08030177CITY OF CUPERTINO"?I".•
_-
;�4CONTRAGTOR INFORMATION
BUILDING DIVISION PERMIT
"UITTnT'3OHNSON AVE
J
TBD — TO BE DETERMINED
08038177
NER'S NAME:
PERMIT SUE DATE
06/12/2008
HONE:
SANITARY NO. CONTROL NO.
AR CHRECTfENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
p
1 bemby affirm Nal 1 .tin liumeL under provisions or chapter 9 (untrucing
with Section 7000) of Division 3 of the Business and Professions code mo my license is
NEW 2—STAY SFDW, RMV (E) 1200 SFDW—SANITARY IS
in full
cussed entre Lie It
SUNNYVALE'S JURISDICTION.
Dam Contractor
ARCHITECTS DECLARATION
I undersand my plans shall be used as public mcorth
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the ConuactWa License Law for the
following won. (Sudan 71313, Susumu aha Pmfesums Cade: My city m county
which mquiru a Permit to comlrucl. ales, hnpmve. demolish, Or repair any mucmm
prior to is issunu, atm requires de.pplicamt far such Permit to file a signed comment
thathe is licensed pursuant to the provisions of the Conmeues llcotlx Us, (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with section 7") of Division 3 of the Busineuand Professions Calc) or
$300000
: Nat he is eumpt therefrom and the basin far Nc alleged exemption Any violation of
A-�I�7 Number
3 7 518 0 3 5
Occupancy
Pane Y Type
Section 703 L5 by arty applicant for. permit subjew the: applicants in a civil penalty or
lel ran. Nan five hundred dollars (M).
.)ff
0 1, u owncr of me Pmpmy, m my employcu wim wages u Meir mle comKwaon,
wilidamework,and6eswcmmmrmsimmndedoro0eredf..Me(Sce. 7W. Buuneu
Required I
and Professions Cade: The Commerce, License Law don tut apply u an ..of
ns ections
q p
property who builds or improve memo, and who does such work himml f or through his
own employcu, provided that such improvements tic not intended or o@roti for ale. If.
however, me building or improvement is mid within ane year of completion, the owner-
,
builder will have the Widen of proving that he did Out build or improve for purpose of
❑ 1, u awoes of the property, am exclusively umuesing with licensed conuerms m
construct the project (Sec 7W. Business W Professions Code:) TW Conuamoes U.
ecru law dons not apply to an owner of property who Wlids or improve demon and,
who contracts for such projects with a eamirmar(a) liunsed punnsns to the Conmuto's
Lies. law.
El I sm camps under See ,B&PC�fo/ty� ,�rD�/yr
mer Data
WORK 'S COMPENSATION DECLARAl10N Ii ,,
1 hereby arm under penalty of perjury oro or the following dulaatiorts:
1 havesmd will mountain . CeNfica e.f Consent m xl(-iuum for Wmlmh Compu-
ader, u provided for by Section 3100 of the labor Code, for me performance of the
work for which this permit is issued.
Cj I have and will maintain Workee, Compensation In11Mn, as hismied by Section
3100 of t e Labor Code, far the performance of th c work farwhich this Permit is Issued.
My Workees Compensation Insurance carrier and Policy number are:
Cartier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlo need not he completed lime permit is forme hundred dollars ($100)
or less.)
1 curly that in the perfommoec of the work fm which this Pamir u issued, l shall not
cmpiquy'pe.h lnmy....nyb5/omem�la de Workers' Compensation
laws Of Caif.mia.DW, (>L(r—err
NOTICE TO APPIdCANT. making this; Certificate of Exemption, you should
butene Subject so the Worker's Compcns thus Provisions of the labs, Code, you muss
farthwim comply with such Provisions or this permit shall W damcd uwked.
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that dert is a construction luding.9ma y for the Performance of
me work for which this permit is issual (Sce 3097, Civ. C.)
Lendees Name
Lander', Add.
..
1 certify, that 1 have read mit application and sum that me thew information is
COMM 1 aFoe to comply with all city and county ordinances and sum laws relating to
Wilding construction, and hereby antho in repioenutives of thi, city to enter open me
alwve-mentioned NoNrsy for inspection perlures.
(We) agree to ave. indemnify and keep haimlun the City of Cupenino against
liabilities, judgments. costs and expenses which may in any way ecru li unst said City
in eansequsnu of the granting of this Pcimit.
APPLICANT UNDERSJANDS AND WILLCOMPLY WITH AL11,, NON -POINT
Issued by: Dale L 2
SOURCE REGU7S.
/
Re -roofs
Signature ofA . Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applinnl m future Wilding occupantaou mbsesi baudons maeria)
'
u defined by me Cupertino Municipal Code, Chapter 9.13. and the Harem and Safety
❑ Yu lot No
IF. Sermon 2553I4)7
All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future Within arose ant pW
pp g P Wuipmem or devices
If a roof is installed without first obtainingan inspection, I agree to remove
P
Dist huardnus it conuminanu ss defined by the Bay Arta Air Quality Management
which
all new materials for inspection.
Disuice!
❑Yes 6 No
1 hew marl me hva,mmsmamrals mquimmcnu under Chaper6.95 arae califor-
niaHcalm&Salcty Code.SYctians25505,25533ar 25534.Iunmruandthuifmc Wilding
does n01 cturconly have . W' .4 thio it Y my rep osiblllly m... ry the IXe.,wo or me
require whichmnsibe t mlcissYanoeofaCcm ac
Signature of Applicant Date
All roof coverings to be Class '%Wr or better
Gerq, Data