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01060016 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: - APPLICATION SUB DATE ' SAN1 ARYN . CONTROLNO. O O ARCHITECT/ NGINEER: BUILDING PERMIT INTO Fz BLDG ELECT PLUMB MECH Hai CI CJ CJ G_I ozya Ihawb fflCmaEDnONTsedunOR'�ECLsofChaaN 9mommemaing Job Description _ L:w wiNSeden]Om)of Division3ofine Businessnder and Professions Code,andmy,license xad yJ a in full force and affect Ow< License Class. Li<.n * NO CONDITIONS ce o• Due Co..", ELL a. 0, ARCHIT_crS DECLARATION ,� 1 understand my Plans sh,ll be used as public racords Y x o O Lensed Professional `x$u - Oat I am exempt from DECLARATION ' w-m 1 masonereby, afilrm thatI 1. cBusin from the Conten,Crete. License Law for the F? following reason.(amnion]o LS,Business and Professions Code:any city structure . e F O which roquircs n permit re cores the alar,improve.demolish,orrepairany swcmrt - v i 3 P t °s a also requires theapplicantof for such conamnntt is ug adstatement. mih GrogBeldpursuant ectionamlpronmonsn3oftheoncmr and LawonsCod9 f'.•;-,'r, Sq.-Ft-,Floor Area (commencing with Section and Division tebeausoteaBus yy dP .Anyv Carel :.F_ ,.t .l Y,t., , :' >,r � :tit L) \ ' E$7yquation or rani he s 31.5b ,hercfmm and me bpiz for tbj alleged hempi oil.Any itplavoiof Section]thLS by any applicant fora permit subjects the applicam m a civil pemhyppppNN��77,Uor not marc man Eye nnwrcd aollaa rssml. - 3162804�mh 1, ancy Type ❑L se owner of the property,or my employees with wages as their sole compensation, will do the work,and the swcmra'is not intended or offeied for tale(See:'] ; Business and Profess Code'The Co macro License Law docs not apply m an �R�a�L,,'�'�r��f1C` ^•. _ owner of property Whobuild 'mpro sm eon and whodoes such rkti self 502 - FINAL PLUN9MGin —�sU'Y or through his own ply provided that such improvements tintended o baaw for sale. f.however.the bulldi g "mprov t Id -tin' ona year of '506 GAS--TEST" - 'romplauoq me owner bu Ider will have'he humten of moving th t h did t build or rov. impfm parpom or sale) 507 FINAL PLUMBING O L u owner of me ptopeny.am exclusively contracting m I cerrsed co manors m _ .. ....__ _.. .. .. _. "-_- camrver mel Z/. Project laps )014 Owner . d Profession,CW :)The C tractor's t. 4crnu law lah wt r c m mi m,. f propcnY 'h leu Ids s Proex thio ha .and who cpmm«a for soch.proltts.wM.,comracwr(s).licensed purwam to me _ Comm a.z License law. .. .. .. - , : sa. ` .' " ;B&Pt for alisrtaaon ❑1 am exempt under Ounce 'Datci:. .. . WORRIES'S COMPENSATION DECLARATION .IIhereby affirm under per I of perjury.one of me folbwing dalarations: I have and will maintain a Cedifinm'of Cori to self-hour,for work,i compensation, as provided for by Section 37m of the labor Care, for me performanm of the work for which this pamdt is izvucd,i. ❑1 have and will maintain Worker'%Compensation Insuram as required by,Sectiont. _ 37m of the Labor Code,for the pndaemance of mwork for which this permit is is d.My Workers Ccm madon lnsumM,artier and Policy numberare: ' r ..i... Cam 'I I PTIO 11 '.'CERTIPICATION OP EXFI.N INS PROM WORKERS - _ ._ ., ,?\..Lt.1 (�r p FV.i\1,�;,�i.\\. s i.•N: 't. :. . .... _..,,,::COh1PENSATION INSURANSE:,,,, , ffh- seri on fiend not be comphuca if the permit is for one hundred dollars -\ T:!�'t 1,).;(I tr.. Ci• (Sim)or leo.) . cenifY mat xh part ntt f m ork f h h m s t , - •• • ...•^•.� ,.•_ shall not employ any Parson in any mi av id becomsu e bject to the Worked - 1'-r.7�.. "•'}" t C mP ten Lawz of C 1'fo D t - " Aliplierin, NOTICETOAPPIIC\NTIt n Wg,h Gen bc tees b ntom wort Co C Z forth th )` 1 with h P,o th mto po irons Otte lobo Cal you mutt t Z 0 comply"' p - npcmi,shall bd d okd CONSTRUCTION LENDING AGENCY a.I hereby afim that ert'. cont construction lead fC g yh prfm p e — y%,..: of the work for which th perm i s issued(Sec.tW] C'v.C.) - : Lenders Name 30 - - i1- Z n rl en that 1 have read mise licetion and _ 0 j* canon.1 agree to cam I city ware ma the above information is U gree p y with all city and aamaity, mpm ordinencea arta stay laws relating " �-O mbuildingconswetion;and hereby autAorim rtprcvcnmuves of thiscity to enter upon L A. me (we) agree oo saw;and for ify and keep p harmis. p. L` (We)agree ro saw; a d 1,,pa and kehi harm,in a c City y.Cupertino against ?b city in co judgments,ems and apanmz which maY in any way,,ttme against said V Z City in consequence of the - Nof permt.,APPLICANT UNDERSTANDS AND WILL C°\P LY WITFALL NON-POLVTsovacERECUATIONS.:, : I Issued by: Date s,gnatureof ApphcanVConvanor. rDae: Re-roofs HAZARDOUS MATERIALS DISCLOSURE "'..'t' Will me applicuail or futurebnxdbg p t m ar Howl hazvdpushearerW _Typeof as defined by the C*hr o.M m 1pal Code Chaps 9 1 d m HeoEb and Safety ._ Roof- CZ, Section 1557](1 t-. - , -T I1 ;� 'r • __ All.roofs.shall be inspected prior_to.any roofing.matenal beinrt installed _ Will me,ppTocnx fru b'ti g«cP t mea P t ccgemh .i err - e .. Di t ic= d z t as tlepn d by m Buy Area Air Quality Management If a roof is installed without first obtaining an inspec[ton;I ao ee:ro remove °is all new.materials for,inspection..,,Applicant understands and will cote 1 with ❑Y .\ ❑No - . ... P y.- ' all non-point source regulations' 1 hale Health thehay .d i maim L 50�iqremen=an d C p,r 6 stand the "\ =,Lha o Haahh s SafetyCode have etians ant.that myd 1x534:I understand mat �ifthc building docQuirennot m, hitsmust be r:max it is myrcspobsi.f.Conotify the cunt of me requirements which man be m<t,prior m iuuandof.a Certificate of ( Occupancy.,,, Signature,of"Applicant I Date _ _ __ _ Owner oramonxed"cal - o„m.;. All roof coverings to be Class B or_beite'i '' .. t .,.. ..... - - --. . - -. _—.. ._...__.._--... OFFICE ..•: . . ., - , ... .�....:... . ........;-' , ;.; . .. .. : � 1 ... Ent _ ,p