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01070118 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BU1 DIADDRESS PERMIT O 1040NG N 0 STELLING RD MISSION CONSTRUCTION 01070118 AAF�1 °SEC RIM FINANCIAL 613 BAY VIEW DR AP ATE gy3B00, PHONE: SANITARY NO. CONTROLNO. (831) 688-1573 q zO ARCHITECTIENGINEER: BUILDING PERMIT INFO kL"w— BLDG ELECT PLUMB ia i LJ L.J IJ I �Ny Z S rn Z LICENSED CONTRACTOR'S DECLARATION Job Description OZ_m Ibcrebyaction that lamlicensed under provisions of Chapter add mmencnse TEMP POWER. with Section 7L4l d If Jof the Business and Professions CW,and my license si y ism a, (ince and ett rc as a License Class Lic.9 7�q 9 34 - Sp60 Date Comram �.KS:z, nW. a{i, CTP11lIALE® LL 0 ARCHITE 'S DECLARATION 1 understand my plans`hull he used as public records w aexp Y Licensed Professional UL 2 6 2001 as OWNER-BUILDER DECLARATION u'S12ia 1 hereby ofErm that 1 am exempt from the Contmaor's License law for the (_Z< fnllnzvingeacm, (Section 7031.5,Business and Professions CWe:Any city nr county- 0 cc va,h pi n perms m conorucL alter,improve,Jcmollsn,or repair any structure ILDING i 3 poor to its issuance.also requires theapplicam lin such perms mfiles signed smtament. rA - 'hat heislicensed purmant to the provision,of the Contractors License Law(Chapter 9 3'5310�t0 bl4gry&a,r` f e , • Valuation (commencing pith Nation]000,of Division J of the Business and Professions CWe) # '• c . . sC'. •ISz.>.A t or that he is azempr theratio n and the basis for the alleged eximp ivin Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars(S500). 10 3 ABN t�ktg}Wer Occupancy Type 01,as do net ofth,property,ormyemployees with wages istheir sale compcncnhon. 304 - ROUGH ELECTRI AL -will do the work:and the'stiucmre is not intended or offered for sale(Sec.7(4{ Bueimels'and Professions CWe:The Compatriot',License Law does not apply m an Required Inspections ' owner of,r.,rly Who builds is improves thereon,and who does such work himself mfla or through his own employeesprovided that such improvemenrs arc no intendedrhor or ' ,offered for sale.If,however,the buildingeni is sold wittirn one � f -- completion,the owa>Isullder will have the burden of proving that he did not Wild or improve for puryose of sale.). co I a:toxionofffi.pmpc.7 am Buss exclusivelycommand,with adea Th tracrers - n.ase the prosect Lapp ]to a Business d eProfessions CW '1 The C ova barren. 1 Linux Law does not apply.poj owner th prop,ny who builds or improves thereon, _Cowhoconverts!mmets.projects witb.a.romractor(s).licensW pursuant.m the. . .._.. ._. _._.-_ .._ . . .. ..._._ .___. ..,_..__..- _. _ .._. .. _. Contractors License law. [I pt ude I am exemnr Seca :B&PC fm mis amom n O• ir D,itc' •. w I• ,..WORKER'S COMPENSA'i ION DECLARATION 1 hereby affirm under penalty of perjury one of the following declamtims: ❑ I have and will'mainmin a Ccnili,atd of Content to self-insure fur W..ker', Compensation. co-provided for by Section 37W of the labor CWe, for the _ - performance of the work for which this pefmit is stand., is M1ave and will mainone Worke s Compensation In umnte.as aquircJ by Section J)IXI of the L,M1sn CWe,for itse Mrlbrmance of thi work for which this permit is iew d MyWorker sC pe 'i I w c unJP l y M1e arc:' - - - _ ., w^ .• Carr _s. t ..Por yN nIsl ,s CHI IIFICATION OEEXEMPTION FROM WORKERS, r i ..COMPENSATION INSURANCC u' L (Thsiucti;,i ad not bcamicilcted fits,permit is for to hundred dollar IS I No or less I„ 1 lcnfy that N peens c fth kfor wh hth.pe lis issoW I .. .;i• t shall t stop y a.yy is on9n y marine o .}p co first t he Workers _ bccomCeEubOel %Y[GSSfl4 Pate —1 1 _ ... . .. _ . . .. _. .. Gm ns tont .. ... . . ... ... .. NOTI .. Applicant Z APPLICANT.If,aftera k g thisC n f to of E e—GTo t, a should j to the Workers Compensation provisions of the La r CWe,you must C)-� forthwithtscomply with such provisions othis t th permit shalt ebedYf deemed pe itod F ' . . CONSfRUC`HON LENDING AGENCY 'o: ncnda ._. . _ .. _. ._ . ... ., = Z Lender's Address - - ,• V � 1 c ncify tine I have read this nppliation and on.that the above inlnmatlon is tzz E:. cwiecr.1 agree to comply with all city and county ordinances and state laws relating fJ rebuilding construction,and hereby authorize apresendideesof Ibis city roamer upon W the bis t sed Impede for inspection purposes. _ F•'.p, (W)chilies,to W ' e mfy and k ph I cs th City olC penim,against VI liabilities j dg m t J expenses which may in any way discgdunst said U. ^ Cry < n. qac ec ttheg yy g[I lh LNPdI APPLICANT UN IS 6AND WILL COMPLY WITH ALL N N-P INT / 7 souacE Y, +'� ! ? Z Issued by: to signator rApp'unVContmdmt; : ate' Re-roofs p f1AZARDOUS MATERIALS DISCLOSURE 'nln llpld tdrw b 1a'r.g' 1 t n h dlefi Wn s t I Type-of Roof Code dth Caput Muri<p ICJ Ch pt 912 dthH hh rods ( y Code Section 355724I _ ` n t a r _ ` ire )` " � a' All roofsshall be;inspec[ed.prior to any roofing material being installed. ._ Will the ppl r t m building , p t Lorequiparlart ordevicas which If a roof Is installed without first obtaining an inspection;'I'`agree to remove h' d us r con W tits os Jef d by by Day Arc A o al ty manage nem n t tet \J all new materials for inspection. Applicant understands and will comply with. ❑Yrs No all non-point sou a reg u do " 1 n5ve,rtadnhe boundless miicrild,requirements under Chapter 6.95 of the California Health&Safety Cade.Sections 25505,255]7 and 25574.1 undwstand that, f the hhllding doe,concurrently hand a tram that it is my responsibility vi nmiry the °iupant of the kquirimenii which most he met prior to Alicante of a Cenificute of ctapan!g. % Signatu of A ' ant Date Owner -uthorize gem t 'I" - DaaT- -- All roof coverings to be Class "B" or better - - :i• -ii • .,;.;... :. . - - 1 - -- OFFICE-- -. .. .. .. _ .- _ ...