04070167 (2) CITY OFCUPERTNIO
BUILDING DIVISION PERMIT `C,ONTRACTOR INPORMATION.
BUaDINGADDRES3: REMNANT TERMITE CONTROL PERMIT No 04070167
OWNER'S NAME: PERMIT LSIIB DATE
/) 12
E: SANITARY 0 OL NO.
ARCHOECUENGINEER: BUILDING PERMIT INFO
BLDG HLECT PLUMB MECH
30G LICENSEDCOMRACIOWSDECLARATION JbDescri tion
1 hereby alarm Nal 1 am licensed under prooP
visions of Chapter 9(commencing
wiNSection70DD)ofDividon3ofthe Bush mW fico era Code,anteeyItemh
�^ Len foAWcd L `/'
�g3pp oem� - C'angrmlor REMODEL (WINDOWS/KITCHEN/2 BAHTRMS)
pp A cxnEcrsoecuR N CONTRACTOR: REMNANT TERMITE CONTROL
3
I understand my plsna awl E used as public recoNa
50 LucnsedPmressiaw
OWNER-BUILDER courap,t DECLARATION
0I I hereby.(Sere on I a1.esempe from the Conlnnors Licence city
a for Ity
p o following nam..(Section t 7 ar tun ewmns and PreImprove.
donons Code:Anyepu city 11 oaten
$ which nqulma•pmnil re c.nsumL alter.Impmw,h permit t orea.ir my tirucmm
poor mits issuance.
ensedpalmngo the tite applicant for suchpermitto Bleatiaw(h¢mem
<
that beeslicensedPSection7 the provisions eBottomrindProflaw(Chomr9 Sq.Ft.Floor Area Valuation
(cat he Is exemng pt
uantitteandOnD osis n3 treteeged exemdea,Any viCods)or
$ that he B exempt Dam(rom and the buts for the alleged eanmption.Any violation of
Section 7031.5 by any applicant for a permit objects lha applicant an a civil penalty of APN Number Occupancy Type
not mom than five hundmd dollars($500).
❑
I.u mvonj of 0a properly,army employes with wagesu theb cele mmpemdon,
will do the work,md the.net..isnotinanded m offered fanale(Sec.70/4,Business Re uired Ins ections
and Profession Cade:Tho c musemes License Law does Out apply m an owner of q I)
pmpmywho Wilds orimprove,Nercon.mdwho doetauchwork himselfordecugh his
own employes,provided that such improvsmenle art not intended oraffered forsele.If.
howsm,dw Wilding or Improvement is mid within arc year of oomPletion,the owner
builder will have the burden of proving that he did not Wild or improve for purpose of
ale.).
❑L as owner of the property,,B exclusively and contracting Professions with licensed mmetan's to I l
came La the an not (Sec.to in Buinm and rrywhCade:)The Cs th aem, red I
cense Law drcA not apply a is owner of pmpeny who Wilds or Improves Norton,and
who contracts for such projects with aconvsemrtq licensed pursuant to the ConuactaM1 /
rase law.
lam esempl antler See ,B&PC far Nis noon /
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the following decimations: ,
have and will mainWn a Cennst to
ificumcd Coenselfdiuure fm Wadars Comre
pe
salon.u provided for by Satian 37M of Ne liter Code,for the performance of the
work fm which this permit is issued.
❑1 have and wilt maintain Wmker's Compensation Insunme,u required by Section
3700 of the later Coda,for the performance of do work for which Nie permit is issued.
M kers Compensation Insurance carrier and Policy number M:
71
am Policy No.:
CERTIFICATE OF BKEMPI N MWORKHRS'
COMPENSATION(,NM
RANCE
(fhb senion need not W completed If the permh is for ane hundred dollars($100)
or less.)
1 uN(y that In the performance of the work for which this permit is lamed,l"I not
employ any person in my mannerso u to became subject to tite Worlan'Compensation
Laws of California.Dal
Applicant
NOT Tp APPLICANT:If.after making this Certificate of Exemption,you should
became len m the Workers Comlcmadon provisions Of the later Code,you muse
.,O font comply with such previsions or thea Permit shill W deemed mated.
z1 CONSTRUCTION LENDING AGENCY
yrs
F (hereby aflirrlt that Nem is a consuuni.n lending agency for the performeace of
CYi> the wort for which Nb Permit Is issued(See.3097.Civ.C.)
QLender's Name
Z la ultes Add.
UQ I canlfy that 1 have mud Ws application aw.late that that me.information it
u.!' cotmn.I agree re ith comply wall my and county Ordinances and sale laws muting re
Q rV' building construction.and hereby authorize repnsentativua of this city to enter upon use
[3] awn-mentioned property for inspection Purposes.
(We)ague to sive,indemnify and keep harmless IM City of Cuperfno against
y liabilities,judgments.eau and expenses which may in my way seems aNnst aid City
V 7 in consequence of the granting of this permit.
G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE TIONS. e/7 Ae-�
-0
rp Re-roofs C7 L
i lean onamrer Data
HAZARDOUS MATERIALS DISCLOS Type of Roof
III the applicant or talk.Wilding aaupmt port or handle tornadoes material
m dented by the Cupertino Municipal Cade,Chapter 9.13,and the Health and Safety
Cade.Section 35533(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes t.
Will the applicant or future Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
I haurdnus air contaminants as defend by the Bay Ane Air Quality Management all new materials for inspection.
16VIc17 1
❑Yes P N.
I have cud the hamdmu materials requirements under Chapter 6.95 of the Califon
nia Hall"SafmyCode,Sections 25505.35533 and 25534.1 mummand that ifda Wilding
Jou twr cumnndy how•anent.Na it u my rcvpowNlity re mtifY oceupant of the
nequiramem,whi uatW tl mCC afa Ccrtill mm Lp".z Signature of Applicant Date
Owner m recd agent Date All roof coverings to be Class"B"or better