Loading...
00050035 (2) CITY OF CUPERTINO MIT NO. _ BUILDING DIVISION PERMIT CONTRACTOR,INFORMATION: U�b � U �� BUILDINGADIIRESS: �g rH � WTCjjp7i V SANITARY NO. APPLICATION SUBMITTALDATE � [ 1-&'r5- Tvvc.T/u�/WW' LA-rr A OWA;r: .'57 4 S�/f NIC CONTROL# PHONL: ❑ ARCHITECTAINGINEGR BOLDING PERMIT INFO a00 P02 U LICENSED CONTRACTOR'S DECLARATION zanz 1 herebW yarfrm I 1 om licensed under proviuons of Chapter 9(commercing lob Description F:_v. with Saewn7gp)of Division3of dm Bminessand Rofessione Code.andmY littnse is MSS'u in full force and Act K.gr T Ci1A5V C u Littnse Chess -S tic.♦ fly-elm��(e� . 3>H Dam Co.. C O gARCHITECTS DEC RA a5 1 unmerited my plana shall W used as Public nocerds i S o Licensed Pmfessiterse OWNER-BUILDER DECLARATION 1-z- I hereby aRrm Wt I am mor,from the Commeora License Law,for da m O following mason.(Section 70131.5.Business and Professions Code:Any city m cmnty 3� which re9nires.pemnil to cnmt,uct,dtee;mpwve,demnnah,nr rtpJr my m itswam Sy. Ft. Floor Area Valuation prim s issuance,sent nominee applicant for such permit we file a signed snmmem ee'']') Nm he is licensed panuant w the provisions of ern Contractors License law(Chapter 9 .90,C:10.O (cumbeencingwan Section 70o0)of Division 3 ofthe Business and Professions Cod0or N NN e —n Occupancy T al he is eaenurnd thebas t therefrom art is for the alleged exemption.Any vholanmm of ane V / / P Y YPe Section 7031.5 by my applicant for a pmtil mbjaa lite epplicanno a civil pnalty of m mote than five hundred dollar (5500). m I,mnwnernrlWlwpnr.mmremphnyttawithwsgamNenroleenmpm.tion. Required Inspections will doeW work.and the structure is but;ntendedoroffeml fm we(Sm.7011.Business and Professions Code:The Contractors License law does nor apply to an owner a pmpcny who builds or improves Neram.and who does such work himself or thouugh his own cmph,on,protruded than such imposemena art Inst intended or offered for We,If,however,the Wilding or impmvemrnt is sold within one ywof eampledon,the merever,innilde,will have the burden of proving dem he did not Wild or improve for pur- poseofWe.l. se I.m owner of the property.am eacsively coommung wide mm bummed contractors to J'�� cons.,the projat(Sen.7(1 Business and Profession.Code:)The Compactors L;- �aV\ came law does not apply to an owner of proper y who Wilds or improves mention,and wed course for such .*"with a cootr Im(a)Neenah pursuant to Ran Conoxmea O i License Law. O El 1areexemPlundersn" .BRPCfm Nismason Owner Dem WORKER'S COMPENSATION DECLARATION IherebyiL] miunderpmaby ofperjury onsof tfinwmingwa esC 1 M1ave end will for byn•Cion 37M of Covent mCodenmm fonwmtrh Compo ssei k l ns provided for mi Section 3700 or Ne Labor Code,for the perfowenoe of the k have which this pewit is issued. 1 hath and will maintain WnAers compensation de,w rk for which ss rtquirtd by satian ofthe labor code,for Jan prfom+auce of Jac wort for wni<n Nie permit i.issues. MY Wor�l Co pe t<I -�mc��emya9�+ ma Polo: L'� ')32 C Camieq)gL L 7�XEMP Policy No.:1_r{7 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION Ie SURANCE section rte completed stieu necompleteddthtid am,ir is rorone Wndrtd edl.rs(sho(y mlcss.) 1certify perp in my mmmser of thework for which this pewitrI CoIshall rotr mUw any prion in any manner...w became subjat to dm Worker'Compeer AppleLaws of California.Dam Applicant NOTICE TO APPLICANT: a Co making than Cisions te de Labou o d you should become scomt to be Workers Cnmpor this positions or dm labor Code,yon must forthwith comply with such provisions or this permit shell M dttmed revoked. CONSTRUCTION LENDING AGENCY Q O I hereby affirm than Nem b e construction lending agency for performance perfounce of Z the work ran which this pernut is issued(Ser.3097.Civ.C.) _ CL Lenders Name s Address tai] ? Leader's certify We I neve mad this application and mem thal the above information is 1 12 comi I agna to comply with all city and county ordinances anal sine laws retailing an 7 Wilding construction.and herebyauehorim mprerznmives of this city in enter upon the V eWvemenlioned property to,inspection purposes. fir. F' (We).gra w ave,indemnify and kttp limbless IN City of Cupertino egaient V Iiabilitim.jndgmmna,cmc and expert which may in any way saeue Memat aid City '. W in consequence of the grmting of Nis pewit. H L APPLICANT UNDERSTANDS AND WILL COMPLY W TOI ALI.NON POINT V Z SOURCE IGU1LA'IONS /. ilArT� Sigtlamrt al Applicarel mama. Dam HA AARDOUS MATERIALS DISCLOSURE Will theepplimice,fuer.Wilding uccopem nom or handle"eardmes material Re-roofs we defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Type of Roof Code,Section 255321.)7 YP ❑Yon 1)410 Will the e,licart or future Wilding occupom use e9vipmem or devices which All roofs shall be inspected prior to any roofing material being emit hmudcus air contaminants.,defined by the Bay Arcs AB Quality Management installed. If a roof is Installed without first obtaining an inspection mi°e' ❑Ya ��L��`eeewww'''��� 1 a vee to remove all new materials for inspection. Applicant (3yvo I have rad the named trials mquirtments under Chepa695 of Nc Cali- understands and will comply with all non point source regulations. forma Health k Safety Code,Savona 25505,M533 surd 25531.1 understand that if be WildmgI snd cu ly lave a tenant,that it is my responsibility m notify Ne occupant of Ne gg a an�.�fPnwwiseuome of.Ceriicmhu Occupancy. Kt. t — tWi2r. Signature of Applicant Date cath edgerate. All roof coverings to be Class"B"or better OFFICE