10110089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: DANUBE DR BLG I CONTRACTOR:AXIS CONSTRUCTION,INC PERMIT NO: 10110089
OWNER'S NAME: CUPERTINO WATERFALL HOA 2566 BARRINGTON CT DATE ISSUED: 11/15/2010
4ER'S PHONE: 4084483080 HAYWARD,CA 94545 PHONE NO:(510)732-6111
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r
License Class 15 Lic.#
MECH r- RESIDENTIAL I- COMMERCIAL�
Contractor (�� Date
JOB DESCRIPTION:CUPERTINO WATERFALL-DANUBE DR BLDG I REPLACE
I hereby affirm that I am licensed under the provisions f Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions STAIR
STRINGER&WALL ABOVE STRINGER
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this pernvt is issued.
I have and will maintain Worker's Compensation Insurance,as provided tiss
Section 3700 of the Labor Code,for the performance of the work for Sq.Ft Floor Area: Valuation:$2102
permit is issued.
APPLICANT CERTIFICATION APN Number:36948000.I Occupancy Type:
I certify that I have read this application and state that the above informat
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this pemrit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source relations per the Cupertino Municipal Co e,Section
9.18. Date: 7- /
Issued by:, /�J CGU
Signature A Date
i
h OWNER�BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municip I Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety C e,Sections 25505,25533,an 25534.
Compensation laws of Califomia. If,after making this certificate of exemption,I r
become subject to the Worker's Compensation provisions of the Labor Code,I must Own r th r e j/�
Date• 1(�
forthwith comply with such provisions or this permit shall be deemed revoked.
CONS UCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm t at there is a onstniction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
;••aemnify and keep harmless the City of Cupertino against liabilities,judgments, . Lender's Address
,and expenses which may accrue against said City in consequence of the
...sting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
C3TY OF CUPERTINO
cIrr Of
OiFEKTINO GENERAL BUILDING - -
PERNUT APPLICATION FORM
APN Date: ( Is- ,
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work onl ) Yes No ❑ If es, rovide letter from HOA
Owner's Name: Phone#:
i("0 _
Co tractor: Phone:
.510-
Fax: 5'/D -
Con actor icense#:
Cupertino Business License#:
Phone: U
YAti RAAC—V
Contact:
Fax:
.esidential g Commercial ❑
Job Desai tion: �� "(,C ./4�{nL.. ;��••�1��,�-���. 'I' !N�L� �+�✓'�%►'!/�'��CY�i�
p to
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type o Construction (Usage Class): Occupancy Type:
-A M=B, IV-HT,V-B �'
1-A, 1-B II/III/V ❑
Valuatio I Square Footage:
Project Size: Express Standard ❑ Large F7 Major F7
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
"-)ints Achieved:
it help, contact Build it Green at www.buldit2reen.or
Revised 07/14/09