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00030108 (2) CITY OF CUPERTINO Peamrr No. BUILDING DIVISION PERMIT CONTRACTOR.INFORMATION: 00060109 ^/ I//�7 BUILDING ADDRESS: r ' ) (� ✓ O 060 l 1. t tiooe - � t ty1y- (�--f/` /saw-/.'II/per, '�^ SANITARY No. APPLLIIC/�UUN. BMIIIALDAT OW 'S def/AOtM.E: �J a /` I / `"ISL I �-f �T�OO O�1 .A_1`i I-rr'/l� / �© S N, CONTROL« 'HONE:_" �7Z- �C.-3 1 V /�/���L//- f f ARCHITECyT/ENGINEERl...il '� ^ DULDINOP[RMIT INFO :.{� a� (? 0 00I- QU(/ lnaa o 4 z LICENSED ban I CONTRACnOR'S DECLARATION Job Description 14_o 1hn7 )of Net1am licensedBunderpftfmof Ch . 9(commercialmyls p F_`u; wide Section 1000)ofDivision3of Ne BuainesaaM Profession C'de,Wmyliccnu is =,�< in ll(9:..ay o �rv7 ,2 yTn�v �lC �DlJ-dam O u O Liete Class lie.« . LL u Date CnntralOr i.O�n¢ ARCHITECT'S DECLARA ON J [understand my pl,n5 Shell be used has public records W�'Ci Iicm,N Professional ^_m OWNER-BURDER DECLARATION C>a I hereby effort emp deal 1 am ast from Ne Co mucarrs License Law for the F O Minerva,mason.(Section 1031.3,Buthnesr real Professions Cuda:Any city or county 3F which returns.permit to construct,elten improve,demolish,or repair my smucWe mSq. FL Floor Area Valuation prior tuna ismance,also requires Nc eppeca.I fo...ode pduo file a signed ruament m0 can k is licensed paamun to ted provisions of the Connectors License Lew(Chapter 9 he fte1Wexcmdonnrmyvieme)m APN Number Occupancy Type that fie is ean'pt Nert(mm W the basis for the alleged excerption my violations of not mato Nan on,ban by any applicant rot a pmmiuubjaa sa applicant m e civil puWry of wim rive hundred dollars($SW). Las ownerofthe pe tome, run employees inuendwiN wars ass dis(So,mmpemai,,, Required Inspections will fr fework.ands:1: arcnisi imorded w'wortsrotueapply tars,Business and P'mfe W b Code:TW Contractor's Lind w law saes trot apply m lf rrwner of his O nY who Wads pr ivided t re muchn.real who does such wort deed nef or though his own own ersx,provided r i sah imprweold w thin nal intended a'Read roe suba owncr,howeT will Wildingur improvement it toldwidensarcyen ofc,prova for the owner-W e).will have be Widen of proving Net he did nm Wild m impmvn for Fur- pass or sale.). ❑h a owns of dte property,are exclusively connecting wide:Kanas contract's m rostrum project(Sec.Two,Buxinesn ny w1Wm onmcto ' Cade:)The Crs Li- came Law b ecormtapplytoor owns of pxoPenY wed Wild,ommt in tho 'sourced .hecontractsLa,forHoch peojata with aemwctor(nl Irenad pursuant to Ne CanuacroM1 License law. ❑1 sum exempt under Sec. .B k P C for this reason Owner Date Fl NA[.Ep WORKER'S COMPENSATIONEC DLARATION I hereby affirm ander pmairy of pmjury one of the following declasatimu: MAY 2 j 1 have and will maintain a Cenificme of Conunt'o W rinsurefor WoxkertiCompery 200'1 tion,es provided fm by Sauon 3100of Ne Labor Code,for the petfomtanm of the 1 wmk for which this pem k is issued. ❑1 have and will mainuiri Worker',Compensation Insurance,as rtquiad by Section 3100.(NC IaW,Code,fa the peefomtanca of dee work for which dei,pormit u iaand. BUILDING cynw ik Comrpe���In�a�we!`Oter Nor b �2Og7 N6�CERTIFICATE OF IDlEEMPPITON IRO WORRIERS' COMPENSATION INSURANCE (This semi''nad not becompleted olden 1.1 is forone hundred dollen nl(Xy or less.) [certify Net in the ed..& wink for which this Forms'-a issued.)Nall nor employ my Person in my manner m as 10 bewrrc subject to the Wori Canyon. ration Laws of California.Date Applicml NOTICE TO APPLICAM'.If,afar making Nin Candice.of Exemption.you should become subject to be Workers Compensation provisions of the Labor Code,you must fonhwith comply with such provisions m this permit mull W deemed revoked. CONSTRUCTION LENDING AGENCY O.Q I West oRrsothat Nab in a consonance lending ageay for dee Perfmovence of ZZ be work for which this permit is issued(Sec.3091,Civ.C.) ti Landon Name 7 lambert AM.,, WI certify dor read n I have d Nis eMlicome al nate dust be, m above infi.tiis 6. G corrte1.1 agree u comply with dl city real county ominret«a said state laws alsoing u .. Z Wilding construction,orad heaby eoNoria moresenwivau of this city re enter upon the eW".uamtipnW property for inspection purpuees Gs. F (We)area to nave indemnify and keep harmlcas the City of Cupertino against O U liabilities,judgntma,coma and expenses which may in my way accrue against said City >, 14 in con5egaac of des granting of this pamen, [� S APPLICAN-l'UNDF:RSI'A NDS AND WILL COMPLY WITI I ALL NON-POINT Zi U ZZ SOURCEREGULATIONS. _q- Sigmm pplicanUContbcmt Dau HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding scup.mmeor handle hazamoustvrerim se defiad by the Cupcnino Municipal Code.Chapter 9.12,1 the HedN aid Srfthy Type of Roof Cods,Section 15532(t). / yP ❑Yes L7< Will the applicant or future Wilding oecupam use equipment or devices which All roofs shall be inspected prior to any roofing material being emit hazardous W cmtaminanu an defined by the Bay Arca AG Quality Management installed. If a roof is Installed without Irst obtaining an inspection same.? I agree to remove all new materials for inspection. Applicant 1 have resd the bround'mm.terWa rcquhoencnu under Chapter 6.95 of dee Cali. understands and will comply with all non point source regulations. fomin Haalth&Safety Code.Sections 25505,M533 and 25534.1 understand Nat if the building does sod currently have..enam.that it is my responsibility n notify the occupant of the eomena which mus C> nor mawc of r Cmc SOccupyl�'y i. 22— 0 Signature of Applicant Date Owner or authonzcd rgml Daa All roof coverings to be Class"B"or better OFFICE