03120006 (2) CI'T'Y OF CUPERTINO
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BUILDING DIVISION PERMIT XTION:
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'DING ADDRESS GREG FAROTTE CONSTRUCTION fNL6o"'003120006
10110 N DE ANZA BLVD
n
R'S NAME PERMIT ISSUE DATE
OCESE OF SAN JOSE 8545 MONTEREY STREET 12Z02/2003
SANITARY NO. CONTROL NO.
(408) 848-9993
ARCHITECT/ENGINEER BUILDING PERMIT INFO
BLEGMFCH
Cff PLDMB
10, LICENSED CONTRACTORS DECLARATION Job Description
t 5 hereby from that I am licensed under powi,iotoof Chapter 9(commencingz u, elicit 7000),ADMtor 3.f 0,BitsiansoMid Profession.,Ciuk,od my license is
in fell force ad effem.
REVISIONS TO ELECTRICAL
z License Class-Lip.N
Dmc_Contractor ORIG PERMIT #02040044
FroARCHITECTS DEC
eon I d I d I -a-
h 11 mused A as P� IN HOUSE ONLY
professional
'
j�I OWNER-BUILDER DECLARATION
�31 1 hereby alfirm Oat I am exempt From Me Contractors License Law for the
00 hollowing reason.(Section 703 IS.Business and promssions Codc:Any city or county
12E which rimlims a Permit 10 immloeU,alter,improve demolish,or repair any structure
s-
:�vr prior to its icsuaape.also requires the applicant for such perini use file. igmd,Mmanprt
a that M,is licensed purpmarro,the onviii.roof the Contractor's License,Law(Chapter 9 Sq. Ft. Floor Area Valuation
[tiro (commencing with Section 7000)of Division 3 of the Business and Pro fiessions Code)or
that he is exempt fficmfmm and the basis for the alleged exemption.Any violation of $0
Section 7031.5 by any applicant for a permit subjects the applicant to acivil Penalty of APN Number Occupancy Type
not more tan five hundred dollars ISM).
n I.as owner of the omfurty.Or My employees With wags M their soup imaritemadon,
will do the work.and the structure,is not intended or offered for sale(Sea.70UI,Business 3 1 G 2 6 0-91
and Prechexalmas Car.:Th.C(morcemir's License Law docs not apply I.an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
town employees,provided that such Improvements are not intended or offered for sale.if.
however,the building or improvement is sold within one year of completion.the Owner.
bui Idler will have the burden of part Oat he did not build or improve for purpose of
sale.).
I,as owner of the property,am exclusively contracting with licensed emorractanx to
construct the project(Sec.7W.Business and Professions Code:)The Cmatoachm's Li.
cense Law does not apply to an Owner of property who builds or improves demon.and.
who contracts for Such projects with a comeachoo(s)licensed pursuant 10 UX Cmahacho's
License Law.
El I am exempt under Sec. B&PC for this reason
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WORKER'S COMPENSATION DECLARATION�
I hereby affirm under Penalty of perjury am of the following declarations:
I have and will maintain a Certificate of Consent to self-insum for Worket's Contacts-
satiam,as provided for by Section 3700 of the Labor Code.par the perforarrance of the
weak for which Baia fermil is issued.
01 have and will Maintain WMkm's Compensation I.M.M....,.imd by Section
37M of the Labor Code,for he Performance of the work for which this Permit is Issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier.—Policy No.:
CERTIFICATE-OF EXEM PTB)N FROM WORK ERS
COMPENSATION INSURANCE
(This auction need not mcomplcwd if the permit is for one hundred dollars(SIM)
in Ices.)
I centify Oat in the paurformanec,of the work for which this Permit m issued.I shall not
employ any Person in any manner so as m hiCition Subject to the Workers'Compensation
Laws of California.Date
A,,Iic..L
NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should
become Subject to the Worker's Compensation previsions of the Labor Coup,you must
fonhwith comply with such provisions or this Permit shall la,deemed revoked.
z 0
CONSTRUCTION LENDING AGENCY
1 hereby affirm Oat OCm is a mrsortieficurn lending agency for the performance of
x .fir he work re,which this pi is issued(See 3097,Civ.C.)
11i Lender's Name
Z
bender's Address
C I keenly Oat I have mad this application and sate that the above information is
Pcorrect.I agree to comply with all city and county ordinances and state laws relating to
U building construction.and hereby aunhorim relnumne3diapit M'dos City to earn upon up
ahan-mentioned prefterty for inspection purposes.
(We)agree I.save,indemnify and oic,harapers the City Of Copprom,against
iI, lialaflatics.judgments,costs and expenses which may in any way see=against said City
U Z in consequence Of the Framing of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S U-C REGULATIO S. /7--2,2"o Re-roofs
uumcfApplicart,Contractorate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will doe or future building OCCUPOIL store or handle haianJous maminal
refined by the Cupertino Mop I C d Ch 912
Section 25532(a), Chapter and the Health and Safety
Dyck All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or furor oildirg Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ill hazardous air can. defined by the Bay Area Air Quality Management all new materials for inspection.
DistrictC3 Yes mX1.
I have read the hamdouo materials requirconcou under Chapter 6,95 of the Califor-
nia Health,&Sakey Code.Sectors MS)S.25533 and 25534.1 understand bac if the bbuilding
does not currently have a unam.Oat it is my mapearni hility w not I y doo occupart of che
qui:; I, h h must lac met r to issuance ora Cerrufle.tc of patacy. Date
02, Signature o Applicant
Xwnc,or MM V-1i,ed age" D All roof coverings to be Class"B" or better
V