07030044CITY OF CUPERTINO
BUILDING DIVISION PERE
BUILDING ADDRESS:
10655 FLORA VISTA AVE
OWNER'S NAME:
PHONE:
PERMIT NO.
TBD — TO BE DETERMINED 07030044
PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 p LICENSED CONTRACTOR'S DECLARATION Job Description
III F 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z w with Section 7000) of Division 3 of the Business and Professions Code and my license is S FDWL _ 4 , 2 8 8 ' GARAGE 539'
in full force and effect -
in License C s L1c. N
t- p Date Contractor i �Z
RCHITEi=S DECLAR ION
at understand my p ns shall h used as public r ords
aV
y Licensed Professional
m
OWNER -BUILDER DECLARATION
< I hereby affirm that I am exempt from the Contractor's License Law for the
in 00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
m which requires a permit to construct, alter, improve, demolish, or repair any structure
Z } prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
ro (commencing with Section 7000) of Division 3 of the Business and Professions Codc) or
m that he is exempt therefrom and the basis for the alleged exemption. Any violation of _
Section 7031.5 by any applicant for a permit subjects the applicant to a mil penalty of
Sq
HAZARDOUS MATERIALS DISCLOSURE /
Will the applicant or future building occupant store or handle hazardous maderiaJ
as damned by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 75532(a)? ,,,,........,,,,errr
❑Yes No
Will the applicant or furore building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes 5No
1 have read the hazardous materials requircmens under Cha the Califor-
nia Health & Safety Code, Sections 25505,25533 u9Qrswen atifthcbuilding
does not currently have a tenant aWtirffiy res i y tonotify Inc occas t of the
Re -roofs
Type of Roof
Floor Area Valuation
$834062
Number Occupancy Type
Required Inspections
Date �4-f J--�
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
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better