04050058 —CITY OF CUPERTINO
BUILDING DIVISION PERMIT 0
BUILDING ADDRESS: ASSOCIATED CONTRACTORS COR .YER11'904-050058
20370 TOWN ( RNTRR T,hl
OWNER'S NAME: PERMIT ISSUE DATE
HUNTER PROPERTIES 840 JURY CT. in�;Z_1.2/2nn4
SANITARY NO. CONTROL NO,
(089) 714-0
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ARI
4 0 z LICENSED CONTRACICWS DECLARATION Job Descrion
I hereby affirm that I am licensed under provisions of Chapter 9(commencing tion
with Sec oth, )of Division 3 of the Business and Proolussimixt Cook,and my license is
hN I.fail f�?ehdoffaq�� r7icil 2,57 TI--BATHROOM UPGRADE
Licenseas,
Dam '0 In one Di: Z ION AsTe C>
tt'eM
I understand my plans shall In used a pub mods
Licensed PlefinsimUL41 OWNER-BUILDER DECLARATION
I hominy Affirm'hot I am exempt from LIM Contractors License Law for the
Wcz following am .(Section 7031.5,Business and Prodessimna Code:Any city A,county y
which mquiret a Permit to construct,Lifter.impmw,demolish.or repair any moisture
Fie pri its issuance.also Acquires thicapplicant forsuch permitto
�q
that he is licensed putiman,to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft,Floor Area Val tion
(commencing with Section 7")of Division 3 of the Business and Professions Code)or
that he In exempt thereffirem and the basis for the Alleged stuoupd.n.Any vicAmon.of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not..m than five hundred dollars(M). 3 6U4CNuh%cr0 0 Occupancy Type
C]1,as Owner oftlin property,w my employees with wages as chair sole compensation,
nilldothework.end thentrocuoni...ti.=&doroff..dfo,s.le(Sc.7W.Businws
and Pirmfoodons Code:The Comoracutur's License Law does not Apply M an Owner of Required Inspections
property,who builds orimproves thereon.and who does such work Ili nselfor through his
own employees,provided thatsuch improvements Are ROL intended or offered forsaft.If.
however,to building.,hoproccou,na I.old within one year.f.anplatt...the wrou.
builder will have the burden of proving tat IRA did not Wild or improve for purpose or
ARM.).
(3 1.as Owner of the prowarry,am exclusively contracting with licensed conermaxas to
construct the project(Sen.7040.Business and Professions Cock)The Contractor's Lt.
come Law does not apply W in Owner of property who Wilds or improves themon,and
who contracts for such projects with a contractors)licensed pursuant in the Commerce,
License Law.
C]I no exempt under Sam -,B&A C for this motion
Owner Data
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury one of Be following declarations:
have
A and will midnWnaCe�ricm.fC....it..If-insumfor WarkesCompn-
A,an pinwhind for by Section 3700 Of the LAW,Code,for the porlmnotnee of the
Am,for which this permit is issued.
El I have And will maintain Workers Compensation Insurance,an required by Section
700 of
%a Labor Code.for the Performance of Ne work forwhich this Permit is issued.
Licata Cmnle"Al"On fromeacce cam.Or and 1,99*cy number am:
11 P"I,"C' XP_) - P O(OL44
A: , 'i
--ar. 3T'%RTIFTCATE OF �:� M WOR
COMPENSATION INSURANCE
(Did;section Road nothecompictiod Box,Permit Is formuthundool dollars(SIM)
Or less.)
I cenify that in the PcTrommarce of the work for which this permit is issued,I shall not
employ any person in any manowron As to become subject in the Workers'Compensation
Laws of California,oat
Applicium,
NOTICE TO APPLICANT.If.after making this Ccifiricace of Exemption,you should
Wricure monject I.We Workers Cmericnitsom provisions of 0.labor Chun,you most
Z forthwith comply with such roviaimor or thin permit shall be deemed
revoked.
0
CONSTRUCTION LENDING AGENCY
I handby.Tion this than,I.a construction lending Agency her Bit por(.mment,or
Cli> the work for which this permit Is issued(Sec.3097,Civ.C.)
Leader's Name
z Lender's Address
0 1 Certify that I have mad did,Application and main that the above infannadun is
come,.I agree to comply with all City and county andinances and Shut Ifins painting to
building cOnSUMLion,and Rarely audoomon mintsentadves;or this city to enter upon the
above-mantimed PMInY forimpaction PATOSAL
(We)agree 1.saw,indemnify and keep harmless the City of Citpord..!Scitu
flabifiticajudgincruscoms and expenses which may in any way accrout agamstsaid By
C7)Z in COAmputmCC Of the gronfing Of this Permit.
LI NT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: D2q/
�' _W Re-roofs
T9.AL1oBS,pIr APidthmotmit.wr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant mom or hsMlc hvudousormatird
as'.r,.d by LIM Cupertino Municipal cipal on,Chapter 9.12,and the Health and Safety
Code Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
[3 Y., ;F�o
Will the applicant or futurc building occupant use equipment or devices ces which If a roof is installed without first obtaining an inspection,I agree to remove
I hazardous air conmmfina;;��der by the Bay Ama Air Quality Management all new materials for inspection.
strict?
[:]Yes
I have cad the hexaml.m.materials roxpommoms under Chapter 6,95 of Ne Calif.,
He &SafmyCode,Sttdmts 35 25533 and 25530.1 de =it BAR If de,building
"ARM
A
ly ft cecupom of the
Hourems which Must ROE. ora"E'
-V-� Signature of Applicant Date
A Out currently have A tenant.BAR I rRyms,ponsibili in
On,
I
t S� All roof coverings to be Class "B" or better
Owner 9 ,uta Data