00080215 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ' CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME'' - APPLICATION SUB DATE
P6 Bi inr�PT PI I IMS I NG00080215
IONS: C _ SANITARY NO. CONTROL NO.
28egg PnnhlhFF qT 08/31/2000
pay ARCHI"FECTlli JAME BUILDING PERMIT INFO
O O - BLDG ELECT PLUMB MECH
aN
y n y LICENSED CONTRACTOR'S .....as of TION ]pl) DOSCrIpflOn
O y_O I hereby affirm Ihm I am licensed under provisions of Chapter 9 tcomniencing
pso wiWSr,Iim70OO)mDr...icn3ofthe Basins,and Prea,hons Code,mdmy limns,
in full force and effed.
�� ,x -
hlecnxa Class Lie.# 1
ca 3 � Dote Comsat,, -
ARCHITECTB DECLARATION
1 amt d ypF ..h 111 :eJ phi d.
a, Licensed
= dP f. I - - WRIER NEATER Q/
OWNI R HUII DI R DECLARATION
ARAI ION
1 by O tl t 1 pt f m Cal I L' Law far the '
(r 6 toll "s easo t.(ant ]les Ls,But u d Pmrexemi,Code:Any toy car .are, '
f?O tun n q permit l t t It ' p' demolish, p' r structure
-
m3G pr t tissuance, mapplicantr suchpermit t n signedstatement -
o, roar, I ' dis : Ito top f the Contractors License Law(Chapter 9 - Sq. Ft. Floor Area
(cut ,eneagwal,Stolon 700()of Divi. .3of the Bu:to JP f ,ion,CoE)
or that he Is exempt therefrom and the basis for the alleged exemption.Any violation '
of Section 9031.5 by any applicant for a permit sohject,the applicant to a civil penalty -
of ao,mere man Eve hundred delta,,($500). APN Number "Occupancy Type
❑L as owner of the property,a,by employee,with wage,a,Bar,sole compen,coun,
will do the work,vW the structure is not intended or oti"coed for sale(Sm.7043, '
Business and Profes,iors Coco:The Contractors License Law docs not apply to an - • Required.Inspections
owner of prrpcay Who build,or Inmre.,,,
se,meand who ares such wad;hi...elf
r through his own mniloyms,provided that such improve ando,are not imeadedor •
offered lot sale.If,however,the building or Improvement Is sold within one year of 36222029. 00 .
completion,the owner-builder will have the burden of proving net he did not haild or -
amiarwofar propose fsal )
❑I of property, exclusivelycontracting alicensed , mr,m 502 — FINAL ,PLUMBING ENERGY
cot t t the prinect(Sec.9043 Business d Professions Cod )'[he Contractor,, 506 — GAS TEST
License Lure does not apply to an owner of property who bill:or inaprovei thereon
and whe carries ser,am pro,i.t+with a couracmrso licensed pursuant to the 507 — FINAL PLUMBI NG
Contramor,License Law.
❑1 vn exempt under Sec. B&P C.for this reason
Owner (late -
WORKER'S COMPENSATION DECLARATION -
1 hereby olRrm under penalty of fingury one of the following declarations -. - - -
T have and will maintain a Certificate Of Consent to 1c;f-msure for Worker',
I _
kbmpeasaflon, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which Ilii,panni)is..cued.
• i
D I have and will maintain Worker's Compensmirn Insurance.as required by Section ,
3700 of the Labor Code,for the info tionl,or the work for which this permit o; '
[,,and.My Worker',Compensation In.unmce curler and Policy number are 7
Carficr. Policy No.: -
CERTIFICATION OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I .. ,
This section need not be mnplcmd it the permit is for one hundred dollars
($100)or less.)
I certify that In the performance or the work for which this permit is Issued.I
shall net employ any person In any mann,an:is n,become subject In the Workers'
Compensation Laws of Cali forms Date
Applicant -
NOTICETOAPPLICANTTf,after making this Cen'dicme of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,yon must
O fonhwin,amply with such provisions or this pcmdt shall he deemed revoked. -
(A CONSTRUCTION LENDING AGENCY u '
- 1 hereby affmn mal there is it construction lending agency me the perfom,et. -
W of the work f..which this permit i,i..aoil(Set,3097,Civ.C.) -
Q Lender's Nana -
z Lender's Address
U 1 certify that 1 have rend this application and slate that he been Information Is '
Lzo E•^ correct I agree to comply with all city and county ordinances and state laws include, -
0 [) tobuilding construction,and heseby commize representatives of thi,city in enter upon _ t
ry) the chn't-babliatond pouipar,Us-' pen p rp c -
�r a (W)agree to suse.inderanify and keep harraless the City f Capardim against
F VA liabilities Podlincon.endsltd asTame,which may,n any Way' cn n aya n.t said
U Z my ga.=etlmeg ant,gram ce h. Q
'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH NON-POINT IssuedDate
SOURCE REGULATIONS
Signature of Am,OmmlC,mvactoe Data Re-roofs .- .
HAZARDOUS MATERIALS DISCLOSURE -
WJI,heam;hwtnmfumrebuddirg«cotes fore or handle ha:,ardoo.ntmeHm Type of Roof
as defined by the Copeman Municipal Code.Chapter 9.12,and the Health and Safety -
Code.Section 25532(01 -
0ye, [I No - All roofs shall be inspected prior.to any roofing' material being installed.
Will theapprcam„ future buddinboecapnn use component or device,whi,it If a roof is installed without first obtaining an inspection, l agree to remove
emit hmnnlnus air.nmminvms ax AefineJ by,he Bay Area Air Quul'ny Manng.mm
,istrmta all new materials for inspection. Applicant understands and will comply with
11Yes 0N all non-point source regulations._ -
i i I have read the n:nardnus n thanala req,lrentems under Chapter 695 of the
Call intra Health&Safety Coda,Sections 25505.25533 rad 25534.1 understand that
if me building docs not currently have a tenant,that it is any insponsibi lily to notify the
ecopanl or the requirements which mast be me, ,in,to issuance of a Cenircate of
Occupancy. - - - .
_ Signature of Applicant t Date .
.Owner or aamrrmea agent Data All roof coverings to be Class `B” or better