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CITY OF CUPEWrINO
BUILDING DIVISION �T.
PERMIT-
ONTRAC*,TORJNF�ORMATIONp
11,41A.41
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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:
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(408)441-9598
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
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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