08020007 (2)CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CQI T9A 0 INFO' ATI0r
BUILDINO,AOYORESS:IEDEL PL
it
LARRABEE & ASSOCIATES INC
PERMIT NO.
08020007
NEWS NAME:
PERMIT ISSUE DATE
TONY UNGER
36 RAILWAY AVE
02/01/2008
PHONE
SANITARY NO. CONTROL NO.
(408)364-9000
A0.CHnER/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
LICENSED CONTRACTOR'S DECLARATION
] JOb Description
- p
1 hereby affirm that 1 am Mooed under provisions of Chapter 9 (commencing
MOS=don7(DB)of Divfsion]ofdm Budn odProfeWaa Codo,andmylk--is
HORIZNTL -FRACURE REPAIR LFTSIDE-GARG AREA, TOTL
LI�snISe COams'. ! Lm.»
LINEAR FT REPAIR APPX 13 FT
Dau Conuamar
ARCHITECTS DECLA ATION
I undersand my plans shall lo used as public records
Licensed Pmfcadanal
OWNER-BUILDER DECLARATION
-
I hereby strifes that I am esempt from we Can"C%Qe$ License Law for No
following mason. (Section 7171.5, Business and Professions Code: Any city or county
which requires a Permit to ennsWct. Mass. improve, demolish, or m*r any structure
prim b its issuance, Saw requires Out applicant for such Permit b Ale. signed statement
be is licensed to Of the Conummm's License Law
Sq. Ft. Floor Area
Valuation
that pursuant the provivaa (Chapur9
$7500
(commencing with Section 7000) of Divi ion 5 often Business and Professinns Code) or
Na he atherefrom and empt therefroand me bass for the alleged eampdon. Any violation of
316 210 6 0
Occupancy Type
Section 7071.5 by any appliaot fm a permit Subjects me applicant to a civil Penalty ofNumber
not mm do. that hundred dollars (5500).
❑ I.uowaraflimpropeny,mmymploymwlmwaguuduswlec=Nmdon,
Required Inspections
mework, sod m s mtkunded, d fuseau (Sec. Sots, Butlnm
case me Canlaamn License (sew dm act apply ir rt away of
and Pr The Orae Law S
was
property who s. it ro or ire protea thermn, and who data such wok himul f ter through his
property bat
own employers, proNdetl thatmach lie not Intended m If.
,ennimprowmcoa laved the owe
me building mImprowmmtissold Merinoneyea of
immpkdm,meowner-
Wilder will haw the buNrs of proNng that lo did not build o immerse for purpose of
Wilder
ale.).
0 1. as awm of the Property... aGwsively conuacdng Mth licensed contramme to
consumer me pmjen (See. 7044. Business and Professions Coda:) The Cmbaemes U.
cense Law does not apply In an owner of property who builds or improv thereon. and
won contacts for such projects with •conuacmr(s) licensed pursuant m that Conu tmor's
License law.
❑ Imesemptunder See .BRPCfmthureawn
te Dau
WORKER'S COMPENSATION DECLARATION
1 hereby dnno under penally of pedury ane of dm following declan0oa:
❑ I have and will awh aim a Certificate ofCanscm m self-iaum far Worwars Cmpm.
sa m. as provided for by Section 7700 of the labor Code, for we perfarmeno of the
wok for which this permit is baud.
❑ 1 have and will maintain Warken Compensation Insurance, u required by Section
77M of the Labor Cods. for we pcRormanee of me work for which this permit Is Issued.
'
My Worker's Compensation Insurance mortar and Policy number m:
y�q —
Gmsr: QggLE- r—tW Policy No.: m
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(msacadm need not lo completed If the Permit Is (mane hunmNtlallan ($10(t)
or less)
I totally that In me performance of the work for which this Permit is issued, i Shall not
employ any person in my mamterm u m became subject to me Worban'Cmpere ation
L.. of CaRfomis. Dae
Applicant
NOTICE TO APPLICANT: IL after making this Ccniacew of Esemption. you should
become subject or the Wanton's ComPom ation provisions of the labor Code. you muss
forthwith comply with such provimoa or this permit shall Ito domed mated.
CONSTRUCTION LENDING AGENCY
1 herohy dRrm madam is a construction lending agency for the performamx lir
the wok for which this permit IS issued (Sec. 5197, Or. C.)
'
Lender's Name
,
Lendeem Address
I codify ma I haw read that applicWon teed sale mal the slow information is
tartar 1 agree In comply Mth all city and county ordinances and sou lawn relating to
building comucamon, and hemby audwrim reprawmatiws of this city to enur upon the
alow-menliuned pmpeny for inspection WTates
(We) agree to sew, indemnify sod keep bamlea the City of CuPenino against
liabilities, judgmmmacow and ..Pa. which may in my way acerae against Said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGUfA
Re-roofs
Type Of Roof
�� �V 6h
Signature of Applicar/ Omaamr D7ic—
HAZARDOUS MATERIALS DISCLOSURE
Will One applicant or for= Wilding occupant mom or haMk lu ardaa material
as dented by the Capudm Municipal Cod, Chapter 9.12 and we Halm W Safety
. Sectio. 25532(.)7 9
❑ Yca
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
.I
each Weardma air c mamiams as defied by the Bay Area Air Quality Management
all new materials for inspection.
Distrin7
Qya m
I have real the hernduamateriasrequireomeS Umar ChaPur S95 Ofine Celifom
nia Hcalm A Sdmy Cade, Senions 25505,25533 and 25534.1 umknaral thalifine building
does ret currently wn._temwittigh u my responsibility m wdfy the aeupal of the
mgdrtmen ma nar�keu °`or. Candlemas arOccupancy
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner
ter wthoriv of