08110085 CITY OF CUPERTINOi 1aa�y„=•" �"- - "�`��"' �:BUILDING DIVISION PERMIT ' CO NT"OTORINFORMATION.' .
BUILDING ADDRESS: PERMR NO.
10582 ESQUIRE PL TBD — TO BE DE
OWNER'S NAME: PERMIT ISSUE OATH
IRM
NE: &krA CONTROL NO.
T IIn
ARCHITECTIENGINEER: BUIIDINO PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
0o LICENSED CONTRACTORS DECLARATION Job Description
4 V F I Emeby Writes Nu 1 w licensed under provisions;of Cb,am 9(commencing
with Section 7MU7 of Division 3 of the Business and Profcummus Code.AM my license is
° N I.fell recessed efficL RMDL KITCHN, 100SQ, NOT INCLD RE—RF OR STRUCTRL
� z License 0. Lc.P
� Dow Conracmr
ARCHITECTS DECLARATION
U 1 understand my plans shall be must as public mouths
snes L.icwed Prefemmal
3
OWNER.B UILDERDECLARATION
F 1 hereby M.that I antexempt from the Contractors License naw for dc
L
00 following muOR(Section 7031.5.Business and Prefe4lnnr Code:My clly m county
1$1�2 which¢quirts a permit,.cnnswq alar.improve•dcmolL h,nr¢pair any swmum
psor as its lsmanc,,sie requires the applicant for such permit no Bk asignM statement
< Nxlthe islicensed Puncermtothe ProvisiaaafdeConmwsU..Law(Cbamer9 Sq.Ft.Floor Area Valuation
y�g (commencing with Section 700M of Division 3 of the Business and Professions Code)or •]625
— thu he L exempt therefrom and the basis for this alleged exemption My violadoo of
Section 7031.5 by any applicam for a permit subjects the applicant no a civil penalty of APN Number Occupancy Type
net mem than five hundred dollars,(SM 32644030. 00
❑I•as owrcr of the property.or my employee with wages as then role evmpewthout
mel dethework andtheswctumeawtintandede Law
does
apply
N,Busnw
all Professes eller The cwtssemn.and
law aces�t apps m rt nwre or Required Inspections
propcnywho builds i impmwchteon.and aha ar essuchwwt himsedfOr his
ownemPbyen,proWdedthat such improvementseretrotean cwolemtl for sale. -
however,the building t1a, ra improvement L hand within arc year of am ronetion the purpose
o-
builder will have the burden of proving Wl h did nm build or improv for purpose of
ate.).
1,as Owner of the property,am echerivcly conuu4ng with licensed convenors m
cenjosel the pmjca(Sec.IWC.Bain and haessloa Cade:)The Comraebra IJ- -
cmun Lav does not apply as an mane Of property who builds Or improvn threes.all,
who contracts for such pmjcws with a conuaclot(s)licensed Furman,he the Conusemr's
IYswo Law. %
1 un eumpt under SSea. h P C for this/frahan
nrr d I.0 Dao f N�d7
WORKERS COh EIi5AT10N LARATION '
1 hmeby ammo under penally of perjury one of the following declamations,
p Iha+c and will msnuinaCeniOota of Coaentmsslf-iaumfarWortcfsCampen-
athon.as provided fu by Section 3700 of use labor Code,for the perfetmana Of Ihe
wort for which this Permit is issued.
❑1 have all will maintain Worter'a Compensmon Issuenco,as required by Section
37W of the Labor Code,for the perform.of the vat for which this permit IS issued.
MY Wmhrs Compensation IaunOce carrier and Poli,number am:
Carrie Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ITL ssNon zed notbecwnplewd if the permit is forme huMrtddoBw(SIM)
or lea)
I certify Nat in the performance Of the wort for which this Permit L issued.I shall sm
employ anyperson in my manners,a m become bi at On Wohcn'Compcnsauon -
IawscfCalifomia.Dae a
Applicant
NOTICE TObj APPLICANT-.If.serer W m n pr Cenilcem of Exemption.you u must
become subject y i worn ro Cwnpcaatian er mishal of the caber Code-you corm
�O feMwiN cemP1Y with such Provisions or this permit shall h deemed mnhd.
Z"v cONSrRUCn()N LENDING AGENCY
'
[-rte IherebYalrmn than there is.comtrocunn lending agency for the NdmOrmeemf
IYfthe wont for which tide permit L iunrd(Sec.3097.Civ.C.)
Q Lender's Name
0.
0 Z Lender's Address
U Q 1 ocr fy that 1 hive read Nis sp iced.and suis than the above information L
u. !'. corm=1 agree to empty with all city ad county on ..and same laws clming m
.C) building consmetien,all hereby sunburn mprtscoatives of this city to eves upon the ,
[s7
move-mentioned property for inspection purposes
(We)agree m sue•indemnify and trop harmlw the City of Cupeninm gsesl
vF,t i Ilabilitie,judgmems,com mull..ebiel ahichmayinaywaysecrox gatatmld City
U Z In consequence of the grating of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RONS.
Re-roofs /
Sngnuurt mf
HAZAttApplrcaaww —ef Dam lv
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wittheapplicantorfuture buildingc.Chapter 9.12.
haMle Health
ud Way
u defined by Ne Cupertino Municipal Cede.Chepmr 9.12,all the HaIN and Way
Coe'Section 255321a)? 11-- All roofs shall be inspected prior to any roofing material being installed.
❑Ya UNo
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huudna sf comemirana as defined by the Bay Area Air Quality Management all new materials for inspection.
District? 1
Yes <o
I have mut the haarlau materials requirements under Chepmrd.95 of the Califor-
niaHralth h SafclyCode.Scctiorts 25505.25533 all 25534.1 undcauM thuif the building
does Out currently have a enanL Nan it L my respo sibility to notify de occupant of the
requirements Which mmubemempgiorr10menaeOfacanifeal,OfOccupancy, Signature of Applicant Date
Owner wauNos�dlglm, �r 'l �� �Da./•9 All roof coverings to be Class'%T'or better