04010092 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT COIVTRAC QR INFORMATI(JN
BUILDING ADDRESS: NOVO CONSTRUCTION PE ""'04010092
OWNER'S NAME: PERMITS ISSUE DATE
APC,'RIvTNT 490 MAPLE ST _03 /22 /2004
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECT PLO MECH
�O Zp LICENSED CONTRACTOR'S DECLARATION
1 hcmb .from that I am licensed under ns of Chapter 9(commencing .Job Description
Y Provitlo p ( g P
with Section 70(s1)af Dtvision7 of me BL as Professions Code.and my license is
n�n. in full(ore(aypeffect
;Ij3 LiewscC. Itaf IGzz- TI--ADD DOOR/SIDE LITE IN LOBBY
yg� a I,P(>_ n c OLIN' & EXTENDING (E) WALL
Y C ARCHITECI'S�6Q 1RATION
YI W� 1 underwrid my plana shall IC uaed pas Ile mcmda
6
Licensed Professional
^ 3 OWNER-BUILDER DECLARATION
4<z 1 hereby affirm that I am exempt from the Contractor's License Law for the
i a O following Eason.(Section 703 1.3,Business and Professions Code:Any city car county
$ which requires a Pewit to construct,alter,improve,demolish,or repair any structure
poor to its issuance,also requires the applicant for such Permiuo file asigned statement
–a6 that he is licensed purm.ottothe provisions ofthe Common's License LAw(Chapter 9 Sq. Ft. Floor Area Valga (g1000
y,S❑$ (commencing with Section 7010)of Division 3 or the Business and I'mr.ainns Code)or Y
3..
that he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fon pewiuubjects the applicant o a civil penally of APN Number Occupancy Type
not more men rive hundred dollars(5500). P Y YP
❑1,a owner of the propenY,or my employees wife oma{es asuwh agile genas1la..
will do the wortand thuwemmis nollnkndc0 orottertd f'nde(See.] Buaiwas H
—.and Pm(casions cod':The Contractors L=nm Law doas4dot apply be an own#or }. equired Inspections
progenywhobuildsorimprowsthemomve whodmumhtvorkhim¢Ifortiuoughhis
mvnemplo,wx,nvidcd fen such improvements tie Dol fi omffered for ask.
If.
however,me wilding or improv n,1.sold within one ye fcoO pletion.' Der •�
builder will have tre burden of in mu he did Dol Wil r Ire row fm of
ask.).
D 1,as owner of the progeny,am exclusively contrncMg with licensed conmcmm to ---
Construct the project(Sec.7066.Business and Profession Code:)The Com nater.U.
cease law does not apply ut an owner of property who Wilds or improv thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant in the Contractors
License Law.
D lame.cmptundm See ,9h PC(orddsmason
120 polm
WORKERS COMPENSATION DEC N
hereby arcnw under pcwy,of perjury one of on,rano vine drclaratian:
and will maintain a Certificate of Conant itself-inum fm Workers Compen-
p ovlded fm by Section 3700 of the Labor Code.for the performance of the
woh for which this pewit is iuueQ
have and will maintain Wortee,Compensation Im urenm,as required by Suction
] fNelawr Codc.fm the pert"wLce of me wmk fm which this pewit is lasuW.
My Wader �nmpevW on Insurance carrier end Policy number art:
�F PoIIdy-�o� _
CERTIFICATEOFE EMPTOIV MWORKERS'
COMPENSATION IN ANCE
(7hho auction need not W completed Irene Permit Is for one hundred wilan($1011)
or kss,)
I cenify 0.11.the perfunomot of the work for which this permit 0 Wow,I shall nut
employ spy perL0lnatty manncyan cstlnew eaten 'C Noss too
Laws"(Calif�rni�ggkw�_l a/l
Applicant %M.
NQ7YCE TO APPLICANT:If,afEr reeking Ibis Ccnircnc of Exemption,you should
bqXo*subject to the Worker's Compensation provisions of the labor Code.you must
0 O fo ith comply wife such provisions m this permit mall on,deemed revoked.
,Za7 CONSTRUCTION LENDING AGENCY
(-+vN.a 1 OMbY alriw Nn then its construction lending agency for we perromanm of
Ci me wash fm which this permit is issued(Sec.3097,civ.C.)
IQ Q Lender.Name
z Lenders Addreat
U O I cenify that I have mad this application and sok that the above mfiowedun is
I[. F comm I agree E comply with all city and county ordinances nd show lawn Elating In
0 U Wilding construction,and hereby euhorim mpoommativ or this city E enter upon the
{k7 ,hove-mentioned property for impection purposes,
�"py (We)agree ro taw,fi d...try and trop hawless the City of Cupertino against
fn thontdea,jndgmeOY.eolw and expense which may In any'w'ay 6cme.gPermit. \alnl Lid City
U z APPLn CANTUNDERSTANDS Acof We&Oarling of nND WILL COMPLY WITH ALL NON-POINT Issued by: Date �/ U
SOURCE LAMO S: �
Re-roofs
gnaturc o ApPlic _H ZA DOUS MATERIALS D E Doc Type of Roof
Will me applicant tar future building meupmt nom or handle woudoas mawoal
as wflned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cale,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
Dyes jeNo
Will the applicant or future wilding occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha-don air conmmtnanu L darned by the Bay Arca Air Quality Management
District? all new materials for inspection.
DYcs ?No
I hew mW the wLrdous mawrlals mquimmenu under Chapwr6.95 of 0w Caliror-
nia Hcotth A Safety Codc,Section 25505,23533 wd 2534,l undcsknd muif tho building
dots not current how a it nan4 that It 6 my responsibility E notify Lou mcupmt car me
quim n which on
soL darIissuance ofaccmrlc. a ponyA I. Signature of Applicant Date
r unuthoozcd.gent Dale I All roof coverings to be Class"B" or better