00030191 CITY OF CUPERTINO PERMIT NO.
nun.DING DIVISION PERMIT CONTRACTOR INFORMATION: Wal 5 0 1
BUILDING ADDRESS.
_n♦ SANITARY NO. -TA PALDATE
Al Wa�e Pd
OWNER'S NAME: �'!a-(`/�Uv�^^ii lJ\ NIC i
CONTROLp
IPIIDN.'.: //pN/J AYL_ ✓rJ lC.1fC-4( ° .
RCHITECGENGINEER ✓"'-- s IfUi.U1NO PEkA11I INFO
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LICENSED CONTRACTOR'S DECLARATION
0 0=c 1 hereby affirm Nat I am licensed undo provisions of Chapter 9(commencing Job Description
F:_w with Section 1000)ofDivision3of the Builnnsad Pmf.siom Cade,Wmyli«suds
ce
y J in full tone and eR<c e"n
zrc< V«nee Class Lic.S IJV
'OwO o
f Date fy Conuacmr v
�p f
z W¢g , 1. LARA ON V
v�y 1 umm�t n tan all b sed r public records
w n° licensed Fre un
- E.DER DECLARATION
I-z>' 1 hereby aRam that i.naUhemp,from Ne Conuacto/c License Law for the
E O following...(Section 1031.5.Business sod Pm(esafom Code:Any city«county
id which requires a Permit in consuuca alter,Imamv,dermlish,or repair any mucturt
prion.iu romance.also ne cr a the applicant foramen permit to file uigabm
aenl Sq. Ft. Floor Area Valuation
INI he is 1i«mes pwsuant to Ne pmvisiona or Ne Conmantote license Lew ICTuger 9
than
team he
sun,al secaon11andm ham,
of Hee,ed e.n"onornyvu Codd or APN Number Occu ane T e
Sec he is exempt m.efrom and the bmis for He elkgd cplicant to Any vlalaman m - P Y YP
Semon 103 L5 by any applicant for a permit subjects me applicant a civil pe,W7 0( 316-
[D
rot man Han of
t hudrca moan(aeon).
Lo the.rof mac property,or myempmyees wimwagsuale(wc compewtkn. Required Inspections
will do the work.Coe: he Contisnorintended Licase awdomlared fmsokpply to an owns,ss
of
and property
w ore Code:lbs Contractor's and w law does nor apply to lf,dorm of
Proper who bunds or improvm Hereon,sod who does such wok himselfro tNoush
his own employe.,Provided Net such improvements w dre nor intended m si,mined for
sale.r.bowesu will
building w impov.arnt u sold within orc Yvr improve
for the
pose,of e.).will have He burden of Proving that he did not build m impvve for pur-
poscdsnowne
1,u owner of the propcny,am exclusively convecting with li«nsod amuctnon to
construct d project apply
7044,wBusiness and Professions Code:)The Cnntrwme•tad
«nae law does nor apply to an own.of propertyaP,who builds or Impao IN mrercon,and r
who contras for such Prolecu wiHecanvwta(al licensed punuanun He Cano-adofs
U.
am w.
ca
Ec a .r S.. DBfotA,PC `s awn U A
WOR COMPENSATION DECLARATION J I MAR 2 9 2000 p
I hereby affirm u r penalty of perjury one of He following declaration: /��
kjD 1 have and will main ism eCmiticete ofC.t to salf.innureforworkcfs Comped
cion,as Provided for by Section 3100 of the Labor Cade,for the perfom .of the t]
y -
k(«which oris pcmdt is issues. 0/ -- —--Jt
1yd�5•have and will maintain Wcrkcer Coremainedtim Damnation.as remained by Section la
ry"lwcfine"baccode,for do perbnrwweof He work for which this permit is issued. -
MyWorker's�s�nEe ion legwsnce cq)�croli Policy nu r.wei �a
CyWo:kerNp ti
Policylic , /
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This it..orad nor a completes ifine rc.,,is intone hundred dollen(2100)
or 1«a.)
Itend,that in mePesfmmarmeoflhe work for which thin .it is issued,Isha11 -.
not employ any pawn in any Taaler w as to Warren subject to the Wnrkerf Compen-
sation laws of Califomia.Date
Applicant
NODCE TO APPLICANT:If,after reeking His Certificate of Eempdon,you should
NO.subject to IN Workels Compensation Provisions of me labor Code,You must
f v hwnn comply with such provisions or His Permit shall IN,de mW revokes.
CONSTRUC ION LENDING AGENCY
O 0 Ihereby alimma Tun tio
is a constmcn leading agency for the pe,fomun«of
Z mm weak for which His peed,is issued(Sec.3091,Civ,C.)
Fes Lender's Name
Ieadeis Address
WE 1 certify that 1 have read His application and sure that the above information is
96 comet.I agree to comply wire all city ad county ordinances surd note laws relining in
D 2, building concoction,and hereby amhai«representatives of this city in enter upon she
t..3 O anode-mcmiond property,for inspection puipmes.
fz F, (We)agree m Ove,indemnify and kecp Wamlen the City of Cupertino against
O U Relit,.jodgmenn.esu and Or amens which may in any war accrue^gins,said City
;,v k3 in consequence of the granting of His permit.
Ir 9,,6, APPLICANT UNDERYrANDS AND WILL COMPLY WITH 14.NON-POINr
U z Sf1URCIiR rU1.A'IONS. 3
li 5i,mo rt pp"Acen .onmw,or Data
H RDOUSMATERIAIS DIR
Will ren ep
future Wilding«cupem sortore.,or handle nvardws marerid Re-roofs
as defined by the Cupaniaa Municipal Code,Chapter 9.12,aod He Hcukh ad Safety Type of Roof
Cale,Section 25532(e)1 YP
Ves
Will He applicant w future Wilding maps nt use equipmem or devices which
All roofs shall be.inspected prior to an roofing material being
edit havrdom,air comaninann us defined by the Bay Arca An Charity Management installed. If a roof is installed without first obtaining an inspection
Dismiss? Y<s I a ree to remove all new materials for inspection. Applicant
lhave goad the Nimbuses modal,mNire .m unmr Chapter 6.95 of orae Cali- un erstands and will comply with all non point source regulations.
forms Hom
adds A,Safety Code.sections 25505.B533 and 25534.I udmuad that if the
building d nscorre 1,have aunam,Nat'nls my responsibility to notify «cupam
ofmu nn ch xnampti.mismanxofa cV a cyyypcy.
�✓ U' Signature of Applicant Date
araumori 17m,
Date
All roof coverings to be Class"B"or better -
OFFICE