02050134 (2) CITY OF CUPERTINO
'.•-BUILDING'DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: .. PERMIT NO,
7893 ROBINDELL WY 020,s50n1�34
�IW 'A�JGO E AND E-PING S APPLIC05Y/22/2002
/•PHONE: SANITARY NO. CONTROL NO.
O ZZ ARCHITECDENGINEER: / BUILDING PERMIT INFO
❑ BLDG ELECT PLUMB MECH
i W
LICENSED CONTRACTOR'S DECLARATION
0 5„E . ." - - Job Description
O Z_.� 1 hereby R mm I am licenua under priwi ions of Chapter 9lcommOMing DEMO
F r_{_tu wiohSmiy ]0yU)of Divisi Sof the Business as fessiom Code.andmylicenx
'S4 ix in full h#gWnJ erfec
0 z a Licen ClaaaaFF Lic.p
O a U to Cotnmam liCl
W 0 fi+ ARCHITECT'S D
C—�.3 I undrnmnd my plans shall be used us p c mcoNs V
F
> \
i p:0 tLiccnsM Pmfcssiunal C
OWNER-BUILDER DECLARATION
hereby sec that I am cacmpt form she Contncmr's License Law fa the
7olldss'ing reason,(Smion]031.5.Business and Pmfcaions Code:Any city or caunry \ $13350
YC tub ch 9 permit t t Imnmprosc dem
oh.h p' y.wcmre
u,3 'I in as
ss also Tey ,—'he
th pplaam for
such permnmfleei -
s�w fn 1,,, .-_ ...
thht he ori dp.N ' me
h p moa of the Course Ltt uLa lCM1 laer9 s\ -3,6-Lq 910 flQOC(�ea�h TT vj+yyJ Valuation
co-oar.,
comm ra ng with Seci a ]0001 i D'vt form
3 of the Buslnet a J Proressiuns Code) I „ 1 v {v,s k,�
or that
be
d escmpi therefrom and the basis for she alleg<U aemptlon.Any violation
of Senion]03 ES by try applicant for a permit mbjcax the applicam to a civil penalty
nrnnt more than Rve hundred enuaa(asw). NO MN:R9Nk9 INSPECT ONS''; ' r'. Occupancy Type
Cl L as owner of da,pmpeny,or to,employees with wages astheir sole ema,m anon,
-wllVdo-the:work and the structure is not intended or offered for sale'(Sec:7BR,"' Required Inspections
'Business'and Professions CMe:The Contractor's License law does not a DS apply an 9 p
awnc
r of property Who Wilds or improver tremor,and who docs such work himself
or through his awn employehowever,t e u building
that such{m en,is sol ere not intended year or
.-or
for sale If;however,the buildin mvcmcni i sold within one (
ge hamlet,
yeldn
t,.pmvtion.the owner-W ilJer will have he Wrden of pmotng them he did not Wild or
improve for puryrx of salol.
zi colas ownerpothe property,am exclusivelycomrofengwiltlicensedmnuacmtsm ., • I' t,
_ - contact the project(Soy to a:Business end property
who
Cod,.)The Ces therw's
= License Law docs not apply m an owner of ampcny wM10 builds or improves t,to due
'_. land actors kens.for.Law_.projcxu.with a comtxmr(s).licenuJ pursant.m the
Conmactoh License law.,., -
--' esemtundcr Scc.' ", T' r�B&PCforthis¢ason Its"• L4'''c.it
I '
on" :F 44P k ' Date - +
WORKER'S COMPENSATION DECLARATION
ihereby vRrm under Penalty ofperjury,otte of the following declarations:
f YI; I have and will'mainmia a Ccnifieam or Consent I sem-imure for Worker's
T ti Compeamion, es porvided for by Section 3700 of the Lamm, Cale, for the
'performance of the work for which this permit is Issued.,
[; :❑1 have anE will mafniain Worker's Compemedon In£urunce,ai required by Section
a er IaMr'CoU< f r tM1 perform f the k f h h this permit rs
mid ed M Workc Co open.roost Imur nc orr d Pt li y ber ore �O _
i'"cFki'k10: t,
' ',:•!CERTIFlCATION OF E%EM F M.WORKERS, - �'+
- ���m COMPENSATION INSURANCE„''a L,_; -
stt: (Thi se2tvtnnecd nut W aimpleovi if the permit is for one hundred dollars
(51001 or lcasJ t ..y+, , . I
'n
7:-'rmiky thnr in the perfurmnncc'of the work Tor vv�bicri sh p< it is kWmd:I
t,hall not anploy'any sermon in any manner,so as hi becunac subject to the Workers'
Cmnpe.iianimi Laws of Ctilifumnint,Dte,
APPIct - ." ..... _...._. -_ ." ._ _ ._ _._ " . ._..._ ._.. __._" . ..
NOTICLTO API LICANf Ir mak gtn'.Cns rE' pt on,you sEnald 't• tt '•
0 becora xub)ttt to the Workefs Compens ton Prov s oris of to W Wr Cale,you must
forthwith comply with such provisions m this permit shall be dames mocked.
CONSTRUCTION LENDING AGENCY 'a
I h byIron that there c st et n lending ager y for the peiforman;e
W r f the work fm wheb thispe t is issued(See 30c17 Cis GI
..Ikndcfs Name-. . . .. _ ..=.. _ .... ".... .. ..... ....
Lender's Address
;•,1 ccnify that 1 have read this city
mumu o and some thin oho d wa i laws relating g
W- 'wren;I egrte to comply with all city ami county ordinance and<mm laws elating
'.0. ao building constmction,and hereby'huo' enoaives of ohih city to enter upon
f� .the b t dp perry f ectarrows.
tr•,
Q. (Wq ag 'i- de dya ep hmmlcss the city ofC p<nino 11 against /
h lieb 1 u I dg t, .t. see. yin any y gaiast said
U.Z City to tonscquFncc of th confirs 6,th pumit.
"'+ v1pPl.IGANTDNDEft kNDS VD ]OS 'LYWITHAL ' ''" I,NT
Issued by, Date
SOUR E RECULAT 5.
P tun apcan tinct Re roofs
a eof APP
,AZAR U MA RIALS DISCLOSURE
plic m f i W IJ' g upam tore or Handle haraNuus matcnal Type Of ROOF -
rdfed sh Cupen Tru '<ipa od Ch pt 913,and the Health and Safety 4�t j•%1_sj ty-• +• + ,_ .,
Cadc.S Yaam 255RW1 .1 ., ..tnY• l I �. a ! s �r'•:.5•i•1 r.:f it
- ' .. .All roofs.shall be.inspectedrprior to any.roofing.material.being.installed..
Will the applicant o'future building occupot use er,tipment or devices which If a roof is installed without first obtaining an inspecti66t ILagree�to}emove
mini bacandmis air ii.rumminam, defined by he Bay Arca Air Qumlity Management
D t cr all new materials for inspection.-.Applicant understands and will comply with,
all non-point source regulations', .,1 17 .l,
'I have matl the hazard ak reyairtments.under Chapter 6.95 of @e.
m
Cnlifomia Health&Safely tions 35505.25533 and 35534.1 undemmnd the,
if the Wilding doe!md ml M1d -a a that
it is my responsibility ai notify one
f occupant of,toe mqu men s tubi W no prior w issuance of n Certificate of
Occupancy..' t
'-• _ v Signature of Applicant, - _ _.- - - DateQKne, ,. . .
pdae m All roof coverings to be Class `B'r or better
OFFICE . _ .. ....