00040153 f - Ai. 4 S -'^ k Y f " PERMIT NO.
CITY or CUPERTINo CONTRAC I QR INFORMATI(QN
BUILDING DIVISION PERMIT
BUILDING ADDRE� / D_.X/moi!/�iAy�.I'dlG V SANITARY NO. APPLICATION SUBMITTAL DATE
CIO '3 y oil 6t�f'Aew
OWL'S NAME: �Y6�6 G r Au �(ga NIC CONTROLX
u�i00 gC ITp,(:VENGINEE= �aXFk4r'W1 OF `9as/) :w:'a;HUDDINO PERMIT INFO,•in..t_-
d 951=
<_ 7CCJJ 77r a S -y�3o
j LICENSED CONTRACTORSeunder
DECLARATION
C'E 1 hertby aNrm Nos I am liccmeduMu Provisions of Chapter (commencing Job Description
f-w with Sec,ion]000)ofDivision]ofN<Bu,NesoWProfwion,Gd<,eM myl�ulu it
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infu
ll fora and affm 3 'o
ods �anaG _ :iv_�<.«
Da¢ Cdnautm
ARCIFITIEC
SDEC
TION
'15 I undersand my plans shell W u A
ed as public records
goo
Licensed Prof<a;onal
m
OWNER-BUILDER DECLARATION
H z< I hereby ffinn Net 1 am memexemptpt from the Contractor's License Law for,he
F o following eeaaon.(Section]031.5.Business end Profcasiom Curie:Any airy or wunry .t
ce n.3_ which its i....
.Perms tocomlrud,aar,improve,h PermN,or..signed Yeuucsuse q. F')OOY�p0.0 �]vaDasl�", '
thatnoiblensedpasort to da,meapplicantfa mchpvtcr`3U soma dm-meet ('/'J(j/Il(//'J
Nes hely licensed Wretham to N)provisions of Ne GO3mi. Udine-law(CMptv9
(commencing wiNSection 7")of Division)of thaBmivar oaf PvRmiom Cdgm � A N umber Occu Cy Type
Nes le is 313 b thuefmm and Ne breis fm Ne a1.8ed gumption.AXY vio4tion of l/o_ 0 — 0
oot con man v any dred doll for•gamut subjects the epplicast Io•civil Pendry of
t mine th.n five nandind adn.rs(Sroe). Required Inspections
L as owarof she pro arty.mmYemptoyeea with offered far
Newel.compewdon,
sand Pr fework,atae: he Concis nosintended m Law
es�e(Sec.00an caeit-u
end property
who
Cade:The Contractors License law rices nm apply s if owner of
progeny who builds or improves t such improvements end wbo re ra work Aima,(or ded f-d
gh
his own employeee provided Inn such oldw thin not intended or offered for
same,(,M1dwgvanthgve building in improvementieholdwithin oneild 1improve for N-
owner-W ilder will Asea Ne burden of proving that he did nos Wild dr improve for For.
pose clean.).
L uower of the property,rte c.clu,ivcly convecting wco
;N keened mm�un m
com.1,Ne projec(Sec.7W.Bminesr and Profcuiom Code:)The Conwnola V.
cense Lew das not apply ur an owner of property who Wild,or improves decision.and
wbo cdn,ncu far ouch Pence.with acov—in'(')beamed Pon-1-Ne Carinate/e
Liccnse law.
El Ism exempt under Sec. .B&P C for this ratan J
Data
WORKER'S COMPENSATION DECLARATION
I hand w einrm under Penalty of of ory one of the following declthes Cor
I have and will merman action 3 W of Consent eLabor Code.fuinhe Wmket,Cori
as;on,r providedichis
for by is issued 3]00 of the Labor Code.for the Pendmmna of the
k for,and ill passim is Hri,,s
�d of
and mninain Workers Cole of the
Insure whihinquired by Section
)iW of Nc Labor Code,for Nc perrormencc of the wwk fur whicbg{eNis permit is issued.
My Work�(]f�� �°f�°� nec< eared Palicyn�bcr g{c: 9.311H
Cartimr. `^' `��`�sur °n' Policy No.: lr/t�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
finis amner amd.becomplved iftha amus is Aside.hundred dollen(8100)
or less.)
Loy an,person
in in my moure. of Newinkfm uich im,his persthe
lissued.,-hall
not employ any person in my menneno....become,ubjvuo the WaAen'Comate
inion taws of Caifurnm Data
Applicant
NOTICE TO APPLICANT:If,after making this Certifies-of Enemplion,you ahouM
bums subject to the Workcra Compensation provision,of the Labor Code,you muss
fonbwilh comply with such proNtions or this ame,shat he domed invoked.
CONSTRUCTION LENDING AGENCY
Q z l hereby afnn Nn there is a comm,edon lending.gen,for the performance of
z, the work for which this Permit is issued(Sec.3897.Civ.C.)
F ti Landers Nm
a 7 IaMcis Adders,
(a31 ceufy the,l have uE Nu
aapplication and sate that Ne above information is
4 E or
mal.l agree to comply with all city a,td county ordinance,and acv laws uleung er
w7 Z, buildiogcons—non,and hereby amannim epicsenutivcs oftos city to easier upon the
U C aWv...nZmcd ao eny for inspection purposes.
ry (Wa)agree u.a...indemnify and keep homeless'he City of Copartner egaimt
Q U liabilittes,judgmems,coneand apcmea which may in any wayamruugelmt said City
W in consequence of the granting of this permit
Vg S(IDIt CA RI,OULATIDN$ND5 'II WILL COMI'hY WITH ALL NON-POINT
mut ofA-LicandCom r Dthe
HAZARDOUS M E0.1ALS DISCLOSURE —v
Will the epplicansor fusuu Wilding..Wis.si handle hadedou,meaeia Re-roofs
defined by see Capacious Municipal Cade.Chapter 9.I7,said the Health the Safely Type of Roof
Code.OY 25532(.)? yP
All roofs shall be inspected prior to anroofing material b
Will Ne applicant or future Wilding occupant use equipment or devices which y pang
ii heaarde.,alt conamearms a,defined by the Bay U.Air Quality Monogamist installed. If-a roof is installed without first obtainingan inspection
++tato Yc ViaI agree to remove all new materials for inspection. Applicant
Iheve read Ne tuwdous melena.mquimmemr under CM1ap-rM195 oldie Cali-
ford.
Understands and will comply with all non point source regulations.
fomes Health&Safety Code,Sections 25505,255)3 end 255)4.1 understand that if du
b' does nm cun<n0y heves osiers'W'unmy mibillry to rosily the Weapon,
fthe site to;
-' .cat,in..-dra.a Date
nature of Applicant
O aro eudronzed agat Da--
All roof coverings to be Class"B"or better.
OFFICE