended oro@red feruo. If.
304 - ROUGH ELECTRICAL
however• the building or improvement is sold within one you of Completion, Ne owner-,
builder will have the burden of proving that he did not build or Improve for pupose of
.a.).
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HALE®
❑ L., caner of de property, am eulusively cauu3ing with Iiconaed contractors to
construct me pm)em(Sec.7DN, Business and Professions Cods:) M. cwt me, U.
more m e law does not so owner of property who Wilda at impsuwa themon, and,
.. 2003 .
MAR 0 6 .
who contracts for such prokets with a contractors) licensed pursuant m the ConuanoYg
Licenae Law.
❑ I Am aemPl under Sec. , B k P C for this msson
r Dam
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BUILDING
WORKER'S COMPENSATION DECLARATION
I hemby affirm under Penalty of perjury one of ms following deClmallom:
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1 haw ad will rudmam •Ceninheamaf Consent to mINnsure for Worker's Cornpen.
udon, As proNded for by Sado. 3700 ofshe labor Code, for me performance of the
work for which mit permit is issued.
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❑ 1 have and will m4n0in Workers Compensation Insulin, As required by Section
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3700 of The Labor Code. par the performance of the work fm which this permit is Issued.��
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My Workefa mpenadm Insunrue nrrier and Policy number Am: O -�j
CA Policy No.:
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C KTIFICATE EXFMPnON FROM RKER'�
COMPENSATION INSURANCE
(Ibis section ed notbecompleud if the Permit faros: hundmAdolun (SIM)
re
lir lax) _ _
_ _ - - _ - - -' - _ � ---- - __---- • -_- _— _ -
1 artify that In the ptufn rmuce of the work for which this Permit is issued. I shill not
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employ any Porten in any manner As to become subject to the Workea'' Compcnudon
Laws of California. Dau
Applicant
NOTICE TO APPLICANT. If. after making this Cenincate of Eampuon, you should
Re workCompctlan provisions isions of labor Cram,you most
berome sobJat to eri w
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Forthwith comply with such provisions or this Permit shall be domed revoked.
CONSTRUCTION LENDING AOENCV
I hemhy Arnhem that then Is a construction lending agency for the Performance of
me work for which this permit Is luued (Sec. 3097, Civ. C.) -
Lender's Name
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. LOmmes Add.
1 cenify that l have rad this application and sum that the above infom,aiun to
correct. T Agrm to comply with all city and county on ince. and some laws totaling m
building anmwction, and hereby Authorim mpresenutives of this city m enter upon dm
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above-mentioned property for Inspection purpmet
(We) Agree to save, Indemnify And keep haemleu the City of Cupertino against
Ilab1Bdea,J dgmeom, costs and exponau which may in any wry acme against said City
In consequence of she Shaming of this permit:.
APPLI9AHT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
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Issued by: Date
s0URf1[JRECU�uON3.
Re-roofs
Typ of Roof
( a \
signature a(AppliesDam
HAZARDOUS MATERIALS DISCLOSURE
HAZARe
me applicant or forum building occupant. lir handle huudom material
ChaprMom 9.1
as defined the Cupertino Municipal Code. Chapter 9.11, roti We Halm and Safely
ed
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�aaasem.nzsvxa7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant tea equipment or dcvlas which
It hazardous air comuminanu As defined by the Bay AMA Air Quality Management
all new materials for inspection. '
trial
❑Yea ON.
I have mad me haardtma maorials requirements under Chapter 6.95.f the OHIO,
ria Health & Safety Code, ScNom 35505.35533 And 25534.1 undenmnd ren if me building
does not currently ban a meat. the It u my mapamihllity to nod ly the occupant of the
numb&rs which most m met pan I of A cegycau of O-op"u-
Signature of Applicant Date
FAA b
All roof coverings to be Class '•B" or better
r..u1h.."-e m
weer ter aulhrriada cm Dom