02070123 (2) CITY OF CUPERTINO 1 6" ' '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERh1IT N
894 BLAZINGWOOD AV 2070123
" M"1M 1ARK S AND LOIS APPLICATCO yy
G`/uSyB 2002
i•PHONE:
SANITARY NO.
CONTROL NO,
Z ARCHITECDENGI\'EER:
' O O BUILDING PERMIT INFO
z w BLDG ELECT PLUMB MECH
I I CJ C. 7 u
zi LICENSED CONTRACTOR'S DECLARATION �T��
= I hereby affirm that l am licensed under provisions of Chnpmr 9(commencing UNGRADE PAN L�F.L71J" � P
m with Section 7")orDivision 3 ofthe Business and Pmfessmns Code.and my license rpgs p.�®
m E is in fan force ane.flea.
aOL U License Class tic.x
L_y Dae Contract.,
ARCHITECT'S DECLARATION UL ' O 2��2
m v, 1 andemmntl my plans shall be.,ad as Public tt<oms V
I g<p O Licensed Professional
o LL OWNER-BUILDER DECLARATION
BUILDING
�a p�/'�
I batcby aRnn that 1 vol exempt from the Conwctm'S License law for the 1� 161J'I V V!
Z following mason.(Section 7031.5.Business and Professions Code:Any city or county i V VI 2 0 0 0
_ d
sxo
which u req Dc,mit re connmcl alter, 0 demolish. repair any wnum
Lam as Dnarl s « I req ' theapplicant for Such permit flea signed Iamcm.
Ilio)henh ttnsea putstiltothe pro umsof the Canonical.,LicseW (Coiner d9 -3�,q i7 BIbVI.`1.¢A
(commencing ipt i ]000) fD basis
or the Businessyngnion. E sCodc) 4��j�Y �1, "`fe snit q t '1 Valuation
or Sen he Is.sem�i Ihcrtfmm and the bas s for the alleged carat. ton.An i�
p B P Any
of Seeoon]0315 iv any hundred
dem dollars
(S5(muo subjects the applicam m v dvil penalty- APN NaH Zn
mr wl old¢m.n five banana sonars(ssoo). 10 1vJaAl1!%LF Occupancy Type
.0 1,asincomOlthePmp.ay,Ormyemplo)mirwith wages astheir ms,e
lecompenon. 304 - ROUGH ELECTR CAL
"dill do the work:and the structure is 0.imenaed-nrO&red-for'sale'(Sea.IMA,- _
fBusmo,,'and Professions Code:The Connanor's Licane Law does not apply to.m 1 tions "
wn.r of proway Who Wilds or improves-be...and who does such work t imoilf
or Ih hough his own employees..provided that such improvements are not intended or
ofremd forsal If,h w IhImId B or imllummen,is said within one a.,of. . . . .. ... ..... ..... ... _._..__..._ .....
ompleaon.lhe ownu'bullder will have the home.of prov ng that he did..build or ^" '
improve for purpose of sale.).
prnwmy exclusively contracting with licensed contractors to
❑1, s owner project
,em esu
_ License theoared(aec.ppl to
BusOwner o and Prof who builds Cade:)Theves the lora ..'.•_. .•. .• -`
Licenre law does not apply to an Owner m prow a woo ice or sed muse -t.the
+:;'. ..and who cs License L such.pmj«a with a.comactorts)licensed pursurant.lo the_.. ._........_........... .__....- ..—__..
C Ira
1 am exempt �deo�r a, v B @ P C for this mason --—_-
Own
_ WORI.ER S CO PENSA DECLARATION
I hereby alBem under penalty of perjuryono afire following declarations:
fh ❑ 1 have and will maintain a Ceni0c6m of Consent to relf-insure for Worker's
Compensaiom, asprovided]Yor by Section 37M of the Labor Corl fee me
performance of dm work for which this w,mil is issued.
'r ❑1 hove and will mnininiri Worke2s Compensaliori Insumnce,'es required by Section t'
3700 of the Labor Code.for the pedor ommee of the work for which this permit is
- issaw.My Worker.Compmessumn lnina.timer:and Policj number amPalmy ;
P e l CERTIFlCATIONOF EXEMPTION FROM WORKERS t1
COM.'' TIOI.INSURANCE;.."" - v
151osectionneed.016[[Om CI[d if lha Permit is for ohundred dollars
�
�0)drJO..) r
-t' I n fy Ih 1 rhe paQPrpt ce of the O k for which this .—• ••,,• - __-...
ah II ole IO nth— *act in S hoe I
r bleat Ip�W kers 't ,,,. •;,i.
Compares p Y Y f rlfoml Y I n�a to '1—
ApPI I ��C-1
OT ETUAPPtlCAN er mbAngm Ccnf to ofE mot yo should
so blecu the Wo k rs Compensationp irons of the Labor Cod you must "
Q 0 fo with comply'with such provrs ors or this amml shall bed mad invoked.
z -- . -..._.. .. _ --- - ' -
- - -
CONSTRUCTION LENDING AGENCY
1
a-? I hereby Pdn this dere is a c.monsclun lending agen<Y for the peeumir ice 1 I -
W.ti of Ne Drat which this w n siuctl(S c 3097 C e C.I
p. IZ 'Londe N - ... _ .. .___._..._ .. .. ..._ ..... -
r7 z Lendc ,Address - .. ... . .........___ .. _ ._.__.
1nRy Iha 1 have d this ppl cat o d sot a
that he bo orm
nflion s
w,(~ roriecl 1 erg a m comply N all c ty aid my mahout have
and train rc
laws lalmg
� O to building weuan'ad hcrebysuthonm rtprcsentaiives of this city to enter upon
}'W the abo a mens diedproperty for inspection purposes
[i 6i f W) gr«to rove maernmly end keep harmless the City of C penmo mumu
r ZI liabilities judgments,ams and expenses which may in any way in me aruns,said
U z' City in consrp ce of the ynnt ng f this Puma g
APN.ICA�?ll\'DG§ST�. A\D WMLCOMPLY NTIHA .PONT" b
S URC IfLAT Ns An ._ ^''� _ --,,Issued y: Date
gnu real ppheanuConme ,. DmfRe-roofs
♦; HAZARDOUSMATERIALSDISCLQSURE T I ;�:I
WII the applic o In future building os' war:am.or hawk hvmdws material
as defined by Ne Cuwnlnd M Iawl CoType Of Roof
Cinque, antheHealth
rand safety
Coatis ton 2553
r° All roofs shall be mspected.pnor.to.anyroofing material being installed.,,_ ___ _
rtdobe DDI oto f rc Wildingoccupant xAli
equipment era emeh If a roof is installed without first obtaining an insp'ectlon,'-I'ag'ee toli'criove
amit ic s num 1 defined d b. 0 Bey Are Air W 1 ty Ma gemem g
District, all new materials for ins ection. Applicant understands and will comply with
d allnonp6intsourceieglations. -' -
e
AI
sue revsNe,he s mare a1S rt ' Ch.,,,,
Cel Tom Hrillh k SafctY Cwe.Sections 25505!25533 end 2553mdm and ohal
Ne building does elamemmly have e¢nen, that it is my m1par,ilaulity to.mify.lhe
a'cupe 1 of do re u'rcmann which most be met poor to Issuance o Cerlfi«te he '
r o« Z
_ Date natre of APP-
m 'dog^t All roof coverings to be Class "B"O!better
OFFICE