08080201 CITY OF CUPERTINO
BUILDING DIVISION PERMITNz
•TQ I ItY•C +�+` �I ".,
BUILDING ADDRESS: PERMIT NO.
WOLFE RD & HOMESTEAD RD TBD — TO BE DETERMINED 08080201
NER'S NAME: PERMIT ISSUE DATE -
KIMCO 10/08/2008
PHONE: SANITARY NO. CONTROL NO.
ARCH=/ENGINEER,' BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
o p o LICENSED CONTRACTOR'S DECLARATION O O O
U 1 hereby affirm Net I m li¢mcd male,pnwisimts of chapter 9(ommcncing Job Description
Fi wiNsection70rg.fDis5sioa3oftheBum.andprofesiomCode.andanylkersseis ADD ROOF TO 2 EXISTING TRASH ENCLOSURES—ONE
in full force and after.
gi License Class Lie g 7013 BEHIND
Date // Corturasser-.-DO. t
QQ27W ARCHrrEcrsDECLARA GN RANCH 99—THE OTHER BY THE APT SIDE.
W U I undenund my plans shall nc used as public re suds
;6
ua� Licensed Professional
sz3 tMh,I.BUILDER DECLARATION
o o I wrcby a1Rrm Nal 11.exempt stem the Canuanora Lions Law far the
❑O following mason.(Section 7031.5.Business;and nne.&sio 'Cade:Any City a county
$ mme
'n which require a permit re cnet the msec,impmsu h permit t fi¢pair any twment
_i y prior m its censed p possums
rtquite thovisio sof for each permit to fie.signedw(Glu statement
< Natwslicensod puswnuo the provisions of Ne Contractors hiacna law(Chapm9 Sq.Ft.Floor AreaValuation
x�n (commeneingwith Sessim]Ina)of Division 3ofthe eusina..and Prormas $nCade)or 30000
—
that he Is exempt therefrom and use huts rte the alleged eaampaon Any Holauoa of
Section 7031.5 by arty applicant for a permit molten,the epplkmt to a civil pmaity of Occupancy
not mom than R.hundred dollan(M). 31605052 . YHsoberT'Pe
❑Lasewwrofthepropeny,mmymployee with wagnas deer mkcmmperuadon,
and dothework rade:Th ContrarmtimeMea Lawdo farsakpply M aa,rumness
ma Profession cone:mpr untteemra and
law ace rot apply lf an owner or Required Inspections
property who
yebuildsvi ireprowcheraaa,and who arcssuch work himself edNreugh his
how em.use building
p ing or i aur teen impmsemmu are not intended moRereE for o e If.
holder use wilaheoaimprovementg mrdwithinarc year ar tprova fa,she owrcr
builder will ham the duan of paving Nor k did rot Wild m imprew for purpose of
ak.).
❑1.as owner of the progeny,am asclush cly conumvng with licensed conwcmn to
cocoon the project(Sec.]Data.Basin.and Pro rose.Code:)The Centrnrera u-
«va law doe not apply to an ower of property what wads or impmwa thateon,and. .
who contracts rte such projects with•conuaeor(s)licensed pennant m the Co—el
Licene,Law.
❑I am mempt under See ,B&P C for this reason
40
No-
-
Dale
WORKERS COMPENSATION DECLARATION
I wreby affirm under penalty of perjury one of the following declarations:
❑Ihaw nO will mainsinaCenificese ofConunlrealf-lasurt fa Workeh Compere
salon.as pmv ded for by Section 3700 of the labor Code,for the performance of the
walk for which this permit is named.
❑I hast and will mainuin Workers Compensation leurance,as naluired,by Section
37a0of the Laver Code.for Ne pedarmmreofue work for which Nis pe.I,is issued. '
My Worker's Compemadpa Issuance ertia and Policy number arc: f
Gads. f� ( /aN� Policy No.:eA/)US OU/C
CERTIFICATE OF E%EMPTON FROM WORKERS'
COMPENSATION INSURANCE
mossecrion need mtbecompleted Rede permit is(moan hundred dollars(11100)
m let)
I certify that in de performance of the work for which this permit is issued.I shall not
employ any person in my manner spas m become subject to the Worl an'Compensation
Laws of California.Due
Applicant
NOTCE TO APPLiCANr:IL after making this Certificate of Exemption,yen should
become subject to the Worker's Compensation previsions of out labor Code,you mast
,J O forthwith comply with such preside.no Nu permit shelf bo deemed rewkcd.
Z n CONSTRUCTON LENDING AGENCY
[-r I wreby affirm Ne Vert s•ed(Sec.30 lending agency for the performance of
D.i w�-r Na work far which Nls permit s isrcd(Sec.3(197,Civ.C.)
02 Q lender's Nero
a z f.anaertAaaaes
U Q 1 certify that 1 have read this application and sus that dre aww infmmation u
w coRCR 1 agRe to comply with all city rad county ordinances and gale lawn relating to
C) wilding construction.and hereby auNarix reprcsonutiw of this city,to enter upon the
r aww-stendomd psopeny for iepccdon purposes
fy and
less,the
ty
f Cupertino
F'c,I liabilities,udgmtns.om,rhtc)Agree to sane,rand espeoes whr�ich may in ray way nattome against said City
V in caveq.of the granting of this permit.
ANT UNDER AND �A WILL COMPLY WITH ALL N0"0� Issued by: Date 'f
SOURC• :GULA i 7
0 J Re-roofs
Si;ddhmcofAppIicwu/OoncmIorU Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliant or returt wilding occupmtume or handle hamrdue materia
aefned by the Cupeniro Municipal Code.Chapter 9.12,and the Health and Safety
.Section M532(a)] All roofs shall be inspected prior to any roofing material being installed.
❑Ye d No
Will the applicant or future building=upset us,wmlpmcre or devicts which If a roof is installed without first obtaining an inspection,I agree[o remove
moll hnaNae air connmina as aeric l by On,Bay Ares Air Quality Management all new materials for inspection.
DisaictT
❑Ye Nu
Ihawread NennaMourm 4al3 q immonsum4r .Cbapw6.95ofde Califon
w erycoae.s dm 25505.x5533araiss53a.Imderwnduatiftwwilmng
dna rot curmn aw a ten mut my respoeinilily a notify the pnI Nc
regairements whk mar et or i tenet on certige¢or Occup ry. Signature of Applicant Date
ow amNoascd astral d Duda All roof coverings to be Class'W'or better