01010127 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINOADDRFSS: PERMIT NO.
10140 FIRWGOD FOM SEASONS R ING 01,010127
OWNEWS NAME: APPLICATION SUB DAI17
L71MLl"i7:GH IdfaldL'Y G45 H01;NING aT' 01/31./2001.
RINEo SANITARY NO. CONTROL NO.
(408)278-111330
ARCHITECHENC.1 iIiR: BUILDING PERMIT INFO
s - BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
C 5 E b I hereby an ,m
traal I an lic come under ontvishms at Chapter 9(commencing Job Description
Finwith Switur7W(Bvf Division 3afthe Balinese and Professions Cadeandmylirence
a .'i«KIIas a and ett� 3�f/ x Z _9 SFIII �I 0 QS
dL E TO ( 1T(]I I
a' i V Dnle ,a,
O SARCHITECT'S DECLARA ION
J undersuuW illy plans.shall bea used as public records
pO [Accused Rnfcxannsl ,
5l OWNER BUILUIiR DECLARATION
.1 hereby affirm that I am exempt fmm the Conference's License Law for the
L•>a following at ISectiun 7831.5.Basineo and Professions Cale:Any city or inti
Z F 0 which require.a permit m cnnswct,ulefr,impmvc,dean i.sh,or repair any gmcmre
t�s63� prinrwits issuanre,ulw rtyuiresthe applicaa lnnuch pcnninu GlcusignvJ staremem
deal lifecord pursuant mmepmsmnsonhecnnaremr.Licensee lyw(Chaptme Sq. FL Floor Area Valuation
aammmcing with seeaan mmol of Division 3 onhe Business and rote Fussier,Cale)
or that he is exempt dmm8om and the basis for the alleged exemption.Any violation $W00
of section 7031.5 ny am applicant for a nemm ton'e'r he anphc:to w a civil perahy
of nm more mttn dvc I....dreg dommm(g5rn0. APN Number ' Occupancy Type .
❑1,as othear of the ndthe s of my a is nous twnh wogea as theo-sole sale
cn.mion,
34235'a-32.00
will Jt the wort,send the immure is not corn,Li or attcrctl low ala ISec.]PLI.
Brands and ProrWhona Cale:The Contractor',License Law ares no,,apply r an Required Inspections
r of pmpeny Who buines.p improves at such.and who Jds such torte himself
a through his awn employees,provided for arpoM1 improvements arc urn intendedyear ar. ,3fr3J l''f�W*E
ctterei periodic. w however,the beading or urdenoement is thin within one year at
307 — 1143UL_ATION
completion.the owncrhnllder will have the harden of proving that he sliA not huild ser
islaoiforparpola:ae.T i RXJF 11i C11T
❑I,as Owner of We Property am eaclusmcly controlling with licensed comments,to 602 Fi'fJI:1F RI_YW OD IdAl:l_
console, the project(Sec.70,14.Business send i'ndeu mal CM :)",Contractor's "
License law dos not apply to an owner oratorical,whu builds air improve,defend, 603 — Fi'GGI= EtATTENS
and who contracts for such projects with a contractini licensed pursuant to the
Carboni Lirene Law.
0 1 a. 600.4 — IOW-- ,T,N—r-tli'C.lGF rSS
1 am exempt under Sm. .B&P C for this recon
DWner Dae '
WORKEMS COMPENSATION DECLARATION
I hereby elfin under penalty of perjury one of the following declarations:
J 1 have and will mainmin a Certificate of Conserv to self-lnnum for Worker's
Compensation, as provided far by Seedun 37VI of me Lada Cale, for the
performance of the wod for which this permit is issued.
❑1 have and will ned rain Worker's Compcnsaian Iasomsm,as required by Section
37g)of the 1111,111 Cale,Far the pedm
ouutec of the work for which this permit is
issued.MyppW�orker''Cmnnetmn/iioor lnmrnnce enrriev anti Policy
numb••��erarc: • -
Carrier: Ay rR,iw („-. Policy No.: .r//�� //�� .
Ciilil'11ZICATIDN OF IiXEMM ION�fer'ROO-MIN-'—OORR—_Kf)
COMPENSATION INSURANCE
(This section mrd not be completed if the permit is for one hundred dollars
is 1110)or lest.)
1 certify that in the performance of the work for which this permit is Mored,1
slwll urn employ any pi in ony manner ser to,es become.subject m the Workers'
Cooperstown Lancelot Cliff ar an.Date '
Appficard
NOTICE TO APPLICAN'LI1,atter making this Cenifcoom of arr ion,you should
Z became suhjmtto the Worker's Counteract an provisions of the Labor Car,you must
Z
Z O forthwith violably with such provisions or is pvo shall be deemed revoked.
F^
CONSTRUCTION LENDING AGENCY
lei I hereby amen that there is s anord(Senn lending C agency for the performance _ o -
W of the wod for which has permit is Ismttl ISec.3119].Civ.C.7
I,enderN Namu
Z IsnJcr's AAdnss .
c beady flat l hale mud this applicaimi and state that the above iallvmntion is
Iti. [.a rant.1 agree to cntnply with all city and enunly brdiaances ani state laws relating
(� o building asnaruction,and hereby authorize representatives of this city to enter upon �Q
�s Gxl the uha(We) give
to pmpcny ton if y and ko purpuas.
LeLA �e,lud see unava,indemnify ani whi hamdess the Clty tr emea ai againmDl
liabilities,judgmenu,coats mW expenses wbich may in any way amore against sailCityin conseueAi O 1e)f5o�APPLICANTDND STANDS WILL.COMPLY WITH��II..L NON POINT IS1lICdhtV /JZROUCE rC t : y: OIC
Signuwre nfA icuntlCnnwctar r I�Uutc Re-roofs 1
HAZARDOUS MATERIALS DISCLOSURE
AIR the applicant or more building mrupam wu<car handle ba:amous material Type of Roof By
on,defned by the CupenintM Cale Chepmr 9.12,lead the Hcaphnnd Safety '
Cale,Section 255321a)T me
°Yea No All roofs shall be inspected prior to any rooting material being installed.
Will theafr i in, ctumbut ingoceup,mtusaequipmentserdavice,wmeb If a roof is installed without first obtaining an inspection, I agree to remove
nitha.anlo.,at,"nlimot demmdbynmBayAn.Ai,QualityMana"anent g P g
istrno? all new mater' Is for inspection. Applicant understands and will comply with
71 yes "" all non-poi ourc gulations.
I have mad the brilliant tnaerials teyaimmems under Chapter 6.95 of the
Catifomia Hi&Safety Cale,Sections 255115,25533 and 25534.1 understand that
if the Wilding Jres oat care tly havea m,that is my respomihility to unity the O
occupant or the maintained,which st he met briar to Nadi of a Ccnifcme of '�
Daapaoy Signalu e of Applicant Date
owner car Dae All roof coverings to be Class "B"or better
OFFICE