04020009 (2) CITY OF CUPERTINQ -•r �" -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION::
BUILDING ADDRESS: ,JOE DONOVAN CONSTRUCTION I L`1IT'904020009
991 T4TT-T-(-PT7.CT RID
ERS NAME: PERMITLSSUEDATE
L;TEVE
L;MTTR
ONE: SANITARY NO. CONTROL NO.
(408) 997-8140
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
0 0
r�+Op LICENSED CONTRACTOR'S DECLARATION Job Description
; F❑ I hereby affirm that 1 am liamm under pro,vyisions of Chapter 9(wmmcnc g —
W wish Scnian7 BufDivisiun3urthc Busirus. mfcssinns Cnde,and my due sic rs
^LRS mfuufo,e deffec ✓ �Y :RE:V,7:ISIC1:1�)DEF TRUSS PLAN & CALES
��? Licenu s Lie.g
�o Da cam or IT ISSUED/ORIG. #03090012
F�ErsARCHITECTS DE ATION
and my plans shall he mrd as public teen's
JiU
I
od Licensed Professional
g OWNER-BUILDER DECLARATION
1 hereby arfirm that I am exempt from the Contractors License Law for the /
20 following mason.(Section 703 L!I.Business and Professions Code:Any city or county \®
which requires a permit m construct,elate.improve,demolish,ar repair any structure V
—ice rancid its issuance.also mquims the applicant for such permit to Glc a signed statement
fLicensethat he is licensed pursuano the provisions of the Contractor's License Law(Charter 9 Sq. Ft. Flo fA c Valuatloj1112
e
ats-D (commencing with Section 7(XXu of Division 3 of the Business and ProfessionsCdc)or /�JJ
i that he is exempt themfrom and Ili basis far One alleged cona,don.Any violation of
Section 7031.5 by any applicant for a permit subjects the pplicam to a civil penalty of APN Number Occupancy Type
not more than fns hundred dollars(150)).
❑I,. awneranneprop r.armrempinreuwhhwagea meo-.alaeampn.dan, 32616009 . 00
will Pr the work.and the helContra not intended oro w do Tortola(Sec.o an owner of
and Profusions Calc:The Contractor's License Law doe,not apply to an r ugli Cor Required Inspections
property who s provided
i thatsuch improvements
and who are
hu work oroffe ed Off sale.
M1it,
own employees,ldinrithatsuchimprowd witiarenot intendedmphortd fm owner-
bidder the building ide.ov Bing said he di in oneWild year will love tau burden of proving Nm he did nm build or improve fur puryax of
salt.).
1,as owner of the property.am exclusively contracting with licensed contractors to
construct the Project(Sec.7046.Business and Professions Code:)The Com mem s Li-
cave Law does not apply to an owner or property who builds or improves themon.and
who contracts for such pvjects wit a contractor(s)licensed pursuam to Use ContrumeS
License Law,
❑1 am CxemPl under Scc, .B&P C for this mason
Data
WORKER'S COMPENSATION DECLARATION
I hereby affon under penalty of perjury one of following declarations:
I have and will maintain aCmtificau of Consent 0 sel6insuu for WorYcfa Confirm-
aSafon,u provided for by Section 3700 of the Labor Cmc,for the Performance of the
work for which this permit is issued.
or
have and will maintain Worker's Compensation Insurance,as uquiud by Section
3]00 of the labor Coils.for Ne a fwmantt of the work for which this permit is issued.
MY'
y Wisdou" m nsati Iota canic�randpPolicynu berate:
C(.rrie� EXEMPTION
��
CERTIFP O COMPENSATION
WORKERS'
COMPENSATION INSURANCE
Clhis.uctio t need not M completed if the Permit is for one hundred dollars(SIW)
or less)
I emify dot in the purfunni of that..,it ear which this pemd,H issued.I adult not
employ any proton in any meaner sat as In become subject to the Workar5 Compensation
Laws of Califomin.Dau ..
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eacmption,you should
become subject to the Worker's Compensation provisions of uta UIWr Cade,you most
,J z forthwi lh comply with such provisions or this Permit shall he deemed mvokcd.
ZO . CONSTRUCTION LENDING AGENCY
f. 4 I hemhy affirm that there is a construction lending agency tar de lerrmmaoce or -
y' 7 Ne work fur which this permit is issued(Sec.3091.Civ.C.)
W Q Lendcr's Namc
D. Lender's Adder.,
U O I certify that 1 haw read this application and scale that Use above information is
W P correct.1 agree to comply with all city and county ordinan as and sure laws rtrating to
C U building construction,and hereby euthOtiM representatives or Nil city to enter upon OC
r W above mentioned property for inspection purposes.
0. (We)ague to save,indemnify and keep batmless the City of Cupenina against
Fw rat li id ,judgments.costs and esloses which may in any way sec.against said City
U z APPI,1 ANTCUNDc grant ng uSIAIND WILL COMPLY WITH ALL ON OINT Issued by: Date
SOU E TIO
Re-roofs
jo�a
poi'HAZARDOUS MATERIALS DISCLOSURaul or DauType of Roofl the applicant or future building occupant atorc or ha Inhmardou maudal
by the Cupertino Mun'iPat Code.Chapter 9.12,and the Health and Safety
ion 25532(M? All roofs shall be inspected prior to any roofing material being installed.
YesWill the applicant or ftarebuilding occupant use equipment Cor dcviw whichIf a roof is installed without first obtaining an inspection,I agree[o remove
onios air com mina u defined by the Bay Arta Air Quality Management all new materials for inspection.
1?
E Yes
I have mad the lawsmaterials recruitments under Chapter&95 ofthe Califon
nice Hcat Safcty Code.Sccti ns25X15.V533and25534.1umkrsubdthuiHhc building
cast a t n nently have tonam.that it is my responsibility to notify t Me ant of the
ew
rim Inchm Ifear toissues oof �/Cm�amor 3p r' Signature of Applicant Date
a rapmodZe G9/ Date All roof coverings to be Class"B"or better