02030008 CITY OF CUPERTINO
BUILDING DIVISION PERidy CONTRACTOR:INFO ON:_
�1 BUILDING ADDRESS: PERMIT NO.
1: 110123 N WOLFE RD 02030008
OWNER'S NAME: APPLICATION SUB DATE
I')WESTLAND PROJECTS N V 03/04/2002
'I10NE: SANITARY NO. CONTROL NO.
O RCHITE,CT/ENGINEER: BUILDING PERMIT INFO
F m BLDG ELECT PLUMB MECH
8 y 2 LICENSED CONTRACTOR'S DECLARATION JOb Description
z K I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Sermon 7100)of Division 3 of the Business and Prefesxinn,Code,and my license REPLACES VOIDED PERMIT 02020041
SX ; is in fall force and effect.
ow
ucenaeclaaa L;c.a ALL FEES PAID WITH VOIDED PERMIT. NO FEE
3 a U Dale Contractor
ARCHITECT'S DECLARATION
P'ON, 1 understand my plans shall be used as public records
i p O
Licensed Professional
OWNER-BUILDER ra exempt
DECLARATION
or I hereby affirm on 1 con exempt from the Contractor's is License Law for the
C 3< following riot,a (Seaton]n 1.5,Business and Professions Code:Any city or county
cx es which requires a e.da.a+construct,bealcor,improve,demolish,or repair any swcture
n 3lE es t t alpetiolesIbeappl ti nPermit t License
Lcourted m¢mem. - . --hill h it l b ion thegrouts f theConnector,i L . L (Chapter 9 s SCI: t Floor Area yy , a Dation
(emnaeiscaswith 5l ]0010)Ofandthemon iflhBsms.pdimi.Anymotde) -,��1� < r 1 c_a{`1;i'.. 1.,'.Lli..�
or IM1vt he is rzcmpi thnefrom and the bads for ds alleged ezmnptios.Any violation '
-df Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty
of not nta,,than five hundred d.11...($500) A umber Occupancy Type
01,as owner ofthe pmpeny,or my employers with wages as their sole compensation, 2 04 _
will do the work.and f W
the structure is not intended or for sale(Sec.] , -
Bunion,and`Pmlb„lots cede:sin Contractors License Law does nut apply to an 501 - FINAL E19HVV t1UW9tiEMERGY'
owner ofmpeny Who builds or improves mereon,and be dues such work himself
or through his own employees,provided that such hnpreve is ars are nal intended o, 505 - FINAL ELECTRICAL
”-offered for sole:If,howe.er the Imilding or tinpro mens is sold within one year of
eduideion,the owner-budder will have the burden df pat that he care,build or
improve for purpose of sale.).
❑Las uctthecoRhe propeny.am Business an PrefutsiAn,Codnsede
Clearrmtato
construct the project(Sec.7o a,Business and Professionsildsor improves
Contractor's
License Law does not apply to an owner of progeny who Halide seimproves Ihto me
.and who commas for such projects with.a contractor(s)licensed,pursuant to the
01Contractorsex License Law,,.
1 um exempt under Sec B'&P C for this reason
Oaoci Date' PINALED
WORKER'S COMPENSATION DECLARATION 't Q
Ih by rbr d pe-altyofperjuryoneofthefollowingdeclaratons: FEB 1 2002
` 0 1 have ad'will dimpid. a Centre I of Consent m selrimum for Worker's
.;y Compel.tin s Provided for by Section 3700 of the Labor Calle. for the
performance of the work for which this permit is issued.
01 have and will maintain Worker's Com perisation Insurance,as required by Section BUILDING
3700 of the Lahor Code,for the,performance of the work for which this permit is
issued.My W'.k r'a C...p..t oil 1 corunce wiser and Policy number area. .. ...._ .. ...... ., . <.. .. .. _ ..._.. -.
IFICACO.PENS XEMPTION PROM WORKERS•• -4 's } +' er ,)k a t.'ap
C n + t Policy No.:
- -
'CERT
ATION INSURANCE`
'(this section need not be completed if the permit is for one hundred dollars
(SI00)or less) '
y p ser so as m become sub act to the Workers
any .y ma. .. 1 ,. . -- _ '•:l -
I cert f that Ne orf mmnco f the k f r which this rapt ie issued,I
shallanteing], no.... a. '
Compensation Low, 1 1, Date.
.NOTICE TO APPLICANT:If,after making this Cenificae
Q� oe
miof Coshould
ZWthe Labor Code,youumust
forthwith nh omply with such previsions or
his Permithllbd d ocoaked.Q
... .... ..__. ..._ ._ J.
_. ....
i1 CONSTRUCTION LENDING AGENCY
Of the 1 h hy' this re construction lending agency f theperformance
k for which
hi<h Ih s permit l¢ c issued(S J09],Civ C)
Ledrs Name " ... . . v. . . ..- -... .. . . ...
;D Z Lenders Adtlrcxs
/eenify that s have read be ii,pliemidn sad sre that the aN.,e it formadi n is
W:[r comer 1 agree to comply with all city and county,ordinances and nme laws relating
ad building cdnswction:and hereby authorize iepresematives of this city mentor upon
�+ W the above-mentioned properly forinspemion purposes.
(We)agree msave;indemnify and keep hatless the City of Cupertino against
tr-W' liabilities,judgments,costs and expenses which may in any way accme against said
V,z City in consequence of the granting d(This permit.' !'s
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' 1
'SOURCE REGULATIONS. t' Issued by: Date
Signature of Ap,Iua YCmumpmr"' "'. Date' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
defn ill t e appUant or future build ng occupied store or handl hazerdaas material ,.,Type.Of Roof, .:.:,..,.
❑Yes-r 2hr ' p s a t 1.., .l f( tat j ....
an d Municipal0 Noca cn t 91z d the Health an _ All roofs,shall be inspected poor to any,ioofin_g material being installed
r'.
e Sect on 5
Will the applicant or future building occupant use equipment or devices which,
If a roof is installed'witliout first obtaining an inspection, Iagree[o remove
emit heiardous air conmminams as defined by the Bay Area Air Quality Management
tel] all new materials for inspection. Applicant understands and will comply.with
❑yes:' ort, (,,, , . , 'r -allnoxi-point sourceiegulations. '
.4 t -
Ist srdaa-tSafety Code. materials 505,requirements533mndu Chapter 6.95 of
ahebuilding
uil Healthy Safety Code;Sections 4550&25533 and25534,1 understand that
fifth b'Id gdoesnI currently Vealeetth Prior myresponsibilitychat
to eddy the -
'o pans of th toga r ed t wh h mu t b met prior lo'i issuance f a Cendicete of "
" Oceoption. Y .,.
Signature of Applicant Date
;o ducla:ed agent. Dale All roof coverings to be Class `B" or better
ul [, . .. . . ... -OFFICE. �........ .._.. _. ... .... .. ... _. ...._.. .