03110055 (2) CITY OF CUPERTINO "«twr '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIONi
BUILDING ADDRESS: GREG FAROTTE CONSTRUCTION ffqthHTNO03110055
R'S NAME: 8545 MONTEREY STREET PERMIT ISSUE DATE
ST. JOSEPH OF CUPERTINO PARISH 11/12/2003
PHONE: (408) 848-9993 SANITARY NO. CONTROL NO.
ARCHITEC iENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
+00 LICENSED CONnRA bits, ovil DECLARATION
LmF 1 hereby affirm Net 1 em licensed under and
Promo of Chapter 9(commencing lob Description
`2,y with Scction]IXN))uf Division Sof Ne Business end Profcuinm Code.and my license is
'�Nin full forte end effect.
Licenx Clea REVISION--INHOUSE USE ONLY
,mac Dam Lic.g Contractor NO NEW PERMIT ISSUED/ORIG. #02040044
£� TION
ARCH IW useTECTSDECLARAREVISION--#03070194/03090015
f W U I undersmnJ my plans shall d m public TION
6
°off Liccvcd Pndcuionel
Oat I am exempt
U rept fr DECLARATION
C O J I hereby alum that I em.Il from Ne Contractors License Lew for IW
.p0 Billwhihrquiresa (Section If13L5,B,alwT, and improve,
nm Co de:Any City or County
$ which requires a alsom cenarvct aWc impmsu demolish,care a sig any structure
prio°i y
dust
he is l issuance,sedrisurcquinesthe lheapplicmr forthe Con permit Contractor's
ecruic Law
nammcm
yZ< thalbeislicenxdpurtuanunlhc pmvisinrunf the Contncmr's Licenx law(ChePmr9 Sq.Ft. Floor Area Valuation
21-0 (commencing with Section 7000)of Division 3 of the Bull and limitations Code)or $82
Q 5 9 that be is exempt therefrom and the baso for the algcd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars($500).
P Y YP
❑ I,As owner of the property,or my employm with wages es their sets compensation, 31626093 . 00
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
And Pmhuioti¢Code:The Convectors License law does not apply to an owner of Required Inspections
property who builds or improves Nemon,and who does such work himse for through his
awn employees,provided that such improvements and not Intended oroRered for rale.If.
however,Ne building or improvement is sold within one year of completion,Ne owned
builder will have the burden of proving that he did not Wild or improve fur purpose of
1.
mlc
❑I,as owner of the property,.B exclusively confessions with licensed Contractor's cmnv¢bre It. \
emtseLa rheproject(Sec.oax,Busineuendry whoiom Cade:)Thevesduon, n
cense Law dots not applyto an owner of property who Wilds or ant Or the Neuron,end co
who contracts for such projects with o cmnuenor(q licensed portiere m the Comndor'a .f�
License Lew. V
❑Tare remmyxam��'/Ij�'sun„�de//r S�'ce. BkPC for this
r I /l ��• `tv
V WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following declarations:
❑1 have and will maintains Cenificamof Comenl to self-iaum for Worker's Compere
cation,u provided for by Section 37M of the Labor GNC,for the peRmmanc,of the
work for which Nie permit is issued.
❑I have and will maintain Workers Compensation Insurance,As required by Section
3700 of the labor Code,for the performance of the work felt which His permit is Issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Cartier: Policy No.: _
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed Him permit It fm one hundred dollars(SIM)
or less.)
I cenify Nat in the Ferfmmance of the work for which this permit it issued.1 shall not
employ any Nixon in any manner an As to Wcome mbjul to the Winima'Compensa lon
Lawa of califonom Dau
Applicant
NOTICE TO APPLICANT:If.a0er making this CcniOceO of Exemption,you should
become subject to the Worker's Cam penial provisions of into Leber Code,you must
., z kinthl comply With Such provisions An Permit hall be deemed inked.
?O CONSTRUCTION LENDING AGENCY
t W rehy affirm that Birm its comuactinn lending agency tot the performance of
Ys. Ne Work for which this .it is issued(Sec.3097.Civ.C.)
:r] E Lender's Name r
= z Lenders Addrom
J C) I«nify shut 1 have Oad this application and sum that Ne above information it
it,F correct I Agree to comply with all city and county ordinances and sale laws Orating to
,JU Wilding construction,and hereby eothorise mprcaenmiws of this city to order upon the
�•'a Ahove-mcntioncd pmNrty for impaction purposes.
(We)agree to ave,indemnify and keep harmless the City of Cupertino Against
F'h Iiabiliuu,judgmenu,core and expenses which may in any way accrue against mid City t
UZ in consequence of the gmming at this Permit t/1
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
RED L
(� - /12Z^d Re•roofs
Si lure of ApplicanUCanuactor Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future building Occupant store or handle hamelom materia
u defined by the Cupertino Municipal] ode.Chapter 9.12.and the Health and Safety
.Section 25532(°)7 All roofs shall be inspected prior to an roofing material being installed.❑Ye,
Will the applicant car future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection;I agree to remove
emit haxarduos air contaminants As do tied by the Day Area Air Quality Management all new materials for inspection.
Dislrict?
❑Yee
I have mad the han nous materials requirements under Chapter 6.95 of the Califon
no Health&Safety Code,Sccdore 25505,25533 and 25534.1 understand that if the building
dura not cturcn0y how a tenant Nat h is my mspumibility m nntily I .mcupml of the
to 1rc eats Inc�R IPriu,it'Ie of.ccmnamfa er.d j Signature of Applicant Date
Owner car hm;,ed agent taxa All roof coverings to be Class"B"or better