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03110060loo £ or pz i ,r•R 0p z ti rat aQ �z UO OU U Fy U 4 C CITY OF CUPEWrINO BUILDING DIVISION �T. PERMIT- ONTRAC*,TORJNF�ORMATIONp 11,41A.41 .yN tII hjy. °&e�iyi o" 4�&,1 inwW'{ BUILDING ADDRESS: DEVERA. CONSTRUCTION INC. PERMIT N003110060 875 VALLEY GREEN DR 4 400 .Its NAME: 1040 COMMERCIAL ST. SUITE RM sYpRO "SSUEDATE OODMONT MANAGEMENT i '7- V%- 11/12/2003 NE: - //' \ n (408)441-9598 SANITARY NO. CONTROL NO. ARCHITECDENGINEER: ^� J %j BUIIDINOPER\11tITINFO �BLDG/ELECr MECH a 11PM? LICENSED CONTRACTOR'S DECLARATION Ob De ri on I Wo by affirm Nu I am licensed under provisions of Chapter 9 (mm racing with Section 0(IO)uf Division Sof NC BusinessaM ofeuiniuC en license is ~' &�Lg In mo rad rrat/� \ 0?'' BALCONY REPAIR Littre s Lk. N Dateo ARCHITE SDE RATI N odcrmanJ y plan hkll be sed u p Ile nce Yom_ Licensed Pmfcuio / LE' -BUILDER DECLARATION I herchy affirm Nai m ucmpt lrum the ConlncmYs License Law for the following meson. ISec: 031 .5, Business and Rofessinns Calc: Any city nr coumy which requirs a re to cnnatron, alter, impmw. Jcmnlieh, nr repair any armcsure$5500 prior to iLL ubuanec, also mquiru tW applieem for ouch permit m Rle a SigncJ nammto, that W is licensed pursuant o the provisions of de, Contractor's Llmmc Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing wi N Section 70011) of Division 3 or the Business and Profcuinm GodC)n! 32609064.00 that he is emmpt thcmfrom and the bub for the alleged caemp0on. Any= of APN Number ane Occupancy p y Type Section 7031.3 by any applicant for a permit subjects be applicant to a civil Penalty of not mom Nan five hundred della. (5500). ❑ I, as owner ofthe pmparty, or my employees with wages at their sole compensation. Required Inspections will do Ne work and the suucmm is nos InteMed oroffcred for We (Sec. 7000, Business and Professions Code: The Conuactori License Law dons not apply to an owner of property who builds or Impmws timrcon,and who doessuch work himself orthrough his own employees, provided that such improvements are not intended omQerW forule. If, however, the building or improvement is sold within one year of complcdon. the owner. builder will have the burden of proving that he did not build or improve for purpose of sale,). 1, as owner of the property, am exclusively contracting with licensed conuacmm to construct the project (Sec. 7004. Business and Professions Code:) The Conuacmr'a Li. comm Lew dos not apply to an owner of property who builds or improve Nercon, and who mnuacts for such projects with a contractor([) licensed pursuant o The Contractor's License Law. ❑ l am exempt under Ss. , B & P C for this reason Data WORKER'S COMPENSATION DECLARATION 1 hereby &Mute under pensity of perjury one of the following declarations: 1 have and will maintain •Cmiliceto of Consent mlf-insu , for Workers Compen- satlon, u provided for by Section 77W of the labor Code, for the performance of the wart for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, u required by Section 3700 of Nelabor Cod0.lor Ne performance of Ne wish for which Nis permit is issued. CFMY rk�sC nsatioyn lnsur�ncfaLatric)rvi licY number arty r PTION 3 CERTIFICATEOMPE SATIONIONFRAN WORKE S' OF ME FROM COMPENSATION INSURANCE , This section need or hocomphoed HOW Permit is for one hundred dollen ($100) or Icss.) I ceni(y Net in Ne performance of the work for which this Permit is issued. I shall not employ any person in any manner so as in Wcome subject o the Workcri Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Ulmr Code, you mut forthwith comply with such provisions or this Permit shall W document rewked. CONSTRUCTION LENDING AGENCY I herchy offsrm that there is a concordance lending agency for the performance of - the work rut which this peonii is issued (Sea 3097, Civ. C.) Underf Name Lenders Address I ttAiry that I have rend Nis applI.1h n and sate Nat the be. information is cored. 1 agree to comply with all city and county ordinances and sate laws relating to Wilding convection, and hereby su i mom mpresenlaliws of this city to enter open the ahov -mentioned pmperty for inspection purposes. (We) agree to sacs, indemnify and keep barriers the City of Cupertino against Iulditks, judgmcnm, and'.psoas which may In anyw mrncagalnstsaid City in co fN L ting u( Nisparmit. ERSTANOS ANO WILL COMPLY W ALL NPO Issued by: Date tSLICANT REE NATIONS Re -roofs Type Of ROOF icanVComrmmr te HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or future Wilding mcupml nom or Ntmk haruduus material Recd by the Cupenino Monte i Code. Chapter 9.12, and the Health and Safety uction 25532(4)1 All roofs shall be inspected prior to any roofing material being installed. Yea If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or Jcvicea which emit Intuitions air comemmunts as d ri d by the Bay Arca Air Quality Management all new materials for inspection. Giant"' ❑ Yes I hayyyyyyssassartWtlm uamnus do requiromcnor under Chapter 6.95aftk Calif., niyH�Safny Cad Savons 25 an30.l unJcmm�d Nvi(Nc Wilding dma I curemly haw meant. t HQ ep osibility m nndl'y th mcupmI of Nc -225577 m rcmcmawhi aspen a t r. ".17sCcnlreatear ap,n' a i Signature of Applicant Date All roof coverings to be Class "B" or better r ser au rizcd ogcm Dam