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00100127 (4) CITY OF CUPERTINO ' v PERMITNO. BUILDING DIVISION CONTRACTOR;INFORMATION: PERMIT r--_< ; : - BUILOINGAD'JRESS: �` �m`11GITi�: 1✓'taf�]/ 1 C1`J ..L SAN]1'ARYNO APPLICATION SUBMITTAL DAT OWNER'S nA IW(Y � 7�,�1 SG,-YI-MS,eA Cin K N I O 00114"U' �,/ r��; �� ARCHITISCpEIJGINEER —1 TV16*0/'_ �7/ ?iTONE AVE BULDRIGPERMIT INFO orcU aF.ZW Fy. LICENSED CONTRACTOR'S DECLARATION z o H z t hereby aRrm that l am liccwed uMa movixims.f CTugtt 9(mmmercing Job Description Fou wifullf a]ardidr Di isianl ofd¢Business,and ProfnsCode,aM myliutueis { �C,` ` G r �© a y 5 in full force avd cRuc, V -C t g. 1 Ir' I✓ �/ o a uren._�i Lia sx �/Cl v —` YY tKil 3 0.y Date Cmwcor y, I undeasM my platy TIARCHEC'S DECLARATION IP MEST I C COPPER ��y shall W used ss public secunda a+Saf c Licensed Profeaioal W m OWNER-BUILDER DECLARATION L:K>' 1 hereby affirm Ills,I am exempt from the Cann corn"License Lew for thr E S o following roman.(Section]o]I.S.Business malPrefeuions Code:My city or county d. which aquhp a Permit m consumer.din,improv,demolish,or repair any moan e S Ft. Floor Area Valuation j primo is issuance,also requires the appliant for such prrotit w file a signed rleumrnt q' Nal he;,licensed W...a,to the Provisions of the Courounne,License Law(CMpar9 (commencing with Section 7000)of Division 3 ofthe Business and Professions Cod.).r AFN Number Occu Type than he is cumin thaefmm anal da bN basis for e alleged exemptioane n.Any vm1m.tis P Y YP Section 7031.5 by my applicant for a permit subjects the epplianno a civil penalty of not or me Im M1five hundred dollars($500). El1,a ovnerof the .employees with wages a their sole cones emon. Required Inspections will do the work,and the surname,is not intended or.Hened for We(Sec.7016,Business and Profeaiors Code:The Contractor.License Law dos,nal apply In an weer of 356:04027. 00 property who builds or impmvcn thereon,and who does such wants himself or through his own employees,provided the,such improwmmu sec n.,imeMed a offered for side.If.hoverer,ted Wilding or improvemrnr is sold withinnne your of mmplmim,the wmerWdaer"it have the Widen of proving that he didnm Wild.,improve(as per- 106 — SEWER & WATER Firs 1,ofsale.) owner.(the pro n exclusively 202 — UNDERFLOOR PLUMBING ❑ R y ren Y cmgmling with licensed c0ntramws la mswallW projal(gec.ttua,Bw�neu aM Professions eoae:,TW cmtmamra Li' 301 — ROUGH PLUMBING came law docs not apply to an vact of propeny wim Wilds or initiatives themnn.and who emtractsf.r such puej=Is with acantracmr(s_)licensee p.LLam m me Commiserates 302 — TUB & OR`'SHOWER License Law. C Iamexcmptender Sec. .B&PCfmthismason 502 — FINAL PLUMBING ENERGY owner Da j 506 — GAS TEST WORKER'SCOMPENSATIONDE.CI.ARATION 507 — FINAL PLUMBING I hereby affirm mrM pemly of perjury one or the follwing'rx'lan,im: O I haveand will maiaWn a Cerdficatc of Co..,toself-inum,for We&&.Co.,.. / nation,as provided for by Section 3700 of the"Wr Code,for the perfom use of the ' Xfor which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,a required by Suction ] of the laws Code,for the perfmmaae of the work for which the pumnis ieu/cd�. Myst bC rep Lion nmamce andy No,. 4D . Ceadcr. Policy O L./ CERTIFICATE OF MOTION FROM WORKERS' COMPENSATIONploredRube eme ANCE (This section need rot W completed ifthe pausal,is(Drone hundred dollen IgA W) or leu.) I ormfy that in me pedo.of the work for which this pemth is issue4l shill Bol employ my peon in any manrcr so as to Wcome subject In the Wasteri Compen- uminn Laws of California.Data Applicant NOTICE To APPLICANT..If.afar malting this Certificate of Exemption,you should beton¢subject to she Wrr ds Compensation pmvisiom of the IaWr Code,you must forthwith comply with such provisions or this pamtit shill W ducmrd revoked. CONSTRUCTION LENDING AGENCY 0 Iherabyalhm thus mart msec.nslmNmleMing agency fm da pemormmce of Z the work for which oris permit is issued(Sec.3097,Civ.Q undre.Name ye > I<Mer's Address k7I certify mal I have sad this application and Lime mal the amve inr.mmim is fins z comol.I agree to comply with dl city and county ordinances and euro laws aluddit m 0 Z building construction,east hereby autwrice rtprcmnutiva of this city to enter upon the U 0 awvememioned property for inspection purposes. [i t.., (We).gra to sew.intensify vd Karp hamaeas as City of Cup,,me f dnst 0 C.1 liabilities.judgmmLL.runs and expenses which may in my way same against mid City >.. Win conxaquacc of me Rutin,of this paamit. [•+ 0^' APPLICANT UNDERSI'ANUS AND WI 1.1,COMPLY W I ALLNONI' INT U Z SOI' .froa' Al' INS. 1D, q pian Cmumlor Dore AZArun.. MATERIALS DISCLOSURE WiIIy teCupen,or future wilding rccupmt marcor hawk Health rdand Safety rid Re-roofs, a m.Sed io IM1e Cupertino Municipal Coda,Gbapaf 9.12,cod the Hedm and Sanity Type of Roof Code.Section 5533(¢)] YP ❑Ya o ma Wilding occupant use equipment drvicex which All roofs shall be inspected prior to any roofing material being Will the applicant orf it Wand.esaircontrunimaisasdefinedbythe pay ArseAir Q`whoyManagement installed. If a roof is Installed without first obtaining an inspection 1(1 I agree to remove all new materials for inspection. Applicant ❑Yes g IhewreadAma theluvandatty. a. aper0.95.fda Gdi. understands and will comply with all non point source regulations. forms Health Jr Safn nae.Sachmx 5505, 53 and 5odc,Gh536.In INt if the huilding snac ly havice,n ,mut it i. responsibility m nam the spm el the LL 1 riIN tui of a Cmiftc ML Signature of Applicant Date Owner. a gen Data All roof coverings to be Class"B"or better OFFICE