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CITY OF CUPERTINO
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BUILDING DIVISION PERNUT
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BUILDING ADDRESS:
1037U MENHART LN
TBD - TO BE DETERMINED
PERMIT NO.
08030144
NER'S NAME:
PERMIT ISSUE DATE
10/20/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
vism" of Chapter 9 (concing
rat I am nsed under pmmme
1 hemby am Nlice
with Sadon 7000)of Division 3 ofthe Business and Professions Code. and my license is
NEW TWO STORY SFDWL- 2,223 SQ FT SANITARY IS
in fall to= and effort. a20-04
SUNNYVALE'S JURISDICTION.
Dam a Conuaem, DeZw
ARCHm1CPS DECLARATON
�
1 hereby ofri m that 1 am exempt from the Contractors Uccr= Law far the
following mason. (Section 7031.5. Business and Professions Code: My City Of county
which requires a Permit m mustnct. alas. hnpmve. demolish, os -prat' any stmeman
prior an its issuance. also m luims the appUent for such permit m Ble asigned aammmnl
dust licensed Commuter's lJanxLaw (Cnaptct9
Sq. Ft. Floor Area
Valuation
heis patmantat the provisions ofthe
r.
S 2 5 0 0 00
(commencing with Section 7000) of Division 3 of the Businessand Profession Code) at
that he is comp, therefrom and the basis for the alleged exemption. Any violation of
37516012 !
Occas
Occupancy Type
Section 7031.5 by any applicant fa a permit subjects the applicant in a civil penalty OfNumber
not mom dun five hundred dollar (M),
0 I. u owan of the property, our my wplaym with wags as dwh Ole mapenador,
Required Inspections
will da de work, and the+rmnum is not intended or offered fa sale(Sms. 7)14. Business
and pmreWo's ends: The Comeacter's License law donee an, apply in n owns or
_
Property who bona or ire pm.n thereon. and woo daa+ueh work himser a through his
Own employes, Provided that such improvements as, not intended our offered for We. If.
however. the Wilding or improwmnt is Old within one year of completion, the Owner.
.
Wilda will has the human of poring du, k did Out build our improve far purpme or
ale.).
0 1. as owner of the p,pany. iso exclusively conaautir, with lianed antrcbrs as
contract the project (Sec. 70M. Business sad Prorettian Cade:) The Contractors U -
centro raw does out apply m an owner of property who Wiles or impmres Ikreo, and
who corsets for such projects with a eonstctoKs) licensed pursuant in the Contractors
Liame" Law.
0 lomexemptunderSec .BAPCfarthisremon
Dale
WORM'S COMPENSATION DECLARATION
I hereby of m under penalty of perjury an offt following declaration:
0 1 have and will maintain a Certificate of Covent in Wf-usum for Workers Compeer -
u ion• u provided fa by Section 3700 of Ik I r Code, rex the perf smos a of the
work fa which this permit is issued .
0 1 have and will maintain Workers Compensation Inwruae. a Minimal by Section
3'/00 ofthe labs Cade. for the performance of the were forwhich Nis permit is issued
'
My Warkes's Compenatin huueOa artier rand Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Nis sectio reed not he completed if the purr it is faron hundred dollars ($100)
Or less)
1 certify that in the PerformaecC of the wank Ire which this permit is issued, I "I not
employ any person in any ObjeEtmCiWorkenCompcnu0n
mOyOgm
lawofCalif
APPliant
/A. .�_PC _ _
NOTICE TO A A.W. 1f, e0erei�aknngyIhu Ce tau of E you should
aver Cn,
becamesubjecttdo pro al of the Iabos Code. you muss
the Worh ro Coon
forthwith amply with each provisions m dds peon, Kali to domed -wtr4
comp y or
CONSTRUCTION LENDING AGENCY
1 kr this then is a lending agency for the performance of
whnfnthi
the we* far which Nu pcmtit u towed (Sec. 31%i7, Civ. C.)
Wood (Sm. 0
readers Name
landefs Address
1 1 certify that 1 have rad this application and sum thas the above information is
corRR 1 ago= in empty with Ill city and matty ardirsr-a and Sate bass mladng to
' Wilding cOnWNon, and hereby authorise representatives of this city m enter upon the
' above-mantiond prepeny fm inspection pulp tuaa
(We) agree to save, indemnify and kap hurmlets the City of Cupertino again,
j liabilities. judgments. costs and expenses which may in any way+ceras against Old City
in consequence of the graining of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:�60Date
HAZARDOUS MATERIALS DISCLOSURE
Will the appllent or future bulminC oacupant+bre or NMIe hvallon material
11,ned by the Cupertino Municipal Code, Chapter 9.12, ani the Health and Safety
. Section 25532(a)T ��SS
]TTI I(No
All roofs shall be inspected prior to any roofing material being installed.
' `
If a roof is installed without first obtaining an inspection, I agree to remove
Will the or Wilding occupant use m dMOI which
ircrmapplicant
w air conwninna as defined by Ik Bay Arta Air Quality Mangcmn,
emit nets a a Air Qu
all new materials for inspection.
District?
DS elT
❑Yes No
I havemad the its. a.astats me,uimmenu under Chapter 6.95ofdx Califor-
.is Health kSafety Code, Seadw25545.25533 and 25534.1 undcraa !thenthe building
Jan cot currently haw • -mount. this i, IS my Mryonibility an ntity the aaupa, or the
- ofacer;eeamofaaPa�.
Signature ofApplieant Date
dC —20
All roof coverings to be Class 'R." or better
Dam
Owner or mtharisd age-