11090095CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20277 NORTHBROOK SQ
CONTRACTOR: DAY AREA ENTERPRISE
PE141 NO: 11090005
O \'NEIYS NAME:
SAN JOSE, CA 95118 Pl IONE NO: (4(18)238-5043
8.
❑ LICENSED CONTRACTOR'S DECLARATION
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
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LICCI1Se CInss^t �' C a ✓�� V "�-'
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MECH f RESIDENTIAL f COMMERCIAL
Contractor N >rDatc t �,�� •Irt� zU��
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I hcrehynfftrm4hb I"amlicenied under the provisions of Chapter 9
JOB DESCRIPTION: SFDWL(2)BATH REMODELNOSQFILADUCLOSP:I
(ennwnrneing with Sectinn 700II) of Division 3 of the Dusincex & P,ofes,iuns
EXISTING ATTIC LOCATION(200SOFT), ADD 2 NEW
SKYLIGI ITS & 2 NEW SUN TUNNELS
Cade And that illy liernse is in fall force and effect.
1 hereby afBnn under penally 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
perfoi nrmee of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided lot by
Sq. Ft Ploor Aren:
\'situation: $20000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued,
APN Number: 31639062.00 Occupancy']') pr.
A PPLICANT'CERTIFICATION
I certify that I have rend this application and state that the above information is
correct. I agree to comply with all city and county ordinances .and state laws relating
to building construction, mud hereby authorize representatives of this city to enter
upon the above naenlioncdpropertyfor'a echo, purposes.(We) agree m save
PERMIT EXPIRES IF WORK IS NOT STARTED
fy andkeep hnnchrus he Cil of upcNnoagainstliabilities,judgments,
iosts.a
OF PERMIT ISSUANCE OR
costs, and expenses which may ace e a insi said City inconsequence of the
and
WITHIN 180 DAYS
granting of this permit. ddanina y,tl applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point sour regulali is r the Cupertino Municipal Code, Section
9.18,
1E�I.�d,1�a�t b�yM�1111SaI
ONNF..R-O]]]LDER DECLARATION
RE -ROOFS:
1 hereby affirm that I am exanpt from the Contractor's License Law for one of
All roots shall be inspected! prior to any roofing material being installed. It it 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,
Business & Professions Code)
Signature of Applicant:_ Date:
I, as owner of the property, out exclusively contracting with licensed contractors to
construct the project(Sce.7044, Business & Professions Code).
ALL Ii00f COA'E121NCS'I'O BE, CLASS "A" OR IIP; I-I'E12
I hereby affirm under penally of perjury one of the following three
dechur1lions:IIA""/.A
I have and will maintain a Certificate of Consent to self-insurc for Worker's
HAZARDOUS h1A"I'FRLU'S DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have rend the hazardous materials requirements under Chapler 6.95 of the
performance of the work for which this permit is issued.
California Ilealtb & Safety Code, Sections 25505, 25533, and 25534, 1 will maintain
I have and will maintain Worker's Cnnpensation Insurance, as provided for by
compliance with lite Ctp' (it Alunicipit Code, Chapter 9.12 anti the (Icalth &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532 )hnuid I store sir handle hazardous nuurrial.
Additionally, should I use q pmcnt sir devices which emit hazardous air
permit is issued.
contaminants a. d fined y e Day Arca Air Quality alasagcnu•nt District I will
I certify that in Elie performance of the work for which this permit is issued, I shall
maintain comp In ce wi hlc Cupertino Municipal Colic, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
I Icalth &
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CONS 1'RUCT'ION LENDING AGIiNCY
APPLICANT CEIfI'IFICATION
I certify that I have rend this application and state that the above information is
I her by affrin than there is'a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances mid state laws reaming
for which this perinit 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
uanify and keep harndess the City of Cupertino against liabilities, judgments,
Lender's Address
s, and expenses which only accrue against said City in consequence Mahe
ming of this permit. Additionally, the applicant understmlds and will e01111)Iy
ARCHITECT'S DF:CL,UtA7TON
with all non -paint semen retpdmi,x,s per It,, Cupernmu Municip:,t a„rte. Scatinn
9. h 8.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professimal