00090013CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
13UI LDI NO ADDRESS:
PURMI lNo
VtQI '1 13
OWNER'S NAM
APPLICA1tON SUB DA'fi
1
a oo
09/09/2000
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PHONE: LUPE -SANITARY
NO. COWROI. NO.
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CO e/Q N0
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Z ARCIII'IECUENGINEER:
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5 LICI3NSIi)CON 'IRACE Olt' S DECLARATION
lob Description
I hereby ulYI a (hat I mor Ilec ewd underp o,i,iuns of Chnpmr 9 (cnmme;aing
arx'irM1 Senimi l(NNq of nnJel.11ie Buxmu. and l'nrtcoioro GlUc. and my license
if in full lortt and
s la,. "i'l� LFa.M_ /OY%
CELL SITE/S. FI_LTHILL BLFD AT WALNUT C
Date
n emit _ Corti -c of-,-)Wfl/
�ARCIIIITC
A r N
5�ans ai;dl be used
Lr cn wl
OWNE&BUILEER DECLARATION
tfon the
or that 1 am mnpr from.the Contmctor'x license
1 herby .(roteh
t.aw
folka (Sccl't ]OILS, and Cuda Any city or county
i. aleass
improve. de.......demolish. ear repair any smucmrc
which requires a permit m Crwssthe Atvc mrpruve.
whims re uires a t
h pereash,
prim mics issuance, me theapplicanttheforsuchmences i Blitasignedgaiemcm
- Sy. Ft. Floor Area
Valuation
- th:runcomman,ithSecannn1htitprinn.onhecheBusinessannPeLow (Chapter
nsedpapontto
n,Cad9
IcmhatIm is withSectionberen]elanof Division3 of the Business and Professions Cade)
or that he is exempt thcmfmm and Inc bnsix for the tion, Any violation
1
fora pcnnit nuljeerx the app c;un In a civil pawky
by u thee( the r,hae;
APN Number
Occupancy Ype
u dred doll
of sol lmrm than ave hundred colla,. (g500).
of redSeelion e than
❑ I, as owner of the progeny, on my employ¢• with wages as their side compensation.
t—„) _
egnlred Inspections
will Jo the work, and the structure oat amended or offered for sal. (Site. 1(RJ,
'f License Law does m
Hluinenx and Prnfarninlrs Codc he Coao-..lor s our apply an
owner of property Who bonds or inrprnva rhemene. and who does such work himself
or through his own ctnplovees, provided that such inhpmreverenu arc not intended or
is
304. — ROUGH ELECTRICAL
offered for .sale. If, however. the building or inrpmmuscnr surd within one year of
,ropleEnn, dre axnerbuildcr will have the burden ofproving that he did not build or
s0.1. — FINAL ELECTRICAL ENERGYempnr
a for fampruc if sale.(
505 — ELECTRICAL_ .
C1 1, an awael or lne propatrry.our eselu,.meiy eomeaamg with licensed coinmctomm
vou,hr ct the pmjem (Sec. 1044, Business and Purfesm... Crxle:)The Conuaeror's
"FINAL
Licenx law docs not apply to an owner of pmpeny who (wilds or improves thereon.
and who contracts liar such projects with a conumcmr(s) licensed pursuant to the
Comramor's License Law.
❑ I nor comm”( made( Sea. li & PC to' (his mason
Owner Ume
WORKER'S CONIPENSATION IIF.CLARAt'ION '
I hereby allirm under penalty of perjury oneof the lollowingdcdn`r^v�qi��n<:
❑ I have and will nmiattein a Cenilicme of Comenr m Belton{{uro'fm-Wmker'a
her by Section 311X) the LuM Cede, fear r
Compensation, as provided of
performance of rhe work for which this permit is rward."
I uhd will maintain Worker's Compensation insmmrce. i, 11, an
C1hmr
is
f
e work ir which this pcnnit
3700 OI the Labor Cacic, lot the pert'ennance of tile f
kith's Unsmion Insurance carrier andPolicy num herarc.
issaeJ. My rmry
+.
"
Carricr'. f Policy No.: G�Clpfi�t%O%
CERTIFICATION 01: HXEMPi'ION FROM WORKERS'
LOMPENSAI ION INSURANCE
(This .section need not be completed if the permit is for one bundled dollars
C$100)or Ices.)
1 «nify that in the penornrmcc or the work for which this permit is issued. I
strdl nor entplo ur Y "'e n i,I anynnuen h u Jit ,- subject m the Workers:
Gunpens;nWyrf Ea
NOTICE:?OAP IL alley making this Cities a Exemption, you should
of the LnMrr Cole. You must
or Work provisions the
subjectrrpmi the,
youb eCompensation ha
bend
fimthwirh mmPly xlrh such provisions ear this pcnnit shall he dcunrtd revoked.
/] CONSTRUW'ION LENDING AGENCY
1 hereby aRrm that them is a construction lending agency for the Performance,
of the work for which this permit is issued (Sec. 3091, Civ. C.)
Lender's Name
IanJcr'n Address
1 ecnify that I have mad this application and ,mate that the above or union is
correct. I agree to comply with Ill city and county maracas tad state lax. velming
Rs building construction, and hereby outhoriic reprexntaines of this city m enter Igen
the uu.m.m,morad pfopertY for in,peation purposes.
L '( eve, Indemnify 11se k hrn the City of nn
.ad n liahilitie, juJgmernv.cm. Sr bath nwy in any way accrue ageing wiJ
a hi mayin ...c r
G amiof thrs�ernw
r WILL COMP HALL NON"PoINT
y, `--�(` q
Issued b /tl✓O4t�CGi DateCommctor
ARLNEISAND
Re -roofs
Date
HAZARDOUS EdAIERIAI ti DISCLOSURIi
Will the app"cantofuma building mcupam Blore arbwJle lmzaNnu.. rnamrial
Type of Roof
m de0nrr by the Cupertino Municipal Core Chapter 9. 12. and the Health and Safety
Cole. Section 25572(x)';
-
oye, [
All roofs shall be inspected prior to any rooting material being installed.
Will the aPphcanl mcomm ba Id�P.recnpanI u.ve c4uirvncm sit device. which
If a roof i5 installed without first obtaining an inspection, I agree to remove ,
emit harardtw, ter contaminants a.d bythe Bay Area Air Quality Management
all new materials for inspection. Applicant understands and will comply with
Ei,tniet?
ore, o No
all non -point source regulations. '
1 have read he ho,crate, neetrimB reyuirnnris mmu, Chapter 495 of the
Cal ifomis Health & Safety Code, Sections 25505. 25533 and 25534. 1 understand that
ifthcbuil' does t my have a tenant, that it is my responsibility to notify the
Occup (r UR4w.a v' a(a CCrt1ECa1C Of
°""I "
Signature of Applicant Date
All roof coverings to be Class "B" or bitter
—iye'rorammmi ed� Daae
OFFICE