Loading...
00040081 (2) CITYOFCUuPERTINO C►© TRA TOR ITN OO R+MATIOO N< PERMITNG. PERMIT DbO4 00 g' BUILDING ADDRESS: /!_ . oAl_ 44U,,4NC. l//N�(,1///W�/-1- /}�/�',g� �/ SANITARY NO. APPLICATION SUBMITTAL DATE 9E?5_ hoele vim C1161OW F. E: /;`qs I'wvt-7l ff F. . I/—/2 NIC CONTROLp .'HO 1-.. {Mct,'f/�Az'N.V tr j ACi}. AR IIITEQ/ENGINF.Ek /�/� 8 7 IIULrDIN YENMI'11f�. aU�a Zuuu`u��jcc Z y 3LICENSED CONTRACTOR'S DECLARATION 1 hereby afOren Net 1 an licensed under provisions of Chapser 9(commencing Job Description m,—roti with Sation TIDO)of Division3ofine Busincesantl Rofnsiam Code,and myli<cnse is ! - - im ramand after. t//,�48•,d'' Mo2� ands . E a0 u Liceea i f-i _ Lic.M— De¢ Conwcwr C m:O gP ARCHITECTS DECLARATION to I al be used n Public records no u W'4�'v, OWNER-BUD.DER DECLARATION cccZ Q 1 hent,aRnn has 1 am comp,from Ne Covrecmr'a License Law,for the O following ream.(Sort[.7031.5,Badness and Profession.Cade:Any city or money F3$ which o,ons a pearl,th con,to...br,improve,demolish,or esiul my suuctum �f. t''IOOr Ared �/�(iilLlatlO�] price irusa Peak)rtquims Ne,alre,anlfort..dimmim.mr r8si,m smemem ((/%' V\ D Net he is licensed pursuant to to provisions of to Coonamla Lima.Lew(Chapter 9 (camel,iomp, Sccdon]000)of Divbionrtha lBuslnnasmdon.A.,oc Code)of APN Numbe c ane Type Net io is 31.5 b Nem from uM Ne buil ut to allegedsomatise.Any it penalty of / p y yp Semon d LS five any applicant f«a permit mbjau the applicant m•civil poetry of /D� 'I pof mart Nen five hurdrM dollus(5300). , I,eawverorm<McPemY.armyemployee.witwageadxirmleeompeeMrn. Required Inspections wif dem.work,and Ne mumure law,imevhd or droned Pontile(See 7 1 .B.... and Pont..in.Cade:The Contruwra Limnce Use does nee apply to an owner of ' Property who buil or improves do m or.and who doer mesh work himself ar through his own employees.Provided Net such impravemems cm out intended or offered for ale.If,however the Wilding.,improvement is sold within one yea of meeplation;the wncr-Wilder,will have to burden of proving mat he did nm Wild or improve for pur pose of sola) ❑I,a owner of ted property,.H i.m.mill Freiman. with liceno Contractors rs w centwcl the firma,(Sec.]INC,weeinas and Property wh bei Code:)The Convncton.LI- whocLaw dorsserapply ets)wattofprapmywce Wdp«improve tnmn,on'a �- Licer.Low. «men paiect.wiN.cannat«(a)mc<nred punaantw me CanmmWr Litt ear Law. ' ❑taro exemptanda Sec. ,B&PCfor Nis ma+mn own« one WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penelry of penury arse of Ne following dalsatiaa: � /D i]1have andwill for bynamortl 37M of Corunar Codinmtefor Woakda Camper !// lion.r provided for by Section 3]00 of Ne Labor Code,for the peAomwnce of Ne for which Nie pernir is issued. O Ne w 1 hove end will maintain Wallace.Compensation Insurance,h required by section J of to Libor Code.far to performance of dm waft for which this permit is lamed. M Wah���r/.eg4 Ra lymruwe certic and Palic J1��(pya Curio ..... Raot.T� Policy Noy ^I ,-�T�,� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This ration need not becompleredifthe permit is fordo hundred dollars($100) or loss.) I Car iy Wt in Use performance of to work for which Nis permit is intend.)shall not employ any fiction in any mmner so es w become subject o to Workers'Counter. action laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you Mould haom<subiauo to Warker'a Compensation provnioe of to Lobar Cade,you mum forthwith comply with such provisions or this permit shall be domed ravaged. CONSTRUCDON LENDING AGENCY 0 I hereby afflon Nat tem is a canmmction lending 4..y far ted perfi.ce of the wait for which this Permit is issued(Sm.MO.Civ.C.) r - E., Landeel Name gd > IaMeh Address WE 1 certify to 1 have rad Nis application and state Net to above informu don is 6. correct.I.gra to comply wit ell city and county customers and state laws missing to V 0 building mmmucdon,and hereby smhorize representatives of this city to enter upon the aWvermemineed property for inapaden purposes. W E.y (We)agree to save,indemnify and keep harmless the City of Cupertino against 0 C.) liabilities,judgments.costs and upmscs which may in my way accrue against said City r� in consequence of to granting of this permit S APPLICANT UNDER STANDS AND WILL COMPLY WITH ALI.NON-POINT r..) SOURCE REGULATIONS. Sigmtuseuf AppmcantlCotraome Dare �1 + HAZARDOUS MATERIALS DISCLOSURE it Will dm applicator future building recupms more or handle hazardous materiel Re-roofs u defined by the Cupertino Municipal Code,Chapter 9.12,and the East,and Safety Code.Section 355334)] Type of Roof ' ❑Ycso Will in,tepplkmt or future Wilding necupant use equipment or devices which All roofs shall be inspected prior to any roofing material being emit hazardous sir motorman.es demned by to Bay Arco Ah Quality Management installed. If a roof is installed without first obtaining an inspection District?❑Yea �a I agree to remove all new materials for inspection. Applicant d P PP thous read the honodous Has mgohanmu under Chapter 6,95 of Nes Cali- understands and will comply with all non point source regulations. 7�� mic Halt&Safety Cade,Seniou]550.5,25533 and 25531.1 undemand tut if the ilding darn sly ca renanLta,it is my respo..toloywn«ify Ne occupant , �h metproormissuaaeofa Ccp�¢y �o�f rySignature of Applicant Date sen or euth zed e.h Date All roof coverings to be.Class"B"or better OFFICE