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04110137CITY OF CUPERTINO- - --- -- 7_17-171-7-1— i r� - - -- - suaoirvc DIVISIONPERMIT �"U a R1�7 (ii2lY%i?�M'�QrNO BUILDINGADDRESS: ", ON _ RANGER CONSTRUCTION PERMR N�4Y1O137 1 ' - ' ER'S NAME: PERMIT ISSUE DATE ,PPLE COMPUTER PHONE. -' - - -.. SANITARY NO.. - . , —.• CONTPOL NO.. (408)283-6663 ARCHITEMENGINEER: - -BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH 0 - LICENSED CON RACTOWS DECLARATION JobDescription ]be affirm out Into licensed under provisions of ChaptV (commencing. word Division Sof dte Badness Professions Codc.md mylicense is intuit'sdpuonh000)of fuit hof' 4npr(fecyL b- :5 REVISION--IN HOUSE USE ONLY Limb Clasa Lk Do _(/-�2-�° comncmr NO* NEW PERMIT ISSUED'-ORIG:- $ 040700'97--==---_:___..-_ ARCHITECTS OWCARAMN - - 1 understand my plena shall be sued as public ends Licensed Pmfcssional OWNER-BUILDER DECLARATION - -I hereby affirm that I am exempt from the Commences License Law for the - . ... .. following maven. (Secdun 703 L5, Business and Professions Code: Any city or county which requires a pcdmit m mniwm, Alto,. Improve, dcmoliah, W repair any ..Cie.pdbrto its issumm. also mqums the applicant for such Permit to file a signed statement tbatheislicenuedlivauantmtbo Pmviainnsof Nc Conuutor's U"nm Law(Chapter9 Sq. Ft. Floor Area --' --"' Valuation$.O (commencing with Seaion70W) of Division 3 of the Busineu and Professions Code)or Nal he u exempt therefrom and dam basis for the dlcged exemption. Any violation of APN Number .. Occupancy Type . Section 7031.5 by any applicant for a Parrott subjects the applicant to a civil penalty lir not mare than, five hunarod dollars (SSW). 01, As owner of the property, or my employees with wages As their sole compensation; .. ., Required Inspections e nsoes will do the woh, and th mombee isnot intended or offered for sale (So. 9044, Business Lice,Law does not apply to an owner of and ProPossions Coda: The Connemse q - P property who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. If. - _ - howevegNebuildingorimprovemenlismldwithinoneyearofcompletion. the owner-- builder will hove the burden of proving that he did mol build or improve for purPrue of - ^ '-" `- -" '- "" -• "` " ' I, As owner of the property, am exclusively professions with contractors V :i The i. copse a the pmjea (Sec. Business and Codes Tim Consmmr's Li- ny who Wi or improves thererac and o in ownar of pmpeny who cense law dons nouchply m sed p who contracts for such projects wiNaconemma(U licensed pursuant to Ore Contnemr's is License law. - ❑lamexemptunderSee. ,B&PCfor this moon ' at Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following decimations: - I ham and will maintain a Certificate of Com enuo self-insum fm WorkeesCempen- sation. as provided for by Section 37M 0( the labor Code, for the perfmmmce of Ne - ......_ ..,�.._ work for which this Permit is issmJ. .. - ❑ I have and will maintain Worker's Compensation Tom... es required by Smd. 37M ofthe labor Cod, for the performance of the work for which this permit is issued. My Worker's Compensation lnsumnee carlennd Policy number am: ' C 'er. T/ ' Policy No.: CERTIFICATEOFE MON FROM WORKERS' COMPENSA ONINSURANCE - (This section need not he completed if the permit is Intone hundred dollars (SIM) or TGs.) 1 certify that in the performance of the work for which this Permit is issued, I shall not employ any person in any manner At, As in income subject to the Worlmrs'Compensation - - Laws of California, Dam Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption. you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Permitshall is, doomed mmked. - CONSTRUCTION LENDING AGENCY 1 hereby alrom that there is a construction lending agency for the Pcrfurmantt of the weds for which Nu permit is issued (S.. 3091, Civ, C.) Lender's Name Lenders Address 1 certify that I have mad this application and stem that the me. information is correct. I agree in comply with all city and county ordinances and sum laws relating In - building convection, and hereby auNoriae miumanutivG of this city to enter upon the ahovc-mentioned property for inspection purposes. (We) agree to now, inticmnify and keep harmless she city of Cupertino against .. liabilities, judgments, casts and expenses which may in my way accrue against mid City - - t in coneequcnce of the granting of This permit. APPLICANT DERST Dg AND WILL COMPLY WITH'ALL NON-POINT Issued by: . �• • Date SO S. Re-roofs - © - o A Prcmvcontmcmr Dam HAZARDOUS MATERIALS DISCI SURE Type of Roof pa tom futureipal Wilby ' teCulpantud th Health defined by the Cupertino Municipal Crde,ap r 9.12. end the Health and Safely Cock,andSafety e, Second 25532(a)7 " ❑Yes u All roofs shall be inspected prior to any roofing material being installed.. --•- ' If a roof is installed without first obtaining an inspection, I agree to remove - ". Will Nc applicant o fuwm building occupant arc equipment or devices which emit humudoes air contaminants u defined by the Bay Area Air Quality Management all new at ISIS for inspection. District? ❑Ycs �u qqq 1 have mvl We hmardtms materials requirements under Chapmr6.95r(the Califoo �.� no alth&SafctyCode,Scc=n505,25533and25534.IundcmwdNatifNc building d not currently h a remna Nu it is my responsibility m nodl'y the occupant of de , coq mmcn6/ic tubcmct'mtoissunomof. comficaleoroccupency. . S nature fApplicant Date d All roof coverings to be Class "B".or better '" ` WW wneru . gent Dam