05090170 CITY OF CUPERTINO + '�' ''"
BUILDING DIVISION PERMIT CC�Ni�I�.9LCTORIIVF`f'}itMATIOI�n;�
BUILDING ADDRESS: THERMAL MECHANICAL Pe3MITN0'05090170
10123 N WOLFE RD # 2104
ER'S NAME: PERMIT ISSUE DAIS
LANDMARK PROPERTY MANAGEME T425 ALDO AVE 11/08/200
NE: SANITARY NO. CONTROL NO.
(408) 988-8744
ARCHITECTIBNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
¢ 0
j0 LICENSED CONRIACIOR'S DECLARATION lob Description
1 hereby M.that I are licensed under provision of Chapter 9(Commencing P
with Section 7000)of Division 3 of the audness and Pmllusbare COIC,and my license u
in kB force and ertat Zr(o RELOCATE ROOF TOP EQUIPEMNT IN
Data"wfQ_ �--��" FOOTPRINT OF THEATER ADDITION
" ARCHITECTS DECLARATION
l I understand my plans shall be used u Public records
a Licensed Protect...I
b� OWNER-BUILDER m the Com ION
E<� hereby ass .(Erm(Section n I nn exempts an he Cssimis OL Lkcnm ty o for me
p o following rest,.. ermit703 1.5,Cementer.
Business Old Prarccdam Code:Any m m manly
5Sr Prior itsIsua•permit reeonwuct,alW,nt pr Coa pars N, ale
a-par my amYLtaI
zh" Prior at itsiensedpalso mgoires ame sO far wchpumitre0kaaLaw(Chnmmt
�< (flanCo me(Commencing
wPawtwt totheof Division
of ore e,Buinessand terceProf Uion,Cc m9 Sq.FI. Floor Area Valu
27, $
that
wilt Section 7 and ofbsi3 or ai eged Business on.My vi Cado)of
('� Nat io r exempt Neserrom and the bur it the u the PPEMOron.Any v1oe Won of ppb t� be
Section 70313 by acy applicant for a perms wbjecu Nv appncant m a civil Penalty 3=62 0 FT 7 T 0 0 Occupancy TYPe
not mart Nut five hundred dOIWa(5300}
❑L u owner ofthe property,of my employes with Colina u ded'suk eompenaad ,/
will do the work and the muctum r ret intended Or Offered for Wa(Sec.71H4,Bual Required Inspections
and Profession Code:The ContracurA Uinta Law doe sot apply m an ow N, q P
pmpenywh Wildsaimprovest ..Mdwbodmauchworkhim fwthrou his
Owa=play=.provided Natsch improvements art set intended overrated fee 'U.
however.Ne building or improvement r sold within one year of cvmpkdan,the
Wilder win have the burden of proving that he did ret build or W i mve for pus mems,P
oak.).
❑1,as"Com of the Property.ma exclusively canuam{ng with Hamm mnuaetwa b
cmutnm List prajeen(SM 7044,anioea and Pmfrssian Code:)Thi Commamoes Il
cone Lee,does am apply to an Owner of property builds or unpin.theme".and,
who enmants Me Such pmjem with ac"nuecter(s)licensed pursuant to the COmt amts
Lic"m law.
O fun nempt under See .B a PC ren this wan f
Data /
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of Perjury,on of the following doelam0om
❑]ham and will outmode aCcni(kam ver Camem to self-inure tem WorkCe'COmPem
ndan,u pmvided tem by Section 3700 of do I Code.fm Ne perf--m Of the
work for which this permit r issued.
❑1 have and will mainuin Warkeh Compensation Wmence,as rtyuimd by Senn .
3700 of me LaborCade.far Ne puformanw arthe wale forwhitlr this permit is iuuw.
duro Policy number are:MyWorkhCpmWannuPolicy No.Czg;2 ZCarrier
ERTIPICAT'E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sermon new ret be completed ifdn permit r for ane hundred muga,IS 100)
or leas)
1 Comity that In the performance of the work for which this permit r Issued,l WWI not
employ any person in my mmnrsu as to become subject to do Worken'C"mpenukn
LaCo or CalilbeelL Dam
Maker,
NOTICE TO APPLICANT,If.after making this Certificate of Exemption,you should
become subject so the Worker's Compensation previsions of Ne Labor Code,you muss
.J ZO fwNwith comply with each pmvimma or this permit shall the deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
E -
Iherehw
yalfirm Men ft.is a comuunn lending agency for dm performance of
E4
> 104 work for which this permit is issued(Sec.3097,Civ.C.)
WW Q Lemke,Nuns
z LandeYa Address
t.)Q 1 certify the,I have mad this application and Cote dui the above infomaden IS
;-+ comet.I agree or comply with all city ad county ordimmea and mm laws mining m
OIrJ" building commuteion,and hereby amhodmrepresentatives;ofthis city toenter upnof
.hove-mentioned property for inspection purposes
(We)agree m ave mdemdfy and keep harmless the City Of Cupertino agdnan
rjj liabilides.jndgrnmaonflus ex which may lo any may acaue.gram"Aclty
C)7 an
nPPPLIC consequence of ERSfANDS A D nsums Is ICL COMPLY WITH ALL NON-POINT Issued by: Date L d�
•ter SOUR EG TIO
0 Re-roofs
Si Omar I onuacro Dam Of Roof
AZA S MATERIALS DISCLOSURE Type
W Ithe ap torf Wilding aauPUL man or handle hrssrdow mu"dJ
a de0nnd b u unieipal Code.Chapter 9.11,and tae Health and Safety
Sermon 23331(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes °
Win the applicant ver r"Me bulldl aprons usu cyuipmcm ver devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huArdon air conuminmu u =Mue Bay Arte Air Quality Management all new materials for inspection.
Diurlet7
0 Yes ago
Ih mad the d.,ream bmqu men oderC u.par6.93ofue Califon
taHaaldb Secdam233U,]SS tad 213 lundcnund thulftne uildingwmnfy a a tenant.L u It b m mpomihl0 se rwtify dst aaupant or dst n hich LI sur da mwp.e r=, rocOpmey.. Signature of Applicant Date
I 4A w ver wua xe e Dam. All roof coverings to be Class"B"or better