01090112 (2) CITYBUILDING rvUUPERNDPERMIT FOCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10555 RIDGE VIEW CT MAI INDUSTRIES INC 01090112
OWNER'S NAME: APPLICATION SUB DATE
COMPAQ 105 BONAVENTURA DR 09/25/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 434-9880
C s i ARCHITECT/ENGINEER: BUILDING PERMIT INFO
Ore 00F BVG ELECT PLUMB MECH
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iy j LICENSED CONTRACTOR'S DECLARATION
= I hereby affirm that I am licensed under provisions of Chapter 9lcommencing Job Descripti n
�{=m COMM. DEMO.
wlm Section T000),n Dixinion]aftheliminessend Profersiaaseade.and my license
LYE.-i is in full force and effect.
i z 6 License Class Lic.g
0 a V Date Contractor
3 3 u ARCHITECT'S DECLARATION
1 u.O unticrnand y :.h II h useid os public records
LASE
no
OWNER-BUILDER DECLARATION
'-�a, I hereby affirm that I am exempt from she Convactur's Llccme law for the
z'a fallmving reason.(Smarter 703L5.Business and Professiom Code:Any city m county $1500
Y F C which requires a pmmit to contact,iter.improve,demolish,m repair any swrt
ctu
n
3 m .prat t 't suaoca also require'theapplicant fmsucb panel ro file a signed statement- - - _ _
thath I used pursuant toN pre nsnom of the Contrxtors 4anse law(Chaqu9
(commencing with Section 7")of Chvisom 3 of he Bromar"and legionar codr) CON i '31OCfn1 'S:t l° Valuation
or that he is exempt Nerefrorn and the basis for the alleged exemptur .Any violation 1
..
of
na mort031 byeh M�ddullnnrfa Pro)it sub)ecta me applicant to awe Fondly
NO VAlY #4Lb INSPECT ONS Occupancy Type
°I,as aware of the property,or my employees with wages as Neu sole compensation.
will do the work,and me nammu a is not intended or offend for sale(Sec.704a,
Business and Professions Code:Tho Convector's License Low does not apply to an Required Inspections
owner of pmpcny Who builds or improves meeim.and who that such work himself f
or through his own employers provided mat such improvements an,not intended or
co pie for sale.Ir,navrcvea the Wilding or improvement fm.,n sold wi did one Year of i• - ,.
completion the n f.however,
the
have the burden ve proving mat wi did on build or
improve for purpose of sale]. l
._... ..o
...r °L e owner priciest:
the p(Sm.7,un Business
clavering nes licensedcontractorsComdors to I ' •. "
e
construct the prosect(Ser.1044,owner o and Professions Code:)The Convector's i. •t
._
License taw dos not rapplysuch
to an owner of property who builds seimprove thereone
._ ;. and who contracts for such projcns with a contrutor(s)licensed pursuant m the .. .. .-_ ..
" Convenor's License law. - � � -_-� - _ •
°I am exempt under Sre; • B&P C Emmis reason 1<l
_ Gwnc Date' "
_ WORKER'S COMPENSATION DECLARATION
I hereby infirm under peoeltr of perjury one of the following declarations:
° 1 hive and will maintain a Certificate of Conant an self-insure for Warker's
Compensolms, as provided for by Section 3100 of the Labor Code, for the
- perficit of the work for which Nis purer,is issuM.
❑I have dnJ will..,main Worker's Compensation Insurance,as required by Section
37Mof the La1ror Code,for the pre voce of me work,for which this permit is
dyad My Workers Compensation Insuraruc tamer and Polnry numbv _-
Curl W
1( " COMPENSATION INSURANCE' .. --------
-NOF XEM FROM-WORKERS' Y- t t i,r 7 t�''t r t k r•�k t �r ' s ,11�
' .Mis section need ret W completed if,k pannus for one hundred dollars
($L00)or less, brrnme subject .SEP 2.,5_
l at icon in an manner so ...• -. .. 1 .. - .. ti
unify that in the performance of the wink for which this pt to t e issued;I n ,t,o0
shall not employ y f y _ a m t at the WOAeni
Compensation on Laws of Celifomia.Date '
Appl
NOTICE TO APPLICANT,IL Compensation
this
..itme Certificate dR Exemption.you should
Wchwithc subject the Work pr Compensation pravisi shall ,chicael,Unit,Code.you ret
z O forthwith comply with such provisions or this pemtit shall be deemed revoked, m
1
F'� .-„ t CONSTRUCr10N LENDfNGAGENCY .. - t
1 hereby'a0lmn that their is a construction lending agency for the perhvmance
G Q of the work for which this permit is issued'(See 3097.Civ.C.)
Lender's Name'
w7 Z LendeYs Address _ „ t",
C:) I certify that 1 have mad this application and state this the above information is '
W 1.., comer.I agree In comply with all city and county ordinances and state laws relating
�.0 to Wilding constriction)and hereby nomadic representative ofthis city to enter upon
the aboem
vcntioned property far inspection purposes.pW„ (Wc)agrerminva,indemnify andk,c,h.lcs,the Ciiy Lf Cupertino,wnn
to liabilities,judgmenu,costs end cape...which may in any way came against said
U City in consequence of the grinning of this permit. "
_ APPLICANTUNDERSTANDSA pWILLCO. LYWRHALLNONFOI Issued by: Date q 2�
SOURCE REGULATIONS •'' Y'
Slgnamfeof Applmonuc tar��.wwwQ��fff...JJJQQ�../AAI K.�':Y7B Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE '
Will use appficaat m f oar WHdin tnoreanertm huaidms materiil Type of Roof .. - . . ... . .. -'--. ._-.
as d fined by,ma Cupertino M _pal <,Cheptu 9.12,and the Halm sed Safety
Cinde.Section 25532( ) uI. .. r I>s i v r i t ss ,'k
❑Ye i7?aa'; _ATI roofs.shall,be inspected.prior.to any roofing.material being installed.. _
Will me applicem or fuwrebuildi tacupam use rquipment m drains which If a roof is installed'Without first obtaining an inspection;I agree to remove
emit hnaardous air comaminanuss def dby the Bay Arca Air Quality Management
DistrinO Yes o No _ all new.materials for inspection.- Applicant understands and will comply with
., . '. .'. . r, all no source regulations:,,,,,.41
I'1 have read the haaallous mate ids requirements under Ch tptcr 6.95�of the
Califomia Health St Safety Code,Sectio'125505,25533 and 25534.1 understand that _
if the Wilding does not cumentlyhave at nand.that it is my responsibility no notify the
4 occupant of the rrquircments which may be ren prim to issuance of a Certificate of
Oc pa'cY -' 1 Signature of Applicant Date
Owner uthonzed agcm Date All roof coverings to be Class"B" or better
_ i OFFICE