04050137 (2) CITY OF CUPERTINO '�%^' �. % •'� x ;
BUILDING DIVISION PERMIT 1"CONTRAC�TO1um"ORMATION
t' �.fi'�3.ro . .Sr`a, k.'.1 ,I
Bu1LDING ADDRESS: JONATHAN ZWEIG PERMIT No 04050137
9 C; TANTATT AIT
OWNER'S NAME: PERMIT ISSUE DATE
JO A
E: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT FLUME MECH
3 G p LICENSED CONTRACT'OR'S DECLARATION O O O O
1 hereby affirm Thar I am Ikmued under povWmu of Chepur 9(commencing criptlon
z IN Smtion]IXIU)of Divlaion3of the Busiw•••MrM Pro(rsaom Code.roti mylicenu is
^< wholi mnwdeffeq.
Z Lkeme Clan Lk.t BATHROOM . MODE] �\
Dow Corroon, <✓ ,/
ARCHITECTS DECLARATION
1 understand my plant"I W Mind as public retards
a
G
Licensed Professional
5
OWNER-BUILDER DECLARATION /
E I hereby.(Bron that 11. ucmpe s an the Cosions CoLicense: c taw far the
C O O which
meson.Permit
t AD L5,Business and dem ns Code:Any shy or county
$ which requires•permit re construct,aike.her.".demopcom,write,
repair ed wmrure
It.,heor iuissumce,also
antin Onres tiro aision of the Co mon'tocense gnedmlamrn,
2FF< (comme Beenud pu
rsuant in On of Division
of the Contmcrossndrsels (Onds)9 Sq. F[.Floor Area Va Motion
3$
(commencing is axe pt Sm ion fmm and
the but,Om 3 of ft al Business and Professionvi Cnde)or
3 Netto k 31.5 b OMaefmm wd Ne bub fm W Waged unman to Any violation of
.1. Mae
m any applicant for a permit subjects the applicant a dull penally of 3 7ffN8Q"er0 0 Occupancy e
m,mom Nm Rw hundred doNn(S3a0). p y�p
❑T.As owner afthe popery,m my employees with wages as their tole compemMtlon,
will dathework.Code:
he ombames Lute,Lt.it Troch(Su.to an murines
And Prtywhobu code:The Con cwAn,and
who law dot not apply lf rt owner is Required Inspections
am
who 0ulldeorimprovu tireoored who am nomh work araffmar Wvugh Ms
awn employes,provided ithmwch improvementstm no,year
of ded
m completion,
the maforsole.s..
Wilderhowever,Ne Wilding or Mpovamwn it wit within ane yean of mpromfor the purpose
of
Wilder will 0Mw tita burden of proving Neel he did not Wild or impmw far purpMe of
tare.).
❑1,u owner of de property,am euluvwly contracting with licensed contractors in
conswet the police,(Sec.7M,Bummess and Prefuslou Code:)The Conmctora Li-
cense Law des not apply in an owner of peopeny who wilds or Impow 0herwn,and
who
contract for Much pojecu wide a conuac,ar(t)licensed pursuant to the Contractors
I)nae 4w.
lama grader See _ ,B&PCT thio n
Our
h D�,e S Ze Oy
WORKERS CO NSATION DECLAB&TION
I relay affirm under penury of perjury ane of the fallowing dmlmdons:
1 hMweM will mainW n•CeNOMui of Comm to self-Iuum fm Wa&er'aCampen-
ution,u provided for by Sncuon 37M of Ne labor Code.for dee performance of the
work fm which this permit it issued
1 have and will maintain Wmkcr's Comprwuon Inwrsnce,As required by Section
3700 of the tabor Own.far the performance of the work for which this permit is iaamd.
My Worker's Compematlon I�Mattes and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crhb sec,im need not W complaint If the permit bforow hundreddallm(SIM)
or lana)
1 certify that in the performance of da work for which this Permit LL Issued.I Mall no,
employany pawn in my on wpas nwbNcome wbjecriothe Wmlucre Compemssaon
Laws of CtelifaMe2QW
Applicant APPLICANT.
NOTICE sTOAPn we WoT:IL deermating Nb CiNfimts w Libor oulyouu muldm
become subject to the Wo&eroCompeor this Permit
of tiro Labor Cede,you mesa
,J O faMwith comply with such provisions or this pcmlt shN ho dammed revoked.
Z v CONSTRUCTION LENDING AGENCY
El hereby arrow that there Is commandantlending agency for the performance of
> deo work(m which this permit b issued(Sea.3097,Civ.C.)
W Q Lenders Name
7 z Lender's Adewss C
J Q I century that 1 how and this application end more that the show Information Is
IL!-' correct.1 agree in comply with all city and county ordinances and suite laws relating to
Q rV^ Wilding construction,ars hereby wNamn representatives of this city tocmer upon the
fbl Mhove-menuoned popery for inspection pugtosea
gL (We)agree in taw,Indemnify and keep hmmlass the City of Cupertino against
h Ilabiliuu,judgments,ewes and expenses which may In my my wcruo against said City
6.)Z in eonsegmnm of dee totaling of this permit.
r.i APPLICANT UNDERSTANDS AND WILLCOMPLY WITH ALL NON-POINT Issued by: Date
SOURCE GU ONS.
_uc ' � y Re-roofs
Sif poli HAZARDOUS MATE ALS DISCLOSURE Dale Type of Roof
III the applicant or future Wilding ocmpammire m hmdm
le hrdous mauiral
u&read by the Cupertino Municipal Code.Chapter 9.11,and the Hulte and Safety
Cook.O ]5532())? '(g�Na All roofs shall be inspected prior to any roofing material being installed.
Wail dee applicant or(own Wilding occupant vu equipment or tcvicet which
If a roof is installed without first obtaining an inspection,I agree to remove
10 hnardmia air commitmnenu u defimd by the Bay Amo Air Quality Management all new materials for inspection.
DluricR
❑Ys 'KN.
1 hew mad thehmam3nusm&W,"mquimm m under Chepar 6.95 of theCalifor-
nuHealth&Safc,y Cade,Scniau25505,25533ud2553a.lundmuindthmifthe Wilding
does not uo ody haw a award,that I,ts my Potability to mu(y the memanl of the
require net ' Aa=be met w�su .Catifcak of occupancy. Signature Of Applicant Date
S �2�
caner cath 'utd resent Dow
All roof coverings to be Class"B"or better