Loading...
00020085 (2) CITY OF CUPERTINO PERMITNO. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: �� ru2-0'0 BUILDINGADDR[SS: �w Omit a (n Ontne,,,^ lo . O ` tea✓/ Avenue V'/ / GyJ ,✓✓ /11Ge SANnARY NO. APPLICATION SUBMITTAL DATI Iv,•S h Igi// L�NM1Ci l�lvy N�t/o�rl it�P' NIC CONTROLg ... 2 — 3°21 J�U�lcU4r�li CA 9ysys/�22 ❑ ARCI IITF.CrfENGINfEg sin -193 -2012 BULDING PERMIT INFO pmz 00 �Z h�i LICENSED CONTRACTOR'S DECLARATION FutO in— I ion? afrnnn Nat 1 am fitheBu under proviuom of Chapin 9(ro Job Description coded Stttion>OW)ofDivipionlofthe Businessmd Rohuiom Code.eMm a f7 infullforceudellen./Jpff/�Y�OI GUo)erhevler �e10/see~f y o uccnll.l�3LWLL+L Co ng ups 3 u.v Dam C ARCHTIF,CTS DELL DECLARATION i undertone mY Plans Nall W used s public rccads H O Licensed professional ¢3_^ OWNER-BUILDER DECLARATION t-Z C N 1 hereby affirm the,I am exempt from the Contractors License Lew for the E:s following meson.(Swim 7031.5.Business and Prof ions Cuda:Any city or county 5 m which mquims a permit to construct,alar,improve,demolish,or taped,any seucture in NSq. Ft. Floor Area Valuation prim to its i...W.Moires The applicam for such peanut m fie a.igmd saumenl that he is licensed pursuant e provisions of the Con c nofe Liccn¢Law(Chaptm9 (diming iNSection7000)ofDivision3ofNeButimasamiProfessionsCoe)m NppNNumber _ Occupancy T at he is exempt Therefrom Nasi efrom ane bs fer the alleged exemption.Any violation a ane 9 _ /S P Y YPe Salon 7031.5 by any applicant far a«mut subjects Ne epplicanno In.civil penalty of p1 more Nan fve l uMr4 deollars($51)0). Las owner ofthe property.nor my empmyeer with wages u Ncir sole compensation. Require ns tions will de,the work.end Ne,macmm is not immded oroffemd fm We(Sm.701d,Buuncst and professor,Code:The Cmirwer',License law enter not apply to an owoer,a property who Wilda or improves thereon,and who does such work himself or through his own employe,.providW the,such impmvemenu art na intended or directed for We. -hmveves,the Wilding or improvement it sold within one year of completion,the r-Wilder coal nava tM burden of proving 51.1 he did nm Wile or improve f«put- pom of se,We.). / 1, ower of.L So,70property,,H exclusively contracting with IicauW oonlunms t. concoct the projm apply o an Business and Professions Code:)The Cmhereon.Lid /1 cense law em na apply je ts widen of progeny who Wilds or improves C---end fir/O who contracts for cath pmjtta with acwnvutor(s)licensed punuanuo Ne Contradott licenm law. 1 em exempt under Sa. .B A P C for Nis Hawn Due WORKER'S COMPENSATION DECLARATION I hereby Affirm broader penalty of perjury ore of are following declanlims: Q I have and will mainuin a Certificate of Consent ro self-insum for WeAcT's Compen- sation,as provided for by Secure 37W of the Labor Cock,for the performance of the Mor which This Fermi,is ivucd. have W will maintain Workers Cam,mounim lmun .as mounted by Sation 3700o1fNc La Wr Code,for Ne perf Icer.of the.,it fm which This pirmil is issued. My WahyifIr,B sure«c aurin end PolicyvlOj( Carrier. 9m LL CRRTA Policy CERTIFICATE OF EXEMPTION FROM WM 00.KERS'S' COo,cour lendtu INSURANCE (Thin setinn need not becwmpleted if the permit in fdronehwMred dollars(3100) or less.) Iunify Rest inthe anAamanceoldie as am.-k for which this gaminisislshall noemploy any person in any manw ner become cubjat to The Worsen''C Compen- mtion Laws of Celifomia.Dau Applies t N013CETO APPLICANT:If,ahamaking this vi,,imam of Exemption,you no ld u" Mehme subject y it Worth ro Coon,or Compensation pmWlona of the IaWt Cade.you mon forthwith comply with such provisions or Nis permit shot W deemed invoked. CONSTRUCTION LENDING AGENCY I hereby affirm' het them is a coni union lending agency for the performance of 7. the work for which Nis pemti,is issued(Sec.3097,Ci,C.) 4 Lender's Name > lander,Addinsx ' R71 certify Net 1 have rod Nis upplicstim and sure Jut do Mc infmma,ion is Oc 0cormet.I agree,to comply with all City and county mdinutas atm note laws nes nng m t7 building construction.eW hereby euthmise representatives of Nis city to enter upon to U above-mentioned%aperty fur inspection purposes. (We)space in save.indemnify and taP ham l"s the City of Cupcnino agaNst U liabiblies,judgmenu,cosnend expenses whichmey in any was eccsueagaiii.said City inconsequence of The ratgin,of Nis permit. APPLICANT UNDI SIt,NDSAND LLCOMPLY WITH ALLNON-POINr V SOURCE REG Il Sigonmre of Applicar for Doc IT RDOUS MATERIALS DISCLOSURE Will Neepplicemor fuwm W.Mmiloccupust nwinofhudle hasallous maretial Re-roofs as defined by the Cupertino Municipal Coda.Chapter 9.11,and the Health and Safely Type of Roof Code.Satins 25531(.)7 / YP Oyer Will The applicant or future Wilding«cupnm use equipment mdevices which All roofs shall be inspected prior to any roofing material being crust hacomminution,rei air comminution,aw deEved by the Bay Area AG Quality Management installed. If a roof is installed without first obtaining an inspection I agree to remove all new materials for inspection. Applicant d Ne h ❑Ya Ihavemeererdms material.rtyairemenu under Chapter 695 of Ne Cali. un erstands will comply with all non point source regulations. frond,Health A Safm C e,Satiom 25505.25533 ud 255M.I uMusuvd that if the building edam nae. t heves mnwLNat it is sur mapondbility in wily Jan eupant of Jct nryuurne must be sun gni suarce dt a Cmitisyt�c cc LLQ- Signature of Ap an Date owner or eu0m : au All roof coverings to be Class"B"or better OFFICE