04100190 (2) CITYOFCUPERTINO sr :Maym'.s 'a•��'+� —
BUILDINGDIVISION PERMIT 4a; - -
BUT LDINGADURESS: OXLEY WORKS PERMIT"04100190
OWNER'S NAME: PHRMTI ISUB DATE
L
E: _, , . SANITARYO. - ._..-C N OL NO. .-
ARCHITEC MNGINEER:' - BUILDING PERMIT INFO
BLDG ELECT PLUMB_ MECH
0, LICENSED CONTRACTOR'S DECLARATION - Job DOSClIpI100 -
^--m I Thereby¢from that 1 me 11 it miar provisions of Chmmr 9(commencing
- _
OS.1. 7ofYd)of Divsstoo of Ne D6 .and Professions Cori yliecnx is
°m°°"d° PATIO' COVER REPLACEMENT FINALE®
og: a c. «
Me
Contractor
A HITECI'S DECLARATION- _
�i c - 1 unJ my plane¢hall a
MIT public rcmrds
a;.°o Licensed Professional _ DEC , _ 2004 _.,-
.�m OWNER-BUILDER DE The COn IDN 1
I 1 hereby nodo .(firm that 11. exempt from the Conlres Ca License Lew for the
D o folwhich
ng res 11 a Permit
to CO L3,Business and Nofcesioli h,or reAny city st County
1, 26! which acquires a Pwmit m constrvct,xtax improve,demolish,or mpuer any structure
Prior to its ismance.alau mquims to applicant for such Permit to file a signed statement _
hat he is limmaid pun.ant 1.On provisions of the Contractor's Lleonsa Law(Chepler 9 ,_ .._ .Sq.Ft:Floor Area
p�$ (commit encingwith Sutiun7000)ofoivision3orim Businevand PmfeminnaCme)or ... t .,
Thai heas attempt therefrom and to basis fw The alleged ncmpdon.Any violation of
section 7031.5 by amy.ppliesrt for i permit subj,.0 The appliiant to.civil penalty of .3�eO O Occupancy 7]y1 e-
notmomOnRvehundreddollua(S300). - p y •7p
p 1,as owner of the property,or my employees with wages as their sole Compensation,
will do the work and the structure is not intended or offered Our sale(Sec.7144,Business Required Inspections
'
_ and Prefess)om Code:The Conumdors
acr's License law .not apply to an owner of �. ., - q p,
Own enywhobulprovi improvesch Improvement;
mprdoeaauch wort himselfor Wough his - -
f.
howemploYea,provided provmentis old within
an intended mpledooraffm ,Theo a r.
however.The building w improvement is Cold within oro Weld of comm a for The owteo-
builder will law the burden of proving that W did not Wild or improve for purpose of
aalcJ.
❑1,as owner of the property,em exclusively contracting with licensed nomination in
convect The pmject(Sec,7144,Business and PmRssiom Code:)The Contrechor's U- __,.•.--y,_ _�. -, _ _ -
^ cense law does not pply in an owner of property who Wild¢or impromam thereon.utd
who contracts for such projects with a conuawor(s)licensed potential in the C°nwnoh '- ------'----- — - -_� —
kjcsjm Law.
1 am exempt under Sec. .B&P C for This won
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aflum under penalty of perjury one ofum following deel.ntioa:
1 hew enc will maintains CcrtlOate of Consent to salf-imam fwworker's Ciul -
sation,as provided for by Section 37M of the labor Code.for the performance of the
work for which this permit is Wood.
❑1 hive and will maintain Worker's Compensation Insurance.as required by Section
3700of Be labor Code,for On pedo..of the work for which Nis Permit is;issued
My Workefs Convocation Insurance carer and Policy number aR: '
Cartier. Policy No.: _
CERTIFICATE OF EXEMP 1ON FROM WORKERS'
COMPENSATION INSURANCE
(Thi,section need not¢completed ifde permlt Is forone hundred doll.m(SIM) ... _ -
or lax)
1 certify,Nat in On performance of the work for which this Permit u iut l shall not
employany person in an anmrmasmecomembjecs home Workers Compcasation
Laws of Calif. le. em -
ApplicaatNOTICE ... _ - .. _ .. ..
,f,omWTOAPPU If,after this Ccninae orExemption,Labor Code.
you
-
om uhjent y the Workere Compensation or Thin previsions of the labor Code,you must
.J O fo comply with such previsions w This permit siWl W deemed invoked. ,
z► CONSTRUCTION LENDING AGENCY
[-+ Ihereby affitm that Jere is a construction lending agency for the perfurmasux of
lYi ti
The work fur which this permit Is issued(Sec.3097,Civ.C.)
1 0 Lendcfa None
7 z Lender:Address
V Q 1 certify thn I haw read Nis application and man Oat the above information u '
E-' Wilding agree to comply with all city olid county otdinances and sou levo enter bring e
I(, Wilding coeswoiomply herebya sty aise county outivamf Nis city lamT Telling
to
W ¢have-memioned pmperty for inspection purPosex
fir (We)agree to sew,iodcmnify and keep haamleta Ne City of Cupertino against
rq liahilities.judgmcnu.costs and ca hi ch may in any stay accrvc against sued City
U z in e° uenc.of le gtemin is perm
MT UNDERST DS AND WI L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
An CATION
Re-roofs
S' at cams an ,
HAZARDOUS MATERIALS DISCLOSURE
Lad Type of Roof
WAIapplicant w future Wilding occupant nom or hendl� ousm.terial
as defined by the Cupertino Municipal Code.Chapter 9.13.and Health and Safety
Code.Seeti..35533(x? — All roofs shall be inspected prior to any roofing material being installed. _
❑Yea
WIII thc.pplicoln or fuwrc building mcupom u¢equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hal d ma all moment mnu as defined by the Bay Am.Air Quality Management all new materials for inspection.
District? \//\\\`^^` ��11 �/ / � �
❑Yes y e �4T�� Q
I have end the lecordous malcriai,sryuim orasuntin Chapterti.95 ofthe Califon. 1�v�.w� q
ria Hcallh&Salm Code,Sectors 333115,35533.425534.1undustand thairthc building !/.Vl� -SII
d lIY hew a enank WAR u my msponsihillmy m nobly th •cupent of
gWmm w -Amuste missuance Ora C a Signature of Applicant Date
w r. amthrrvadagain Data All roof coverings to be Class "B"or better