04050132 CITY OF CUPERTINO _. .. . I �C �+"ky'ytvy^. b ;<`�s�7 �'ansa �k*,� ON- ,,,,
fir
.BUILDING DIVISION - PERMIT �L\s1, �lI�� Al'1AVL\� -
bE Cap"f9lYyx x„ S7R �. {'il�Ra'3t.
BUILDING ADDRESS: THERMAL MECHANICAL PERMIT N004050132
10123 N OLFE RD
OWNER'S NAME: - PERMIT ISSUE DA'Z'E '
WESTLAND PROJECTS N V 425 ALDO AVE
E; SANrrARY NO. COMROL NO.
(408) 988-8744
ARCHITECf7ENGINEER: .. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
o 6 LICENSED COMRACIk3R'S DECLARATION - -
O r The¢ aErm that l am licensed ummcr provi on of Chapler'9(commencing _ _IOb Description
a ..
with )ofDlvWon]Of No Buttress aha mrCode.mimylkenttis
mfull f nadeflon G G - TI 'COOLING TOWER AND REPIPE
b 2 Ucena Class Lk.N Sloy✓�
Dem Is
. REPLACES PERMIT #03080053--
Contractor
(03080053
ARCHFIBUTS allnamedas RATION 11�16�04 RECD PERMIT ,APPL EXTENSION LTR/GREG•
Its nJ my Pali ehvllbou¢tlapuhBcw�---� r , _ -_
c Licensed Professional - - -
OW NER-BUIUER DECLARATION
I I hereby warm that I am exempt from dm Conlnaot's License Law for the
a0 following numn.(Sadon 7031.5,Business and Profession Cade:Any city or county
$ which oulmo e a permit to construct,tiler,improve,demolish,or repair my structure
F,Zprior to its issuance.also requires the applicant farslKh permit us file adlgned W¢rnenl
< Nat he is licensed purnant In the provisions of the Coniracmes License Law(Chapter 9 .. Sq.Ft:Floor Area Valuation
$ (commencing with Section 700M of Division 3 of the Butinra and Profession Code)( �O
Nu he is exempt therem froand the bah for the alleged exemption.My violence of -
Secdm 7031.5 by any applicant for a permit abjecu the applicant to a civil penalty of APN Number' — - •�- Occupancy Type-
not mommhanRwhundred dolim($500). - -
❑I'm owner ofde property.rmy aoplayees with"Sea u d¢hmm compensation•
will do Ne work.and tha,uuctua h not InlerMeA ar oRaed fr ssIe lgac.70M,Budness
- and ProfeWan Code:The Cmuncmh Lieenso law don not apply to an owner or 'Required Inspections -
property who builds m i m prow thereon,i nd who don such work Mm¢3f ar through his
ownemployen.pmvided NatmchimprmemmuarenotimcndedmaRemdforsab It. �. - - •- -- --"—• --^-- -
howeva.the building or improvement is told within one year afaaaPletion.me owner- --
builder will have Ne bu den of proving Nat he did not build r Improve for purpose of - - - - -•'
ole.)..
❑'1,u Owner of Ne property,am exclusively contracting wish licensed commcmn In
1 conmma the project(Sec,700,1,Business and Profession Cade:)The Conuamoes U. f�.y
come Law dao not apply m an owner of property who build,or improve tremor,and Af � II " ' '-
who contactsfor such pmjecmwith aconmractor(0 licensed pursuant In We Connector, - - - 4 l'/! 1' fj�IjaN\)
Lkanso law. +l 4. -r I.(:.
❑Iunexemptunda Sac,' - .BRPCrortmsomem '
';. Owner Dau ;p/(f�tf1v I -
WORKER'SCOMPENSATIONDECLARATION
I hereby villin under penally of perjury one or the following declarulon:
haveand will mdnWna CenlrrcemofCon¢ntlo¢If-iaum for WedoesCompen-
atian,m provided for by Section 37011 of the Lahr Code.for that performance of the
work for which this Permit is Issued. -
❑1 ham and will maintain Workers Compensation Insurance,u mqused by Section t „ _. •'{
3700 of the Labor Code.far the perfarmmmce of the work fr which this permit is hand. - - - - -
My W a Compenasu
don Lnma ncanna and Policy number are: `
Corti Policy No.:C20
CE 1 CATE OF EREMP170N FROM W -
COMPENSATION INSURANCE
(Iris salon need not becompleted Irma permit is forme hundred dmlua(SI00) -or Ins)
I MokfY Not in the performance of de work for which this permit is issued,l shall net
employ any person In my manner anus to become subject In de Workers!Compensation
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,after making this Ondraate of Exemption.you should -
me me subject to the Worker's Compensation provisions of the Labor Code,you must -
.J O forthwith comply with such Provision or this permit Mall a deemed revoked.
,z,.m
4 CONSTRUCTION LENDING AGENCY
[-i mew l areby affirm that Nem Is a construction lending agency for the performanct,of -
!Yi> to work for which this permit b issued(Sec.3097,Civ.C.) _ - -- .•.- ,, - -
WM A Lender's Name
.7. z Lender's Address
U C 1 crud ry that 1 have mad this application and sum that the above infrmatlon is
IL f~ conom I epee to comply with all city and county ordinances and stale law,misting to
U building construction,and hereby authorize mpresenmivas of Nis city to enter upon Ne
LLj above-mandoned property for NspeN A
ad (via)agree m am,Inde y atm hep lea time city of Cupertino again1
wwy Ilabllidn,JudgmtnW costsan Penna which may' any way aarneagtlnsl said City
Ux in comequence Of d of this Permit. `V(�
'-•' APPLICANT NR DS AND WILL MPL WITH ALL NON-POINT Issued by: Date
SOURC A710
�' — Re-roofs
SigrutfAppli a 1
AZA OUS MA Ams DISCLOSURE Type of Roof .
Will Neap lu¢Wildi occupant no¢r handle Innuendoes material
a defined by the Cupertino niclPa ode.Chapter 9.12.and the HdIN and Safely
Cade.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yr
Will the applicant or future building aeeuwnt use equipment at devices which If a roof is install firs soloing an ihspec ' n,I agree to remove
Il haardna air contaminants as danced by ore Be,Area Air Quality Management all ne mate ' s for mspec
District?
❑Yes
the mad the hs muusmauniels quire nounder ,Chapt,6.95afthe Celifor- ^ -
niaHealth SA
Section25505, 533and 5U.lundooduaddemifthcbuildingd n lenm4 Nal It' y neap. hit m no” Ne aceupanl ofNemy i bcmet poor luumm cc. 0 of ancy. oat r cant D I
ow rr.0 oris ate A roof coverings to Class "B" better