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CITY OFCUPERTINO�a
BUILDING DIVISION PE
T'C0 TRACTTTTTTT R INF�URMATION .
Bun,Tt(raA6l31 ORRE AVE
COBE CONSTRUCTION
PERMIT NO.
08060165
'S NAME:
JV
PERMIT ISSUE DATE
]:TY OF CUPERTINO
2470 S WINCHESTER BLVD STE
07/09/2008
PHONE:
^
SANITARY NO. CONTROL NO.
(408)371-3400
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
I Job Description
P
1 bereby srrrm that 1 am lienwd under provisions of Chapter 9 (comm 1.&
with Section 7")af Division 3 afthc Business anal Pmreuram Code. send my licenses,
REPLACE (E) BOOKD DROPS W/NEW BOOKE DROPS LOCATED
UU.cla1Iud`ffees
Lic.a
ON EXTERIOR BLDG WALL.CITY JOB NO FEES.
Date Contractor
ARCHITECTS DECLARATION
1 undeaund my planes shall W used u public records
Licensed professional
OWNER -BUILDER DECLARATION
I bemby affirm that I am exempt from dm communes License Law for the
'
following mount (Section 7031.5, Business and Professions Cour: Any city or county
which rmuirea a permit to conson:6 setter. Impmw. demotim, or repair my subclmc
Prior u, its issuance. also re9uims the applicant for such Permit to role a signed statement
Contmcter's License law(Chape, 9
Sq. Ft. Floor Area
Valuation
that he is licensed pumunl to the provisions, of the
$ 0
(commencing with Section 7000) of Division 3 of the Business and Roreuimu Code) or
dun he is exempt therefrom and the huis for the alleged eas mpuon My violation of
6 9 310 3 3 N Number
Occupancy
P Y Type
Section 701IS by any applicant for. permit subjects the applicant no a civil Per" RY of
ml mart the five hundred dollar ISM3
.
❑ L u owml athe property, or my wployes with wages u theh role cempenuum,
Required IHSpeCt10DS
will the wars, and memuatuee mol rounded Busiea
ad an
W Pr Cade: The Contractors Llwue Law dao ren appy m rt owner of
, Law dd ss not apply
onywhona
des,suchwalkh rolleamthrough his
propertywhobuildsm dthat
Inthereon,anduaha
awn employees, proMded this such rmprowmmcs are not inteMM run sale
n.
however, the Wilding or imp rowman t,m V rola within one year of mprom m, Ne marten.
completion,
buildervela have the Wham of proving that W did net Wild or improve for purpose of
tile.).
❑ 1. u owner of the property and, acluumly contracting with licensed conaxmm m
ceesmct the project (Sec. 70ad. Bosinm and Professions, Code:) The Cmummr's U.
_
cense Law does not apply to an owner of property who builds or reproves damson. and .
who counacu for such project with a contrmmr(s) livened purswnt to the Containers
Lice s. law.
Iam exempt undo See , B At P C for WS neuron
Dam
WORKERS COMPENSATION DECLARATION
1 hereby air,. under penalty of perjury and of the fallowing deelermronz
1 have and will anamufn a CeniEnuaf Cmismo to seff-m uto fm Worl efs Comperom
sanion, an providW for by Section 3700 of the tabor Code, fm the performance of the
work for which this Permit is issued
_
0 I hate and will maintain WorYels Cempcmatlon Insurance, u minuend by Section
3790 or the labor Code, for the performance of the wort for which this permit is iuued.
My Worleer's Compensation homnvum artier and Polity number art:
Carrier. Pais, NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
r171is realm need ml be cmnpleted err Ne permit Is fm see hundred doRms ($ I OG)
m alas)
I a+uh than in the performmm of the work for which this permit is ironed. I shall ON
employ any perm- in my mama r w u b become subject to the Workut Compmwuan
Laws of Caliromia. Dau
Applicant
NOTICE TO APPLICANT: IL a t r making this Certificue of Exemption. you almuld
become subject to the Wohels Cempentitim provisions of the Labor Code, you most
forthwith comply with such provisions or this permit shall W domed mroked.
CONMUCrTON LENDING AGENCY
1 hereby affirm Nu more is a construction lending agency fm the performance of
the work for which Nis permit is reed (Sec. 3097. Cir. C.)
Lcndces Name
Lender's Marti
1 wufy that I have rtW this Appecavon and sus, this the show intermaum is
emren. l agree m comply with sit City send County anBnmces sad sus, law Maung an
Wilding construction, and bemby au thane mpRYnntsam of this city be mol upon dm
tan inspection purposes
ahovcmmudgm
(We) agree no save, indemnify and keep howlm the City of Copertrm against
judgproments. sit
mu and expatseswhich may In any way move agaiulsaid City
in of
in consegnence of the granting of this pemin. '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Signature of AVGI(emUCentramen Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applianl or future Wilding m njou'atou m handle hauNous material
fined by the Cupertim Municipal Code. Chapter 9.12 and the Health and Safety
'
.seamen 35533(a)7
❑Yes phase
All roofs shall be inspected nor to an roofing material being installed.
P P Y g
Will the. Burnt m furore Wilding sew, am use a
PP 6 P equipment m device whim
If a roof is installed without first obtainingan inspection, I agree to remove
P
m hmasdnm air cmuminants u dcfimd by the Bay Area Air Quality Management
all new materials for inspection.
Di
Disticrt
❑Yes 0 N
1 have mad the harardtw materials m9uimmmu under Chapter 6.95 of the Califor.
nia Men?" Safety Code, Secuom25505,35533 and 25534. I underwnd sew iflW Wilding
does not currently haw, a unanl dw it is my responsibility to notify da: occupant N the
ra)Ylmmema which most he mel prior b issuan4 of a Ccma w of DCCUpmCy
Signature of Applicant Dale
I All roof coverings to be Class ';W' or better
Owner er mthmr>m agent D,teI