00080177 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PIiIt MIT NO
OWNER'S NAN11:0481 STOKES AV SM I.ICAIION.
'IIONIi:
CEDAR YORAM AND ZAHAVA 6305 D NANITARY NO_ G 4611171000,.
C Om C ARCHHECIENGINEER: (.925)556-6010 ]WILLING PIiliMl'I'INTO
V.ccw�
BLDG ELECT PLUMB MECH
ad
ZN LICLNSIIat NTRACIdIt'4DEC..L,mCIO:N ,106 Description
_C 1 M1ereby fifirin 00,4IThal 1 tan kernof the B under Lac1 P oe,,i Chapter 9lcmnmcncine
m s-w with Sceniun 78101 u(Div' nnJ of me Oua,ncss rood Pndesxiom Cale.and my lienee
�Y^� 'w in pull force unJ dlcd.v
R a w U U.Itcnm Class I.ic.#ucurr
ccac ARCHrn?Cr'SCora
DECLARAIDON 4—TON A/C & ELECTRICAL CIRCUIT FOR A/C
t=�� I undcmm�J my plant zhall h used a auhlic mcnNs
Wba
2590 Licensed Prolessionul
a. e ce OWNER-BUILDER DECLARATION '
H I hemhy ill!....don I Lou eecnrpl Isom Ilm Cunuacmr's U...oe Law for the -
F'>< following reason.(Section 7031.5.Rosi cw and profession,Cade:Any city or county
x e which requires it penuil m curotran.alter.Improve,dell er mini,any xtmcture
wt-
prior loibi....rea:Jxo rectums the applicant for suclgrermif m file us'igned sm¢ment
'hat he is licensed panaant to the provisions of the Contractors license law chapter 9 Sq. Ft. Floor Area Valuation
(,ort etch,well Section 7000)of Division3 of IM1e Business and Profession,Cute)
or that he I,osampl tunnel rent and the basis for the alleged e.ar,ai ur.Any—nation
of Section 7031.5 by any applicant for a pctmit subjects the earl icanno a civil penalty
ill mnmomdnmtWeharbor!dilu,sSIM). APN Number _ OccuparAIRITyp8
❑1.is owner of the property.or ny employees with—alms as their sole comltetuminn,
will his the work,and the structure is not ialco6cd nr otfemd fin side(Sec.7044,
llusinos and Professions Code One Council s License Law does not apply to an 32647056RegIf fired Inspections
of properly Who build,or huprovc%thereon,land who dates such work himself
or through his awn nnployee,pnrvided that such intprnvcmmrts aro not intended or
Whirred lin side.If,however,the building or improvement is sold within ane year of
tmpmann,nreowner-builder will have not balden of proving that he slid not bond or 303 — ROUGH MECHANICAL
in,..Vefor trrn`e
'tnf`ale.) 304 — ROUGH ELECTRICAL
❑I.as owner onhe p,openy,nine,eisively ennnnling watt licensed eounumefr's Ill505 — FINAL ELECTRICAL
construct the proiecl(se,.7844.Business and Pmir
es,ion,Ctde:)Tire Contractor
uec,s,I,w does not apply to an owner of pmpeny who build,or improves tnemon• 508 — FINAL MECHANICAI_
and who eonouets 6r such projects old,a commdoas)Ilcemetl pursuant ro the
Commemrx License Law.
❑I ant enema,Lunde,Seo. ,B&P C for this mason
Owner Dam » .
WORNEWS COMPENSATION DECLARATION -
I hembv alYr,n under penalty of perju y one of the following declarations:
-p I fare ad ill natural..Craps fat f Consent n self f N der'.,
Comp am Pmsidled f by S'ct 37.) if l • Labor Cold, for the
perfintracurecol he work ti h m:pen , '.:lad /
❑dl lI od or k ':C Tip t 'e ch Jsis �i/
0110 of the lain Ctde,for the aerfomrancc of the In work for n.,ni this peter Section in
issuedM..��yy\\Workcre``C\a\mpen%tt jamnCe�M hs."�1rid 11Pal icy��n,u'm'M-r''ar(a� O
Cmrier:Jy"ilaga I Policy No.:��y_t_ O
CV1It HVICAI'ION OF EXEMPTION FROM WORKERS'
COhdPHNSAIION INSURANCE
(This section need,sot be congtle4d If the permit is Lorene hundred dolbm
LSlgp or less.)
I eerily Ioa in,he enlofmanre oI thework to,which mix permll is seed.1
shall not employ any person in tiny manner m as to beeome suhjcc,to the Workers'
Compensation Laws of California.omc
Applicant should
NOTICE 1 o APPLICANIE If,after making this Cenif icam of Exemption,you s
Manu,subject lar the Worker's Confen.wtlon rmrisluns of the father Code,you oma
ET's fnnhwhh ebmply with such provisions a,this perant shall he deemed revoked.
Lz—I z CONS'IHUC'1'ION LENDING AGENCY
C > 1 hemhy dlitno that there is a dmsmraion Ick ing agency fill the Iwrfunnmmc
Uof the work Err which this perrml,is issued(See 3097.Civ.C.)
S Q faner's Nene
z I.cmdc,'s Address
V L cenil v that l have read this application and state that the uiwe infiltration is
correct.1 agree m comply with all city and cony ordinances and state laws mining
C) U Tithui Iding construction,and hemhy nall 1,mpresentmis m of Ibis ciy n,crime upon .,
F'
the above-mentioned ve- entioned property for inspection purdri -
y Ove)agree h,save,indemnify and keep ham less the City of Caperton against
r to Iinsidious.judgments,coos and expenws wh lch may in any way accrue agui test said
U Z City in consquence of the gmming of son pcmrit. Y
APPLICANT UNDERSTANDS AND WILL COM PLY WITH ALI,NON-POINT Issued by: ✓� Date
SOURCE REGULATIONS. y'
Signature of ApplicmnlComraclor Date Re-roofs .
HAZARDOUS MATERIALS DISCLOSURE
Wm theapplicant eefuture building ocenpant>famorhamimho.,mdeo,manerial Type of Roof
a derned by the Cuppri Mneicipal Code,Charter 1.12,and the Health and safety
Code.Section 15533(a)1
C Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or Lienees which If a roof is installed without first obtaining an inspection, I agree to remove
m,il havardeos xlr"Ooll rrell'odefined by IM1e Bay Arcs Air Quality Munannuent
District all new materials for inspection. Applicant understands and will comply with
CYes °No all non-point source regulations.
I bac mad the hazardous mnenals repmenuents under Chapter 6.95 of 0e
Calij...
ma Ilealth&Safety Code,Sections 21505,25513 and 25g4.1 undersand than
if the building docs nm cur,emtly have o tenant.In,,,it is lily espnmiiliy to notify Ihu
occupant of the requirements which must Mand prior al issuare of a Cenificam of
Ocm
Signature Of Applicant Date
Owner ort,Luroonbedagg nt�Jr `� — — Ito All roof coverings to be Class "B" or better