08090072 CITY OF CUPERTINO �s�s,� /�� %�].� a�/.
BUILDING DIVISION PERMIT L V�Q�L\^l, �
BUILQ Iy G�aRRqa FSS: PERMIT NO.
LLUVif OAKDELL PL GOFF DEVELOPMENT & DESIGN 08090072
41VER'S NAME: cu PERh11T ISSUE DATE
791 E BROKAW RD 09/15/2008
PHONE: SANITARY NO, CONTROL NO.
(408) 441-8076
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
aOp LICENSED CONTRACTORS DECLARATION -
FF 1 hereby alnt,n that 1 am licensed under provisions of chapter 9(commencing Job Description
�z1a`S
with Section 7")ofDivision3atNCBudneungNefeuiuuCode.aedmylicense is RMD KTCH&1/2 BTH&RMDL MSTR &SECRY BTH;RMV EXT
in loll race and ell
�qz
License WALLS@ KTCH&RPLC W/BEAMS IN PLACE OF WALLS;NO
ARCHITECTUe,Ca(nn�—t—AjVV X051)
S
RE—ROOF& HAVE STRUCTURAL BEAMS IN PLACE OF WALLS
,( 1 undrstan mss plans shall be tied as public record
6
SG Licensed Professional
OWNER-BUILDER DECLARATION
t gl I Wroby.term that Mc I em exempt from Ne Conlramofs License Law for the
C 2 o fallowing mason.(Section 1031.5,Buclaars and Pmfrsafau Calc:Any city or county
SI f which recromm a permit to ennstrrmL alcor,improv.demolish.or v:pur any stmmuin
m prior N its issuance,alio requimJ NC applicant for SYCh permit to JIM a Signed Stancom
Edo
(hot he is liecrosed popecont to mc prevismant of the Commeson'S Uscrom Law(CMP=9 Sq.Ft.Floor Area Valuation
�{ $ (commencing with Section 70M)of Division 3 or Me Business and Professions Code)or $85000
[
that he is exempt Motorman and She basis for the alleged exemption,Any vioiatican of
session]cols by Say applicant for a permit subjects the applicant W a civil penalty o
net more than five hundred dellass(S500). 32618044 .Number Occupancy P Y Type
❑1,u owner of the PORrtY,ter my rmplpyco with wags u thev Sole rntnpemdon,
will do Ne work and Neswctue is not intended or offered for ale(See.70th,Business
and Professions Code:The CompactoeS Lmasn Law does MI apply to an owner of Required Inspections
property who Wildorimpmvratheramn,tend who doessuchworkhimselrerNmugh his
manemployres,provided that such improvements are not intended woffercd for sale ff.
however,Ne Wilding or improvement is Sold within one year of completion.the ownes-
Wilder will have the bond.of proving that,M did net Wild or improve for pmpo¢of
sale.).
❑1.as owner of the property,am combo ely command,with licensed contractors W
construct the project(Sec.7010,Business and Profestlau Cods,)The CoemSoWfs U. .
sense law does net apply W an owner of property who Wild or improve,Warton.and
who contracts for such projects with a contramer(s)lieened ptmoUra W the CormanTafs
Teem taw.
❑lam"Crnptundersec .B&PCforwMMmn
net Dae
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of peduty,one of the fallowing declarations
❑I love and rill mainuin•Certifiuteo(Unum w elf-iasurt(or Worksite Compen-
sation,r which this
(sir mi Section 3]00 a(Ne labor Colt.for the RRarmenec of the
wart for which Nu permit is issued.
❑1 have and will maintain WorkeYs Comperoamn,I..,as required by Session -
3700e(Ne 1aWr Code,for the pcRarmanex.file work for which Nu permits,hsued. '
MY Worke Com asset Inpnnetee.TriesandPn1irynumberart:
Cartier. (/-7 r) CJ Policy No.: OJU—�WILD Q�j
CEROFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
f'ro'nt section teed rot be completed If tle permit Is forane hundrtddoRus(5100)
or jus)
1 cutify Nat in the performance of the wart for which this Permit is issued.I Shall not
employ any person in try manner an as W become subject W the Wortrn'Cmnpeuation
Laws of Calirmom Date
Applicul
NOTICE TO APPLICANT:If.after making this CeeiOcaW of Eumptin,you should
become subject W On Workefs Compensation provisions of the L dne Code,you roup
.J 0 forthwith comply with such Provisions or this permit ahall W demand invoked.
z�
CONSTRUCTION LENDING AGENCY -
[—t I hereby afnrm that ft.isoeonswetion lmndinY.geney for Ne pefform.or
rl the work for which Nis permit Is round(Ste.3091,Civ.G
�W Q Lender's Name
Z Lend,Address -
V 1 certify that 1 have mad No appn®ion.od SUM that Ne above information 4
L3.
commet.1 agno,W comply with all city and cowty mdimanRt and some laws rtlating W
-p Wilding cowauction,and hereby aulatni mpresenutiM ofrhts city to enter upon the
r W .how-mrnacgra ms.procnyfor inspection prupces which may
n, (We)agree to asm indemnify,ted keep harmless the City of Cupertino against
fn incormaqueecofM.coausnd ex pof is remiichmryin anyway Sonne agalastsud City
C) z t.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON- INT Issued by: Date
SOURCE
� Re-roofs
Srgnazue of Applacaat(Conu Wr Da
I�AZ1R osis M DISCLOSURE Type of Roof
Will IW appiiau turn Wal oeecuputpose1.handle hauNoumamfial
de0Sed Section
de Cupertine Mudcipal Cao.Chapter 9.11.and she Ha1N and Safety
.s«donlsslll.n
0y. 'ANe All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or fuwm Willing eccupanl assn equipmrnt or dulcet which Pe
Cookmha'rudoas sir contaminants u de0ned by the Bay Area Air Quality Management all new materials for inspection. '
❑Yes �Na
I haw earl dm huatdn s'emoriab ns rMmmens undcrCNPter6.95 of thc CART..
nu Health&Safety Code.Sessions 355D5.25533 asv135534.1 marmoset ted if Ne building
does nm curtendy have a mnanL dead u my M.I.mty m notify thin occuput lir the
/D All roof coverings to be Class'%¢"or better ,