01040076 (2)CITY OF CUPERTINO
-„ BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
01040076
OWNER'S NAME:
APPLICATION SUB DATE
04/1.6/2001
`IIONL
SANI'd'ARY No. CONTROL NO. .
ARCHI'I ECI UNGINEER:
BUILDING PERMIT INFO
BLDG ELECf PLUMB MECH
.I L,J ISI CI
hICENSEDCOM'R17OR' S DECLARATION
Job Description
I hereby a0 ire Thal 1 alit Iicemed under provisions of Chapter 9lcommencing
r
wish S,,alon 7lgllpof Ali on,,fill. If ants, and Pn,fcx nx Code, and my liter,.
„i
is in lull forte and . //i
i l0 ��
ire„n t,� nits..— --
SHAKES TO TILE.
Date g�f S'DITC,m_B� _
ON
AI, halluh1woLARA
1 add .ravW my plana shall he ideal it, public rccunb
��
F I N A -
I.a,cnwd Prwlcasinnal
OWNER-BUILDER DECLARNION
I briefly alfn,l than I an, exempt front the Contractor'. License Law for the
fallowing up on. (Section yin 1.s, Benoist, add Pmrex.l,rr Code: Any city or et,unty
MAY 2 4 2001
which ic,ofres a per all to comloo t, aloa,, u,rO,.dr id.- d,ur cry orro ire
pri to llpOdance. at,.y th ppl a in. , perrund file g d. t repent
Sy. Ft. Floor Area
Valuation
that he is ficansedp o tl Its, provisions ofm C ales License Law (Cho-pter9
from g ithSection 7000) of Division 1 of II. dl fe .Code)
.,,flat he is ea, my thatch sad me bas,1i, the .mon , ,eged.ae nay violation on
a„ ..
DEEDING
of Section mi I5 by any apphcarn for a pemdl subjects the applicant int, civil Penally
APN Number
Occupancy Type
Of not more than live hundred dinars (s500).
❑ I, as nw,e, of he proper), or my empluye'ex with wages as their sale coni,haidon.
I a. 00
_369130
Required Inspections
will do the xatk. and the .....came is not intended or offered or sale (Sec. 7(ro.
Business and Profession, Code: The Contractor's License Low does nil apply m an
builds, hupnrvca Ili ......, and who does such walk mnaulf
r of proven, Whit ,
or through his Own employ«., provided that such in,prosements are not intended or
305 — FRAME
.it,.) for .It. It: however, the, budding of imp,nssail l is ,III widdn ....I yar of
nopletiin, the owner-Mliff r will have the bunlen of proving that he did not build or
307 — INSULATION
improve for parry's, Invade).
607. — ROOF TEAR OFF
❑Lusowner oftheptepcar. am exclusivelycontracm,gwith htensed&alruclel,to
the nojce, (See. luta, hoin... nd P,nmx,ianx Code:) The Contralto,
602 — ROOF PLYWOOD NAIL
L,..hurt
icense Law does not apply to ad Ownerf property who builds Or improves thereof
ajeci, will, a at r:am,is) liecs,d nursuu
sad wbn outran, 1, osuch Ir” alt , me
60..r — ROOF BATTENS
Convector's License Law.
❑Iant exe,nplundersea. .B&rClormi,rea.an
6044 — ROOF IN—PROGRESS
Date
Owner Dare
N'DRKIiK'S CG A'll(IN DIiC1.ARAlIO
'N,
/�
0
1 beach, ,fill m, „ode, pcndty of perp,) ono of the fans, mg deaaradan,:
,Yv
.
:1 1 It,,, and will n ooldahl a Ccnlread of Consent It self-ia.m. for workers
Cooperstown, as provided lot by Section dngl of the Labor Code, for the
perlonnance of the work lilt which this nnit Is iceuul.
,*have and will maintain Worker's Co,nl,enw,tion Insurance, as required by Section
up of the Lahor Calc, for the perfind ance if the work for which this pernal is
issued My N'o//ryy--Is oci inn I... rance courier and Policy mM:Or not.
�CCuu�mp
G
No.: �a %-lit cJ ZJ
Carrier:_%(i{i[yy_.Kdiay
CER1 IIICA'I'ION DI' EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This anion neOd nit he cnmplcmd if the pc.Oil Ic for one hundred dollars
ISIMB or le".)
I cmify that in the ciforounce (11 the work for which this parmil Is issued I
shall not employ ally pelsoll in ally nmm�ur so as u' beaooc subject to the Wnrkerd
Compcn,miun Law, of California. D:nc
Applicant
NOTICE'1 O APPLICANT: If, afar making this Ccrificnte of Estrunion, you should
heome subject m the worker:, Cmnlxreutlon Nmvisions of the Lebo. Code, you nmsl
load with comply with such provisions or this permit shall be deamed revoked.
C'ONS'IRUCfION LENDING AGENCY
I hereby alBnnfilm there is a construction lending agency lin the ry:rlannunce
'
of wick for which this Nonoil i, is,ted (See 3(W7, Civ. C.)
,
lander', Nome
Under', Addreee
I cerlay that I have led Phi., application and state that the:do'se intornanion is
correct 1 agree In comply with all city and conn y nNinancex and state laws mining
-
In Wilding construction. unit1 1) authorize representatives Of flus city to ter upon
he ah-e.dierflonall for insiscefionp opo
prolsely ..
(We) ill t save. italtracHy addkeep I unless live Cu, ofL,d aga,.a
liabilities,il costs and ex,coses which inay in any wayar against said
City in consequence of the gmrtu us panni,.
APPLICAN9UNDERSTANDS DN LLCO LY WITHALLN�O[N INT
SOURCE REGULATIONS. K l4 /� r
4
Issued hy: Date
Re-roofs'
Signawra of ANpliaam/C'ontmcua Dam
HA%ARDOUS MATERIAE S DISCLOSURE
Will die,pprcanal a, hall ,iriding accapanl store m handle hazardous matentl
Type of Roof
as defined by the Curcuma Municipal ode. Chapter 9.12, and the Dearth and Safety
Cud. Sm,ion 259320)!
❑Yes ON,
All roofs shall be inspected prior to any roofing material being installed.
Wil he applicant, or roar, Wilding oce.... t ase egopmncot or de, i,,, which
If a roof is installed without first obtaining an inspection, 1 agree to remove
.rail W,ud aa, ter emnaminonls as twined by the Bay Area ter Quality Mana,co,0
DotrivO
all new materials for inspection. Applicant understands and will comply with
oyes 0N
all non-point source regulations.
have read the ha Code. al,ron,ls requircmcmx ander Chapter e,ta nl the
5. 5.133
Cody.avea Iityto l:rad 0m
railing dth &os of
�\
t\�\ti•�"fir`/j/ �///6
reason. it responsibility
ifthebuildingc not currently yhavea¢,ant,ohm it is any msrymsinilityronnlify the
if the cur that
7
,ctupam it d'e rayuha,n,m, wldm „m., he a'n poo. m ixsuan,c of„c,nuiemt ar
Oa,upan
/�— lt/ � � 4D
Signature of AI plicant Date
All f to be Class `B” or better
Ownerortafir I 1 D,a
coverings
roocoverg
ge
OFFICE