04040010 (2) CIEIRVINE
INO '.t•.r �f�a e.:: > '' ° r s;
N' PERMIT COl�TRACTnI2INP,UR�4AT«TQN ,
BUILDRAEGER CONSTRUCTION INC PERMIT N0b4040010
ERS PERMIT ISSUE DATE
PARTMENT COMMUNITI S605 COMMERCIA 04/14/2004
ONE: SANITARYNO, CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
200 LICENSED CONTRACTOR'S DECLARATION'
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section]OfID)of Division 3Orth.Bounem and Professions Code.and my license is
imm�mresandenter, STAIR REPAIR
q z uanso Claza tie.w
C Dam ContractorDELL
v' ARCHITEDECL
CTS ARATION
1 understand my plain shell be used as public records
�yU
30 Lianscd Pmrcxsinnei
Oat I am exempt
from
DECLARATION
E 2 f 1 hereby affirm 1 sin cBusin from the Contractor's Co License Law for the
E22 p O�, following re son.Permit
t ]11]1.5.Business and improve.
de nm Code:Any city or county
sottish requires B Issuance.also ill crinsrequires
rthe nlMc.Ian pons[,h Permit t file
mash any poor tenement
5iy that hes itscensedursuant to the thrrisiosofcant for the Contractors
Permittofila=LawJnaumenl
E < NathmencienWJPSectiolmtbcofDiviomnfortheBusinesrandProclsw(Chapter ode)or Sq. Ft. Floor Area Valuation .
R$ that he is(Commencing enter,
Section n and are
Division]of Nc Business exe pt on.Any nsCd,on of
Nn he is exempt Nepfmm and the bines fano Ne alleged exemption.Any violation of
Section 7051.5 by any applicant for a permit subject/the applicant to a civil penalty Of oro 0 Occupancy Type
not more Nan five hundred dollars($50)).
❑I,u owner of Ne property,or my employees with wages as their sole compression,
will do the works.end are strucmm is not intended or offered for sale(Sec.]acts,Business
and Professions Code:The Contractor's Llcmue Law does not apply to an owner of Required Inspections
property who builds or improves themon,and who does such weak himself or through his
own employees,provided Nat such improvements are not intended Or ORea d for sale.If.
however,the building or improvement is sold within oro year of completion,Be owner.
builder will have On burden of proving Net he did not Wild Or improve for purpose of
1
mJ.
as owner of the property.,B sine exclusively contracting with licensed uscures m
onterua des not (sec.]acts,Businessend Professions Ca dei The
vesthe on.Li .
ams Law dins not apply m an owner of property who Wilds or improves Ncrcon,and,
who commcu for such packets with a contactor(s)licensed pursuant the Camnno"
License Law.
❑lame I d CC. - ,B&P f rthis azon
neo _ Dau
I COMPENSATION DECLARATION
1 be of a natty of Perjury one of Bar following dalvalioni:
I have and will maintain a Cenificuu of Consent m sel6insure for Workcr'scompco-
1-171M"
on,ss provided for by Section 7]110 0(the Labor Code,for the Performance al'the
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,az required by Section
of the Labor Code,for the performance of to work for which this permit is issued.
Worker's Compensation Insurance carrier and Policy number arc:
Carrier: Policy NO.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thtssectioo need not W completed If the Permit is foronc hundred dallara(SIf1o)
or less.)
I certify Not in the performance of the work for which this Permit is issued.I shall nor
employ any person in any manner an ss an become subject o N.Workic ComPensaion
Lion's of Calif and..Due
Applicant
NOTICE TO APPUCANT:IL after making this Cenifcau of Exemption,you should
become subject to the Worker's Cumpcsuuion provisions of farm labor Code,you most
.,O foMwith comply with such provisions or Nis Permit W deemed revoked.
Z�--� CONSTRUCTION LENDING AGENCY
IZI I hereby firm Nat Ncrc is a contraction lending agency or On Performance of
7 Ne work for which this permit Is issued(See.509],Co.C.)
QLenders Name
a z Lender's Address
V Q I certify Net I have read this application and sues that the drove informaBun Is
ly (~ cancer.1 agree to comply with all city and county ordinances and[esu laws relating u
0r, building construction,and hereby authorise representatives of this city to cnuruPnn Be
W above-mentioned property for inspection purposes.
(We)agree In save,indemnify and keep humless the City of Cupertino against
,.y y liabilities,judgmenu,eosu and expenses which may In any way seems against said City
in can cncc orthc IB I.nC of this Permit.
'-" APPL N U D RSTA 05 AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
sou o S.
Re-roofs
SigneWrc A lice Conn ear ere '
Z US MATERIALS DISCLOSURE Type of ROOF
IOr epPlito urc Wilding acupantim.or handl.hazardous material
az defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
ado,Section 25532(4)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will the applicanto mer.building oreupamuse equipment ordevices which If a roof is installed without first obtaining an inspection, I agree to remove
It hazardous air contaminants as defined by the Day Arca Air Quality Management all new materials for inspection.
istric,7
O Yes Nu
I have mW Ne haraNr usmaurials equipments under Chapter A95of Oc Caliror.
nia Heal k SarctyCarte,Satioru75503,25555 and23534.l underaund the ifthe Wilding
Jou n urt m vc a un a dot it u my msp9nsibiliry m notify Nc aaupant of ire
colordmca rats hmuB et pd issaanaonceniWamoraap Signature of Applicant Date
Owner ser til rirsd m Da
All roof coverings to be Class "B"or better