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05100155 CITY OF CUPERTINO 7717, BUILDING DIVISIONPERMIT O1VTRACTQR INFORMA =IONm BUILDING ADDRESS: DOUGLAS ROSS CONSTRUCTION 24QIeTNG05100155 10080 WOLFE RD OWNER'S NAME: PERMIT ISSUE DATE MENLO EQUITIES 909 ALMA ST 03 06 2006 E: SANITARY NO. CONTROL NO. (650) 70--700 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O D O D moo LICENSED CONTRACTOR'S DECLARATION U 1 hereby at Orm Nal 1 am located under provisions of Chapter 9(commencing Job Description '+ with Section 7(00)"(Division 3 of the Businev and Professions Code.Mill my licumnu in mB fame and eBect REVISION-SCULPTURE BASE INSTALLATION 3q?p LicenseC r Lle.a O NEW PERMIT ISSUED/ORIG. #04030151 &`JData ConlfaCWr ££ ARCHITECTS DECLARATION K - 1 undcrsund my plans shall W used a public records >du lot' Licensed Pmfcssional Oat I am exempt from DECLARATION E a 0 I hereby macro ,(fort that 11. ezempt from the Conlon Cc License Law Tar the p O following macron,(Section AD LA Business and ate.protrusions Code:Any oily of county S$ which requires n permit w do s use, eltec Improve.for R,h Perlia m repair any structure -z> prior to its issuestec,atw requires tite applicant for such Permit to the asigncJ sutemcnt o wnomencegwithsmammNcpmdaioatolortheBusiithfsuaat<I,wsCod r9 Sq.F[. Floor Area Valuation (cox€� that he is exem with Section and of Division 3 a,al aged Business pt Professionsted,W or $0 Nat he u exempt thert(rom end ad,base for the alleged exemption.Any violation of hh'' Section 7031.5 by any applicant for a permit subjects the applicant re a civil Penalty of APN Number Occupancy Type not mum than r.a hundred dollars(3500). P Y YP ❑I,as owner orrhe property,army employees with wages a their sole compensation. will do the work and the structure is notinu sted aro@rad forage(Sec.7Wa,Business and Professions Code:Tbe Contsacwr's Lissome low does ant apply in an owner of Required Inspections ert propy who builds m imprava thereon,and who does such work turnstile,through his own employmer,provided that such improvements are,not intended crorreed forsake.If, however.Ne Wilding or improvement is sold within one year of completion.Ne owner builder will hese the Wrdcn of proving that k did not Wild or improve for purpose of (\/ sale.). ❑1,a owner of the property,am exclusively contacting with licensed contactors to V` coawct the project(Sec.70".Baines and Profession Cade:)The Conuuwr's Li. ccnu law does not appy in an owner of propenywW beam or nt woshr thereon,and te \ who contracts for each prontr projects with a couwr(s)licensed pursuant Ne CanwmoM1 License Law. ❑Lem exempt under See. ,B&PCfor this mown Oweru Data WORKER'S COMPENSATION DECLARATION 1 hereby turner under penalty of perjury arc of the following dclatvtims: ❑i haw and will mainolin aCcnifcd,of Ctaem wolf-insure for WorkefsCompcn- ration,a provided for by Section 3700 of Ne Lothar Code,for Ne performance of the work for which this Permit is issued ❑1 have and will maintain Worker's Compertsauon Insurance,a required by Section 3700 of the UM,Co le.far Ne puformance of tits work far which this permit is issued. My Worker's Cam nation lnsun cF cvrticr and Policy number am: Carrier. y J t Ge L Policy Na.: 3 6 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE . OTU section need not be completed ifthc permit Is furrow hundrW dolare(S10o) mk s) 1 citify that in the perfurmence of the work for which this Permit is issued,I shall not employ any person in any manner so ns to became subject to the Workers'Compensation Laws of Califf raiii.Dad, Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should become subject on the Worker's Compcwtion provisions of the IOWr Code you most .,O foMwith comply with such provisions or Nu Permit mall be accrued revoked. zN CONSTRUCTION LENDING AGENCY I hereby alarm Out there is a construction lending agency far the performance of C's7 the work for which this permit u Issued(Su.3M.Ci,C.) QLender's Name ' .7. z Under's Address U0 1 certify that 1 have mad this application and sate that the above information is FCotocL I agree to comply with all dry and county ordinances and sold,laws mutual to OU building conswction,and hereby endocrine mpresenutivas of this city to enter upon the W shuvomentioncd property for inspection puepous. (~ LL (We)agree IO save,Indemnify and Imp harmlcfs the City a Cupertino against h liabilities,judgmcnu,costs and expenses which may in any way accmc against said City t.)Z in consequence of the granting of this Permit. �^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR R GULATIONS. 3�G Re-roofs Signature of A,ijormlCtartacum, Data HA ARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future Wilding occupant mom of handkc hazardous material as defatted by the Cupertino Municipal Code.Clamber 9.12,sed the Health and Safety Cook. 0Yes 25532(.)' I A. - All roofs shall be inspected prior to any roofing material being installed. Yes / Will due applicant or(future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haa7dnus air conolminant V&rf.d by Nc Bay Ama Air Qudiy Matolgcmcnt all new materials for inspection. District? ❑Yce I have mad the hadardous materials imuimments underChap erb.95 alum Califor- nuHcakth&Safely Code,Sutioa25505,25533 ad 25534.1 understand thatifthe building U.not currently hoc v tenant,Nat it u my reaponsitubty In Wdfy do,azupus of m requirements which �Jbe�met p—ri-n�nwissvanaor.ccmrte,m p(.g'J apjLtcy.©C Signature of Applicant Date owacr or a�xcd egern b'-- �_ -yr,-0 All roof coverings to be Class "B"or better