08070170 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CLIPITRACTQR`IIVI`'QRMA
BUILDING D E95: PERMIT NO.
].0 � VISTA KNOLL BLVD ANDERSON-NISWANDER 08070170
OWNER'S NAME: PERMIT ISSUE DATE
0I.t I.UY L.IM 3620 HAVEN AVE 07/24/2008
ONE: SANITARY NO. CONTROL NO.
(650) 369-9443
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT t� t� Poums MECH
(� 0
u o o LICENSED CONTRACTOR'S DECLARATION
U I forcby afaom that 1 am Ikensed under provisions of Chapwr 9(commcming Job Description
with Suction 7000)olDivision3 ofJw Dominant and Profcssbdm Codn.md my Heenan is VOLNTRY PRESCRIPTV SEISMIC UPGRADE
111:1.1 faaeand c CL�
Liz Dow clue - I Lk.x ANDERSON-NISWANDER RENEWD BSL 7/24/8
Dew
F ComMCL
p� ans metrELTS DECLARAT7oN YhISLtsS�✓I OQ
a 1 uMcrsunJ my plans Nall he uvA an Public memJs
6
k Licensed Professional
3 Oat I en cUIIDER mDECLARATION
C 0 f 1 naso .(Siem that 1 1. ,Bono.from Ne Contractors CO IJcensu Law for Tho
O O fallowing Inco..(Section conte,Business and Pro.d000ns Code:My ct1Y su county
CO2
$ whk4 rots bon a permit as ceras the alwr.impmsu demolish,m epalr any suumum
uZ> "tic istlkc= innocent
bqn Us,lrovisi applicants for da,mchpumi'wfiessle ao La (Clara rot
IlutlwulkcvcdpunuantwlhegovisioluafNeConlsxwr'sLiansclaw(CMpn9 S Ft.Floor Area Valuation
YFC (commenting with Scotian 7000)of Division 7 of tie Bananas and Pmfrsiona Code)or q- $6000
y $ use k is exempt themfmm ad We buts fm the alleged nem0 .My MW Won of
Section 7071.5 by any applicant far a permit subjects the applicmt b•avil pu ul,y of Number Occupancy
non mare thus fiw handmd dollars ISM 32613060 .'rIV' Pane Y Type
❑bummer oftk ptopeny,or my wplayw aiN wag(ulhe'vcok emmpewuon,
wiBdothework.andtiesw umumtintendedmanemdfmsak(Sec.TOa.Bu road
and Protectionist Cade:The Conaacson Liana Law dao rot apply to an awam of Required Inspections
propenywho buildsmimprores thereon.and who doasuchwork himsrlforduough his
owocmplayca,provided that such improvements tie not inbndnd oroROW for sok.If.
however,Ne building or improvement b cold within ane year of cornpkuon.tlm owner.
Wilder will num the boram of proving use ho did no,build or improve fm purpou of
ak).
❑1,as ow fir of the property,am exclusively connecting with licensed contrmmia to
coawct the project(Sec.7044.Business and Profasimts Cade)The Contractors U.
cave law dos not apply to an ownurr of property who Wilds or improve+damon.ad
who contracts for ouch pmjc.with A ctuouactone licensed pursuant to the Gnuactors
L rose Law.
❑Iamoarillmder See ,BAPCfor Niaaamn
nu Dau
WORKER'S COMPENSATION DECLARATION
1 beteby aRhm under peoakty of pmjury and of the following deckMons,
Thaw and robed far by ood.3(w of Cmtscmwxlf-imum for Wortrrtandofm- -
anon,r provided far by Section 7IOp of Ne Labor Code.for the peofooma�of tie
work for which this,pmmit is iumd.
❑1 haw and will maintain Worker's Compensation I.,as n immd by section
7700 of Nc laborCade.fro the Wrformaece of the work forwhich this permit U bound .
MY Wookeh Compp�eemse.Insurance(orifi uW Poliry num scrwaref: v�
Cama: {`v'\�C �Uhh Policy No.: 3s.vfIM-00
CERnFlCATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This secumn mad not ho cainplced if the penal,is forma,hunAcd author(SIOB
or lea)
I altify that in the pertwmance of Ne work for which this permit is issued.l shall not
employ any Panama in my malerco u b become subject to 1.h Workers'Gmpersadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making his Ccnifieue of Exemption,you should
become subj,ct to Ne Worker's Compensation provisions of tho Labor Crile-you muss
.J 2 fonhwid,comply with such provisions or this pundit"I ac dxmed avnkcd.
z O CONsn UcnON LENDING AGENCY
[-i I bueby elinn the Nee is.consutucunn kndingagcocy for tib pMormana of
a the work fur which this permit is issued(Sec.7097.Civ.C)
4 Lamers Name -
Z-3 z Luldeh Address
U O 1 at ify that I haw r(d this application W sow the We show Information is
IL Fcmrc(1 Agan b comply with all city and country mdimrces andloe alana elating to -
pU Wilding construction.and hcmby authorire eprnsanerm of Nu city to enlmupnn tie
LP7 ahow-menuaned property for inspection puryosas
(We)agars b aro.iMcmniry and trap humkas tie City of Cupertino against
fag in costs apcnsasnall. may in anY wyamue Maine said City
U'� In PLICA T 0f Na RSTAN of NIa pmr111L
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO[7 %R.EGULATION
�� �� ��.p tpy'l CC Re-roofs
Sign: o rRmOCmmoabr Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or futwe building accupantuom ade
or Ak hardous maurial Type of Roof
an,donned by the Cupertino Municipal Cade,Cbapt,r 9AZ and Iho Hold,and Safety
Cork,Suction 355726)? i
[3 You 0N All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an ins ection,Iree to remove a
Will the applicant,or fulua Wilding nmvpant use cquipmenn m devim which If P g
ounithuaNnus air comerimnts as dcOred by Ne Bay Asa Air Quality Mamgcment all new materials for inspection.
t]Y( 0N
I haw mad the haamonamusame,m9uiamencs under Ch.N,,6.95 of de G1.ifm.
-I.We 9Selay Oudd,Suctimu255B5.25573 weZ534. lhuifue building
Joosrot ouY low.:coal Nu it is my rapoimNliry b notify Nc occupa,of de
aqui nu hmostWmn mwiaaaaofacemrec
e.wofoa„tp. y. Signature of Applicant Date
Own,Am. a All roof coverings to be Class'%q."or better