06090066 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT dC��NTRACTORIIYIt'ORMATIQIV
BUILDINGAODRESS: AECHA CHEW PERMRND'06090066
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n o 0 0
;op LICENSED CONTRACTOR'S DECLARATION Ib Description
m 1 bmepy affirm Nat I am licensed under providam OCSCTI of Chapter 9(commencing P
�i� with Sabo^]Of111)of Division 3 of the Business and Professiom Code,and my Ilcrn¢u
�„ mm0fbrcemderfeme TEMPORARY POWER POLE
? License Class Lic.g
NaDx Conuatemor
ARCHITECTS DECLARATION
i
i I mtdcrsund my plans shall be uud u public mcords
iyO ^
G�; Licensed Prof cuicreal 7
3 OWNER-BUILDER DECLARATION ,
aE I hereby so a(Sect Out 11. uempt from Ne Co^umctors :Any c Law fou Ne w
.a O
which
mann.(Section](131.5t Business and ive.Otani
Cade:Any city or county
which issu a permit re ennmua.alms.Improv,h pirmts t fi repair any mucron: V 3 5 Q
-Z<
prior mitscensed e,also mgo theres provisoes,of the Connector's
icroufile 3 t ned Law(Chapter
;i (comm is licenseitpSemantrethe prevision of theeut Buinessnd Prof Lions Code)or Sq.Ft.Floor Area �'dlU CIOn
4�$ (commencing with eecdorm and ofbasis
Divisioneth al Business inumnd Professions Code)of 6
IMt he'a exempt therefrom and the meso for dm alleged esempdan.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant or a civil penalty of Occupancy Type
net mom Nan rise hundred dollars(ISM.
I,as owtnrof the property,ar my employes with wage as their sole camperoadon,
will do the worki and the awctem is not intended or oRemd fousale(Sec.7814,Business
and Pendisld.Code:The Commmrs License Law doe act apply m an vomer of Required Inspections
Property who pts ilds or im proves thereon,and who does such work himself or through his
awn employee,provided that such improvements are not intended morlefrd forsale If.
haw Wildingofimprevemant u mid within one year o(cempletiun,the ownce-
builder 1 have toe buAu of proving Oat he did not Wild of improve for purpose of
sale
L .
8 I,as owner of toe property,am exclusively contracting with licensed mnuxmrs an
consumer f project(Sec.7014,Business and Professions Code)The Commetori Li.
ouncelaw dao act apply m n mwnu of property who Wilds or impmms thence,and.
who con suchp 'elswithacon m icensed Internet w f Commerce's
Lem
declarations:
I have and will mainuin a Certificates ar Consent in self-imam for Worker's Compere
saripn,u provided for by Section 370(1 of dm Labor Code,for the performance of tW
wort for which this permit is issued.
❑1 bave and will mainuin Workers Compensauo^Inaurma,u required by Soetion
37W of Ne labor Code,for Ne pmfmmanee of the work for which Nu permit is issued. '
My Workers Compensation Insurance carrier and Polity number are -
Camcm: Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm laccompleted like pc.our...c hundred doll.(5100)
or less)
1 certify Nat in the performance of the work foe which ch per nit is issued,I shall not
employ anyperson iR man co c b' Workeri Compcnsatiun
lawn of Califomfi Da
Applic
NOTIC lI,a mf making thts CediOcate or Exemption,you should
become subject to the Womkers Compensation previsions of the Labor Code,you must
.,O forthwith comply with such provisions w thu permit shall be domed revoked.
'Z,'" CONSTRUCTION LENDING AGENCY
[—� 1 thereby alruo that Vert is a (Sec3 lending agency for the performancc of
fY, the work fur which Nis permit u issued ed(Su:..303],Civ.C.7
Q Lenders Nene
] z l<ndcr's Address
U C) T certify Nat 1 ban read this application and sum that the above information is
correct.l agree to comply with all city and county ordinances and sum laws relating to
rJU building construction.and hereby authorize reprexmnivei of this city to emir upon the
r a above.mentioned properly fur inspection purposes.
(Wc)agree to save,indemnify and keep homeless the City of Cupertino against
F',ir, Rittolides,judgecnaxosa andupensea which may in my way...against said City
(„)z in con' uezof�jmjfin,Aof D Wl'APPLICAA .AND WT Y WITH ALL NON-POINT Issuedby: Date. � / Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will(ce applicant or future Wilding occupanssmm or handle hzrardoes material
as defined by the Cupertino Municipal Code.Chapter 9,11,and the Health and Safety
Cade,Section 25532nd?
41 0y. krN- All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an agree to remove inspection,I
Will the applicant or forum Wilding oavpanr sax equipment or devices which P
emit huardous ale conurnmr;u def ed by the Bay Arca Air Quality Management all new materials for inspection.
D str ct?
❑Yes
1 hove maJ Ne Wrallous materials rtyvircon nu undo Chapter 6.95 of the Califon,
nu Hu1N&Saftty Co ,Se An 25505,25533 �f.lumkrnand thoirue Wilding
docs nor evnently hu pant,Nat no
res silidn m noddy the acupant of tW
mdimmntsw m x
All roof coverings to be Class"B"or better