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04050041 J, I�DOH,* Y OF CUPERTINO t a UILDING DIVISION PERMIT 0t-0NT--_, bR�C' Po' ''AMATJON n , Vii, 4, ADDRESS: TIMOTHY MCAULIFF CONSTI .CO PERMITND04 050041 'S NAME: PERMIT ISSUE DATE SANITARY NO. CONTROL NO. (4n8) R79-07 n ARCHITECTIENGINEER: gan Ilk BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o I� 40C LICENSED CONTRACTOR'S CLARATION Job e '�uF 1 hereby affum that 1 am Ikenud unJer p aions of Chapter 9(commencing a¢ with SectionIKl7 of Division3of NC BusinesaB Pnfcssium Code,end mylicenu is << Lcenforceand' c tGj REMOVE WET BAR/BEAM n Z DatenuCI ( / C CoreAD, ys a NOV o q 2004 A HITECTSDE A OJq -° I undcraland my plan hell'W mad as public records BUILDING Licensed Professional W OWNEm exempt DECLARATION Commencer E a j I hereby o7Bem Nm 1 am exempt from the Canuactofs License Lew for the a O following mason.permit t ]onstr,evaim¢s and Professions Cale:Any city s county K$� which myviru a permit Ira construe,,alter,improve,demolish,m repair any structure yiy prior n its issuance,also requires the applicant forsuch Permit to file a signed statement FF G that he is licensed pursuant tothe provisions ofthe Courteous Limme,Law(Chapur9 Sq. Ft.Floor Area Valuation Y $ (mmmcncing with Smuon 7000)of Division 3 of the Business end Professions Code)or that he Is attempt Iberefrmm and the breis for the alleged exemption.Any violation of ne�rf�rrw�.rs Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3`Y1T L,3 i P®er0 0 Occupancy not more Nm five hundrtd dalhrs(5500). .. P y Type I,u mmr of the pmpmy,m my employe a wlN w¢gu a their sole comp melon, will do thework,and the structure is notimenthed oroffered formic(Sm.7044,Busimo Required Inspections and Profusions Cade:The Connector's Liam Law does not apply to e an owner of q p propeny who bre Ilds or Impmvu thereon,and who dmuuch work himsel f car Enough his ownemployces,provided thatsueh improvements are notimende t croRcred Eurasia.if, however.the Wilding or improvement is mid within mu year of completion,Ne rocs., builder will have the Wrden of proving that Inc did not Wild or improve for purpose of sale.). ❑1,as owner of lie propeny,am exclusively contracting with licensed contucloa to construct the project(Sec.7064,Business and Professions Cadk:)The Convectors U. come law does not apply to an owner of property who Wills or improves thereon.and. who contracts for such prejeets with a cmou]emr(¢)licensed pursuant to the Contractor's License Law. ©I sm exempt under See. B&P C for this comen Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following decimations: eve and will maintainuuulf a Cmiriume ofConno -im m,for WarkcfsCompass. ,m provided for by Section 37M of Ne labor Code,for the performance of the work for which this permit is ismed. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of rise work for which this permit is Wood, - - My WorkeYs Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE erhls section need not W completed a,W permit i¢(mono hundreddollme(SIM) or leas. 1 certify the,in the performance of de,work for which this permit is bound,I shall not employanypmaoninanym nersnuto subject tp Un Warkere Compensatlon L ws of Cali���q�n� o ' `w PP ant�'?•L.- ! CE TO RPP ANT: fie,m�alsing this rtlBcau of Exemption,you should orae¢uh'cct an r'a Com anion aions of the Labor Code.you mug Q Zr forthwith comply with such provisions or this permit shall W deemed rooked. zO CONSTRUCTION LENDING AGENCY [—i IWuby Mo.that there is a construction lending agency for the performance or ai> the work for which this permit is issued(Sec.3097,Civ.C.) _ QLender's Name 0.z Lender'aAddress U Q 1 certify th¢I I have read this application all sou Nat the above information u IS. F comer,I agree to comply with all city and county aNinarrom and sate laws relating to 0 building construction,and hereby authadne representatives of this city to enter upon u, W above-mentioned property for inspection purposes. gy (We)agree m save,indemnify and keep harmless the City of Cupertino against f/) liabilities,judgments.costs and expenses which may in my way secure against mid City U 7 in consequence of the gaming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCER ATION Re-roofs Signmu plicand nnector r Data ZARDOUS ALS DISCLOSURE Type of Roof Will dr Iicamorfmurt il ' g occupant store m handle hamocous material u the Cupertino Municipa Code,Chapter 9.13,and the Health and Safety e. 0mu Yen 25533(x)? a All roofs shall be inspected prior to any roofing material being installed. �Yes Will the applicant or fretum building aceupan,sou equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air mntsminams as defined by the Bay Area Air Quality Management all new materials for inspection. et? C]Yes Nu I have read the hvaNnus materials rtqu"cumn n rChapter 6.95 ofthc Califoo nialiealth&SafetyC Seedou25505,25533and undcssundrhatifdre Wilding does not commit a tenant,that i,is my res ty atooufy tW occupant of the ne uhmu 0,e r cedficateorOccupancy . ry Signature of Applicant Date er Ownr Iluonicdagenl Doth All roof coverings to be Class nBn or better