06030053 CITY OF CUPERTINO �°'"•• �»' ra�:- uc +s-=�,S-ih` '�'
BUILDING DIVISION PERMIT CQNTRACTOR INF0RMATIO. N
BUILDING ADDRESS: LNPERMIT N0.
10092 BIAICHI WY
tU-S NAME PERMIT ISSUE DATE
MID-PENINSULA HOUSING 10982 BIGGE STREET 03/24/2006
PHONE SANITARY NO. CONTROL NO.
(510) 577-0294
ARCHITYCT/FIIGINEER: BUILDING PERMrf INFO
BIDO ELECT PLUMB MECH
0 0 0 0
300 LICENSED CONfRAC10R'S DECLARATION Job Description
C 1 bercby affirm Ibis I am to cogd n under provisions of Ch cr Y(murmuring
;jUvffi 7")ef DM6on3aft Uud "Pmfcahnu Cade.0 myl is
+�� aonivdRr«made0ca -6 �Z REVISION-FOUNDATION FOR RAMP & CM WALL
sg=_ LkurCW _u .. NO NEW PERMIT-ORING 404060014
g o Damesy Canuact«
' W (,- - T' - ARCHrtECTS DECLARA N)N- VT
Sc�'7u I udersuN mY P4^•Wall k ued u puDAc rtcmds
�$ L.iccucd Pmfcuiow
OWNER-BUILDER DECV,RATION
F 1 hereby aR that I am..pt from dw C..tW.LJeam Law for the
G O folbwin,res a (Saban 701 S.Buincss ud Professions Cods:My city«mumy
e 3 which requima a permit to corwnra,.Irr,ini me,&.1lisb,or mWk any srrawm
prior tow issuers.also mittiru tia,eppBaanl for such pewit to fik•utmd wlemal .
£4o cmtbcI,l�codad ..m tomo ion.a the cnnt,o<wr,t Law(ceaaer9 Sq. Ft. Floor Area Valuation
ytt (com.mclnS with Section 7000)of Division J of the Buincsi and RofuuomC or
3$ this he 4.,1 dam from and dr bass,for the alkyd.0.My tiaallml of
Scum 7031,5 by any pplbm fora tenNt subject,the Wdk,anl to a doll pushy Or CCDPaDCyTYPe
mtmmthan fw bmdol dollars(ML 34'?yvTb`00
O Lno.'rcof Wepropmy,mmymp"g ww�wuwkwokmtpenwlm.
.nu mlhnw«k..ndwe.usKturmwes La Us.
apply.7Ban.of Required Inspections
proad PmrcufoIm cods:The emu ,and
who law aeu or hips b rd oalb is q pe
own con los b. o,«Imptmu Ncwn•.nd oho douaucb sort w0fllfmlforsa his
owoemplol oiprovidedwtouchimpmwmenuart n«u ofcmpkcaed for ask.If.
nowesen,w bonding or heaovemw u sold rlWin me yeas acompktko,w awmr-
huldcr Wim h.w w wren err aa.ina tnu Is ala a«hdm m iminnw r«pmpoc a `�
❑1,u arms a Ne Irropeny..B et, and<ovuanlpg suint:)worse mnuxwn a v
.Lathea. (Secoan Baum,apP w1 asomistoCodri Thews tM .Lid
e®c ntrdoCn«applybN a'YIILfaaOpRlJ w1cected pacrImapm,ICm hoer,
who contracts for arch PmJal•vitt h contractor(s)Ikeved pmvw w Ne Cmuauofa
I ¢ m
❑lamuvna order See ,Bk PCfm th4 rtawn
Dam
WORKERS COMPENSATION DECI.ARATON
Ilamby LRrm ander pena1ry of perJtay nK of ur ralowmg acdantionx
I low and v01 mainuin•CW Dam aCauc«w mlf-move fmwortcfsCmnaa
ration,as provided for by Swim 7100 of err Lahm Caere.for the pufotmanm of the
work for which this pr,nit is issued.
❑I bawd anti maintain Work .CampetnaWv 1.as myui.d by Salim
3700 of the Labor Coco.for tK pmfmmame a ts,work for width W4 emir is w at
My woM•.``CWnppu�itvyda�n�lasaraace e»riec and Policy num on:
Palsy No.: O l
CFATIFlCATE OF EMPTIONFROMWORmERS'
COMPENSATION INSURANCE
(thismaim p It 4fmonehmareddogma(5100)
m1 )
I«nify that In the pufomance of Ibc work for wbi 04[canis it issued.l W.11 tt«
cmployanyauramany mantrran as nbaamc subjat I.the WOrkmY orn xmdalkn
laws c f California.Dau
Appl not
NOTICE TO APPLICANT:If.after mating this Cmifturc of Eamta4n.yin shoom
become auhjret to the worker's COmpewdm aovWom a Labor Cock,yin most,
O QMmvitieru m this pernWa
fowith comply with such plt ll he d cdl tuokca.
Z� CONSMUCnON LENDING AGENCY
[-.— I ltemby affirm that arm 4 amuwNmt lataing agemy for the peeformsrrca(
C4> Iht work for which Nis Pemir 4)voce(Sc 3097.Civ.c.)
AUndcr's Name
Z Lcdcrs AENeics
U0 I aNfy wast I Ww mad this alaplkaEOn and ver wt We above iofomu0m 4 .
U.P coney lagrtewc«nply with ulniry and county oaiwres ad naso Ora mla0ngw
OU WIdingeonumetim,and"by amhuris macmmaiws of this city to entcr upnthe
L[1 alww urcntioad pmperly for lNNuion purpuec
(Wc)it w sass,idcmnify and tap harrnku Ne chy of Cupc mo Itsaw
y liabiliuujdgmmWc=sndecprma wiikh mayNanYwyhcvue.g.huuaia Ciry .
U is cu oarao of err p.ntlng of this[�mit
APMICAN UNDERSTAND N LLL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC GUI.A _ Al
/ - Re-roofs
•. Slywum of ApplionUConuhuor—G - -- ---�. Doc '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
w,B the applkant or fumrc hooding occupant ams or bandk hoardou martial
as tinnd by Ox Cupmino Municipal Codc,Cbvp 9.11.W the Ninth and Way
AWko�M531(.n�- NAll roofs shall be inspected prior to any roofing material being installed.
c,
O
Will the aWlicant ormtur,Miming nattpanl uec4tuPmmt«douse which If a roof is installed without firs[obtaining an inspection,I agree to remove
cine ba,a .4 conumiwt4 n acfurd by w Bay Ams Air Otmlity Mang rocnt all new materials for inspection.
O.ruin7 S .
❑Yo �Nu
1 basertb the c,Seconmne . rt33 and!msu1.I apW695anteCa4fm-
wNmlth u SafaY Cod:.Smv that 11, my r ad25531.1 0 rradf Is,oths,tui hulling
Jou tKK currently haw•Want IEH Il Y my tuamuhilitY b«dfy the aasgant of Nc
myammcros muREcymt wwim,mrepr.cwrtoror _ Signature of Applicant Date
Owxr«wth«isda m All roof coverings to be Class 'B"or better
Dw