08050120 BUILDING DIVISION PERMIT s CONPRACTQRINFORMra.'CIO
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BDa5T flDBFse�'ARTMAN DR TBD - TO BE DETERMINED PERMIT 08050120
R'S NAME: PERMrr ISSUE DATE
OHN RICKET 05/14/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHr1ECTENGINEER: - BUILDING PERMIT INPo
BLDG ELECT PLUMB MECH
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3 o a LICENSED CONTRACTOR'S DECLARATION IOU Description
m 1 hereby affirm that 1 me licensed under provisions of Chapter 9(commencing P
ra� withsmtion7O(gofDrvraon3oftheBuamssm Praressiameme.andmylicemis RMDL 2 BTHRMS,NON-STRUCTRL &INCLD ELEC/MECH/PLMB
mfwrelraw
Liramoaay up 3�7ELCO BAY AREA PD FOR BUS LIC 5/14/2008
s. Date //t r...� Convssmr
`l- T�T�ARCHDECrS DECLA ATION 4 Ad P7
iG [understand my plam,hall he med u public Ommis
gas
�. Licensed Professional -
OWNEon com t Immthe ConasDECLARATION
'�a Ni I hereby.(Su an I am rumps from the Convector, :Any c Law for the
i O o following mean. emit t ]construct.
Buaneu and ere.duoli Cade:Any city tmuusy
z$w, which requires a gamin re comtmct.alter.Improve,do are,,t fi repair ed ,cadent
_Za pdurmiucensed Issuance.also requires the applicant for sushpe an'sIG esus Lawdnummem
p < Nuneisciag id Secen7s )dDivWon3of CBuubrslJceruclaw(Chapter9 Sq.F[. Floor Area Valuation
(con mea excerin SPation70ndthebataonl of the Bped cues p Profrs vi Cadc)of $40000
— S u a u except b rlertfrom and the per (m the akgw eawant s Any l peens of
Sepias 7011.5 five
myapplicantdant r«a Premia subjecu Nc applicant m•civil penury of Number Occas enc-Type
sat more Nan Rw hundred dollen(g500). 32613 087 :°�� P Y YP
1,u owmr a tae Prepmay,m my employees wrN wager u de'v u.eompenu8m,
will Pr fe work and ,ram Co 1,Inst rounded m Law
des has (Su.71344,B ser ss
of
and arty wh bas Cade:The ves tracmr,mama law doh osis apply lf u owner of Required Inspections
oweem who Wiid,miroprowash i me,and who dam,Mnwmed matt fm through W
o mover.oyer,provided dot sub improvemmm tae not ear ole mattered forme ole B.
nuwever,the Wilding m dem owmcnl u sold a did ma year im rev tion,the purpose
o-
Wilder will low the WNm of proving Nal he did ret Wild a improve fa puryom ar
ask.).
❑1,as awnm of she prepersy w exclusively convecting with demand mnvumrs b
mmtroct the project(Sec.70aa,Buena s and Professions Cade)The Contraeuh U. -
come Law does am apply to an owner of property who builds or improm Neater.am .
who eonvaeu for such Projects with acanuamor(,)Beata paramount to tba Conuapors
Licuum Law.
❑I on exempt under See ,B At PC few this mason
Data
WORKERS COMPENSATION DECLARATION
I busby a futu under penalty of perjury one of de following duluatiam:
have and will mamas a Cul fmate of Comam m calf-Wuae for Worter,Compen-
mion,as Provided for by Sedan 37W of the Labor Code.far Ne peaftumance of the
wort for which this permit is immed.
❑1 have and will maimme Worme.Compensation I.,as acquired by Sacro.
3700 ache labor Code.fu the p,Ramuco ofthe wag for which this pc mit is imued. '
My Winter,Compemuion be.caaa.and Farm,number,ere:
C-Min, policy No.: '
CERDFlCATE OF EKEMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(7@u section need Out be conpkud if the permit I,for ore nunNW dollars($100)
or Ws)
1 certify del in me Mr...of the wort Ire which Ni,permit u fsscod.l"I ret
employ any pecan in my manz oleoma 1.1u.the Wortrn'Compensation
laws of California.Dam sV
NOTICE
OTI ant
N come subject
APPLICANT: ,area national;ng Np Certificate of Exemption,you sham
.J Obcome,comp y de Wartcr,Compemihis ermiit me of Ne lane Cede. roup
foMtith comply with such Providom o Nu permit shat W dcemnd meted. _
Z ^ CONSTRUCTION LENDING AGENCY
[-a rte+ 1 Wmby maim dw chert era muuvdM leadinga for agency performance of
6i> Le wort far which Nu mit u Ironed(Sec.309].Civ.C.)
find
G 0 ers Name
a z lander,Address
U O I comfy that 1 have ram Nie application arm sum thu the above ufomation u
V4^ corms.1 agraa m rnmPly withall city tad county omimrce,sM mute lar,relating m
O IS.^J Wilding construction.and hereby mNotlm mpmunulm of this city m enter upon the
aWve-mentioned Property for inspection purposes
F y (We)agree to taw,indemnify and bcep nay Or m the City of Cupertino agarol
C.1 Iiaconseaence OfheeonsendOf this expenses which may Or my way acme against City
U,'Z A APPLICANT
of dm UNDERSTANDS
of Nu permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -S,—,/t'(-O('
SOURCEREGUyL�ONs ��_
G�=T� &x1/410 L Re-roofs
Srgnuum ofApplicaIIAZA SDam
OUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future Wilding aceupml nom or handle bastards.on.aM.n
u defined by the Ctryenino Municipal Cade,Chapter 9.11.tad the Heallh and Safety
Sedan 25531(e)] All roofs shall be inspected prior to any roofing material being installed.
❑Yrs We
Will Nes applicant or future Wilding aces nt use If a roof is installed without first obtaining an inspection,I agree to remove
nn B W ea Air Dustily
viva which g P
eDiitrict? nw air cmumimnu u defined by Ne Bay Area Air Qnaity Management all new materials for inspection.
❑Yca �u
1 have mad the Intimations maerials OONMOM w underchapmr6.95 of Ne Califaf-
-in HculNk Sal-WCpk,Sesim,V5505,25533 aruIMM.1 understand Nm iflhe Wilding
doss ms currently have a mrua6 Wt It is my reapandbiiily m Mary de mear,m t at de
requimmcnu/tahich ec met Primmmuance of.cmainmm of Ocapmcy. Signature of Applicant Date
Ems'
Owner or mNonood agml Dam All roof coverings to be Class'%W'or better
f