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00120057 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: IIHRMIT NO. 7359 RAINBOW DRIVE SOUTHBAY CONSTRUCTIO14 00120057 OWNER'S NAME: APPLICATION SUB DATE SGIJ DESiELOPIhENT S1i DIVISION STREET 1210812000 PHONE: '� SANITARY NO. CONTROL NO. (408) 379-0400 BUILDING VERMIT INTO 0 YO ARCIII'1'Ef-f/ENGINIiIiH: BLDG ELECT PLUMB MECH w� day yG lmnLICthlEDCONN,IboarRACfOR'Sde,s Dirous of Cl N Z Hamby union tow 1 rrra ncan.ed nnacr nroni,ian,lar cl:amer 9lemmneneing Job Description FRC. Is th Scdion 7000)ol'Divivion 3 of the llnvine2.and Prnl'rWitc.Code.and my license a-� i,irr Tau fame and euect. DEMO Sz c a Licence:Class Lic.p y P n O Date Commemr, W 3 a.�; ARCHuEcl S DECLARATION C O< I t derit my plans%ball he used as public record., w i 5 p z Licensed profes+:oiml OWNER-BUILDER DECLARATION I hereby alrrm that I ran canopt form the Coutmctor's Liccnu Law lit the C> following reason.(Section 7031.5. 1.ol1rs%noel ,,,lemons Code:nnY city lar ramnry G•LO sublin 1 n ll I Ilt n lo lin 1' to am to Itinrt t L, y I .. tl Ipc I I g Int(Chapter morn licensed p . a rt m m . nn tContractorsC 1 onsCodY Sy. FL Floor Arca Valuation (commencing e with Section lain)d t Division hi3 the lege tic.,and i nen..a n.cede) $,:,5000 or that M is exempt therefrom; yphi and the hoes%for the.,,ha exemption.Any violation of Sectio 711315 by;wry shod doll r, n pemrit snnlecu the applicnm m s civil penalty anmttnrne litre live.hmdra�l nannt,(,sou). APN Number Occupancy'Type 01.as owner of he I topcny,or my curplo,ocs with wages as their sole cour,ensecon. .36231.029. 00 will do the work,andthe,Vadum i,nm order or sale uttered far le(Sec.1014. an Business d Profession,Codi:The Contractor's Licca¢Law dons not apply to an _ Required Inspections nt� raf l,ro@ny Who bunds or Improves mcman.:md who dues.arch work himself NO ASSIGPJED INSPECTIONS 11 [1 In,own anployces.provided mat such improvcnand arc not imarded or - ofland tit sole.IL however,the building m improvement is stilt]whhin one year of completion.he owner-Wilder will have the burden of proving that he did not Wild or mp we for pm row"Code.). I,m owner of the pru,o i I csurvive,cuntrnci ng with licensed contrac tors to rnt the project(Seg.7044,Ilaninros mW frol'esxinns Ccal,0 IIt,Couraclo,1 Luice e.Law,does not apply to in owner til property who builds or Impar es thereon. and who contracts for such projects with a eommctnr(s)licensed mursmm to the - Cnntratorz License law. ❑1 um esu r under Nyyy,RJ'C for this Hasan Dwrr \VOR IiR'S COMI'IiN5AT1(lN DECLAN ION 1 hereby affirm under penalty of perjury'Inc of the following leclarmini . ❑ I M1ava and will neuntan it Ccrllfca a of Consent to self-insure for Wud.cr'n - Cnrnvariation, av provided for by Section 3701 of the Laher Code, fur the pcdbm,ance til the work for which this permit is i¢uul. 01 have and will maintain Wader's Compcnnation Imumnm,as rcyuired by Section , 3701 011 the labor Cate,for the perrormano,of the wad Ivor which this permit is ural.My Wader'.Compen.enion Insurance corder and Policy number are cam": looter No.: CLRI'HICATION 01'EXEMPTION FROM WORKERS COMPENSATION INSURANCE of his rection nod not be conrplend it the Punnir is for one hund,cd dollar% (Slap or lits) I certify that intone permo mneu of be.,,,it for which thin permit is issued.) shall not employ any person in any nunner so as to become subject to the Workers C....mcnnmlun Laws of California.Date Ao 11 - Not ICE'1 O AI'I'LICANT,IC unor nr.Aiog this Certificate of Emmaption,you should become whject III the Worker;Cmnpensation missions of the IaMt Code.You amid OQ forthwith comply with such provisions or this armritshall be deemed envoi CONS'FRUC ION LENDING AGENCY 1 hereby mann That there is a nrn.vtmcuan landing ugcncy trade p,Hor anee tithe work I..which dn,Inmril is issued(Scc.3097,Ci¢C.1 1 Q Lender's Name . .= 7 Lender's Addre,s U O I certify thin I have read this application and%ane that the above mfrocalt r is - �+ [yr correct I agree m comply with all city rind cnumy mdinfor-v amt s0m sews relating . O U to,gilding con,oadinn,and thereby ardam,c epnsemative%af his city to inner ufran the aMrromernloned prnpcny for inspection put ii [.. 4 (We)agree to%rive,indemnify and keep harmlesv the City of Cupertino against (n Iinhilkic,,judgnunn,costs and eyx:nsc%which may in any way accrue against said U Chy in coura"un a or'Ire granting tit his proud. �z—O APPLICANT UNDERSTANDS ANI WILLC(IMPIN I Ah1.NON-1101 IsSuedb Date a SOURCE HF.GULATIONS. ! O Y' Signature of ApplicanVCnmracmr Dgtc^^ Re-roofs HA%ARDOUS 1ATERIALS DISCLOSURE Will he applrem, itm more holkhro,accupam item ar hamm le namou.,raedal 'type of Roof m dctlnu,l byline Cnpenlnu�l Pel Code.Ch,,acr 9.12,unit te hHealth and Safety Gde.Section 2553240 \� O Ye; lNo All roofs shall be inspected prior to any roofing material being installed. Winnie applicant(it boom building oc'cupmt use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit houacho,mr aanuunimml,us dclined by the Bay Amu Anr Quality Munagenant Outdo! - all new materials for inspection. Applicant understands and will comply with G Yen "Ito No all non-point source regulations. I have road the Wound.., naerials re,mothacnts under Chapter 6,95 of the California Health k'.S:dcty Code,Section,25505,25.533 and 25534.1 understand that l the FuQ yn.htilconyu=,pons.Whty mamlfy the accopwre,ncola which btu be met prim to issmmce of g Cenrrc te ofOccap / � Signature of Applicant Date owner el agrrt All roof coverings to be Class 'B"or better OFFICE