08080105 BUILDING DIVISION PERMIT >^CONTtRACTORINFUI.tMATI
BUILDINOA DRESS: M PERMIT NO.
227..1.4 VIA CAMINO CT CTI BUILDERS CORPORATION 08080105
NITER'S NAME: PERMIT ISSUE DATE
390 E MCGLINCEY LN STE D 08/14/2008
7AH1CH
NE: SANITARY NO. CONTROL NO.
(408) 377-0181
ECTIEaGINEER: BUILDING PERMIT]NPO
BLDG ELECT PLUMB MECH
3 0 LICENSEDCONTRACTOR'S DECLARATIONrly1 hereby affirm that 1 an Iiconsed under provsiam of Chamm
pmr 9(cocacing Job Description
with Section 7")tuDivision3afdm Butircas end Professions Code,and my liceem is WINDW RPLC14NT LIKE4LIKE NON STRUCTRL
n in full ramc ams efram.
Z_ License Clan��. .�Lk:.t Dam x—r ��na ice' Cosmetic,
S ARCHITECT'S DELIARA 1 N
1 understand my plana Nall he used as public record
a iii4000 Ci Vcased Pmfese...I
5 OWNER-BUILDER DECLARATION
y i hereby.1n.that I am uempl[ram Mc ConuaneYa License Law for the
O O following.anon.(Section 7031.5,Busiome.and Professions Cade:Any city m county
9 which mquim•p Trait m cmmuct.alter.improve,demolLth,Or repair any structure
radmicisusuanco.abortup ressmapplieani farsuchpennitmrleasiLnedsutmcm
FFE< that he is licensed Pursuant W Me pmwis ons of Me conuacmra uaem taw(Chap=9 Sq.Ft.Floor Area Valuation
o
S$ (cmmencing with Section 7000)of Division 3 of dm Business W Professions Cadc)or $5000
3 Nat he in exempt NenUrom and the bails for Ne allrycd examindom Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Patently of
MNumber Occupancy l mart NN fin hundred dollars(SSCO). 32646007 . 1Ype
❑I,asawaer of Tie property.m my employees with"gas asNeo sole compewdon,
and Professhom,
Newark.end the he Cam t not s¢Med era w do fmsak(Sec.in an Busimas
Nd property who
t"or The CmnVMNI Llemsedwho ecus does I ul apply lf rt awMr e( Required Inspections
propertywhe s.ia a impmwa thmrnmandwho do seal wok Mmselfm Uuaugb his
employees.Men,proWded Net such impmsemenu ere cot tended maQnW Me We 1C
builder Me building wden of pment4halt within am of campletiaq pu Owner.
saildm MB have to burden of proving that h did rot build her improv fm pugose of
tale.}
❑1.as on.of the property.w exclusively conuacdng with Ilaved mnaremors to
comaroct Me project(See.7044.Business and Professions Cada:)The CommustoYs U.
acme law does not apply in an owner or papery,who Wild Or improm Neman.and,
who canes far such PmJecu with a...memor(O licensed punumt to ie Camramofa
Licances Law.
❑luoeamnptunter See .113PCfarthismamn
Data
WORKER'S COMPENSATION DECLARATION
I hereby mRrm under penally of perjury nee of the following declaradom:
❑I have and will maintain a Certifeeoof Consemto self-insure ror Workn's Com en.
sation,as provided fm by Section 3700 of use Labor Code,far the performance of de
wok for which this Permit s issued.
❑1 hale and will maintain Workers Compensation haurence,u required by 'an -
3700ofNclaarCade.ferr dm prfanmantt of Ne wad fm whichii,permits i d. '
My Workn's Compenutian�I�m,rmmce anise e n art:
Carver. WGO�iO1Y IS�Y�PoIIry No.:
CPnON FROM ERS'
COMPENSATION INSURANCE
(This motion meed mthcompiemd Ifdm permit sforanc hundred deBars(71010
or leu)
1 ratify that in the prfmmanee of the wort,far which this Permit is ivmd,I shall not
employ anyprson in my mannerso a in became subject in Me Worless'Compvmon
Laws of California.Dam
Appliance
NOTICE TO APPLICANT:If,aAct matin`this Cenificate of Exemption.you should
become subject in On Work.',Compmadtion yrovsions.10.labor Coda,you must
Oz foMwilh comply With such pavisiam Or iia Permit shall be domed revoked.
.'zy
lYi" CONSTRUCTION LENDING AGENCY
I hub .M.its them s e comuuednn leadirt +
.�.
(" Y gcnry for Nc prfomantt of
the Wedfar thus Pe
which thrmit s inuW(5ec.1097.Civ..C.)
Le
:3 z
Undoes Name
o '
z Leaders Addmsa
V 0 I cerdfy that I haw seal this application W sum that the marc information is '
Ii.^. Barren.l agree in comply with all city W county ordinances and sues laws relating in .
0 SU' Wilding contraction,and hereby mNmim mpm ossmim of Ns city to motor upon Me
[37 naw-mentioned puppy fm Inspection purposes
y (We) Zme to saw,indemnify and keep harmless dm City of Cupertino against
y Iiabilida,judgmenu.e used a;IN which may In my my aarec against said City
V z in Comegttnc M gof thup "
UND NDS IU.COMPLY WITH ALL NON-POINT Issued by: Date
SO �-
URCE
Re-roofs
HAZARDOUS
Signature caHAZARDOU e
S MATERIALS DISCLOSURE Type of Roof
WIIINec applicant mfuom building eavpmtroseorand ft Hesdifaanmamriat
sa defircd by de 32(x)? o Municipl Code.Q+Por 9.12 and the HemN W Safety
41r,Scott.YU 35sJz(+)7 All roofs shall be inspected nor to an roofing material beim
❑ran Na P P � Y 8 g installed.
WTI:Ma applicant or future building Occupant one equipment her devices which If a roof is installed without first obtaining an inspection,I agree to remove
mall hocardnaa mr..1..mu. fined by the Bay Am.Air Q roily Management all new materials for inspection.
Dimic,7
0Yan No
I have mad Ne bamuctmatkaiil.notchmancrus uadr Chep r6.95o(the Califm.
maHalM& C 'am, 5.21533am.125534.1untimmundurnalfusebuimiag
dna u ntiY h enL t 11' Y mpnsihilitY m notify Nc aecupant of the
.qui roma n afaceldrmamafoc Signature of Applicant Date
r mmon gent Da All roof coverings to be Class'N'Or better