08040103 CITY OF CUPERTINOk
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BUILDING DIVISION PE 1L'Q .' i. 0fT• "�"'. -
PERMIT NO.
BmLglgc�lqDpF3HOMESTEAD RD TBD — TO BE DETERMINED 08040103
OWNER'S NAME: PERMIT ISSUE DABS
NOBEL GROUP 04/14/2008
NE SANITARY NO. CONTROL NO,
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
TEMP PERMIT EXPIRES DG O PLUMB O
30o LICENSED CONTRACTORS DECLARATION Job Description
e V 1 hereby arRrm Nal l Yn Iiwnued under provisions of Chapmr 9(commencing
eZ with Swoon 700U)of Division 3o(No Business and Pwfessims Code.and my lkenw is
` in full force end effect.
Lkenw Class Wc.a
111--- Dam Contractor
ARCHITECTS DECLARATION
I unicreund my plane shall he used as public records
7
S8 Licensed Profensian.I
OatNEm BUILDER DECLARATION
t<5 I masto affirm that 11. exempt from the CssionstCo License c Law for the
r p a which
mason.(Saito 7M LS Business and Professions Code:Any city or county
S$ which its im a n permit on cnnuaq aimr,improve,demmls4 m repair any wecture
poor to its ksuarmm,also rtquirm that applicant far mommit mke file.signed statement Valuation
teme
< Iherlekncensedputmentm hrpmNaiansa Necanumcacm,uwnm Ls.(Chapter 9 Sq.Ft.Floor Area
95lwarommMng with Schon 7000)of Division 3 ofthe Businessland Professions Cade)or
`i 9 am,be" pt therem froand we bmumank for On alk6ed epdmt Any vimad'on of
Section 70313 by ary Applicant for a permit wbjcm the applicant m a civil penalty of __ATN_ Number Occupancy Type
tot mart Nan five hundred dollars(SSW),
❑Lase of Na property.mmywployeea with wagesas thk mkcompcmaaon,
col dolesimm Cam-TO caw domraak(sly In An Bwioa Required Inspections
proAnd Pro.1w W caller Tim Conwcmra And
whan law doer net appy il,t awne is q P
care ertywW Wlhk Yed Oat
tsach Improvements
andwho darnmmharkhi affemr threats his
twoaver,m Wilding
Nalweh Improvement ere notimm�dndormfered fon sale.B,
however,Ne building m den of plant is told within ane yen of ample for Nc owes
Wilder will lova the burden of proving Nat he did not ddld car improve for PrrTow of
YICJ.
L as owner of the property am exclusively cowmacting with licensed conuYmn m
wmwct the project(6m.]04e.Business sed Professions Code:)tiro Contractor's Li-
'Aa.law does not apply to an owner of property aha boils or whom.Neal.And.aha contracts for such pmjcm with a conaactons)licensed paramour In the Convenor.
Llee.law.
❑lam pt code gee .BlP ( this moon
Owne Dae
WORKERS COM ENS ON DECLARATION
I hereby alarm under Rnshy of perju arc of Ne following decimations
I have sed will main Wn a Certificate ofcmmnt In self-imus for Wormers Compon-
YdAn.As provided for by Seconn 3700 of the labor Code,for the performance of the
work for which this permit is island.
❑I Nve and will maintain Workers Compensation Imaruxe,u mgvim l by Section
3700 of are labor Code.for the performance of Ne work forwhich this permit is intend '
My Workers Compensation Inwance carrier and Policy number art:
Cromer: PoOcy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Dtksection need not In completed if the Permit Is(mune hundred dollars($I00)
or less)
1 Certify that In the performance of 1M work for which this permit is issued.I shall not
cmployanYpenon in any mannermasto 'ct Wft CampenYOm
Lool of Calffamk,Date n
AppOcant �j'1��)�i—/
NOTICE TO APPLICANT:If,after making thk Cenif mo apron,you mould
become subject m the Workers Cure mmitmn provisions of a lahar Codc,you mm
.,O forthwith comply with such provisions a OU permit shall be deemed revoked.
EM CONSTRUCTION LENDING AGENCY
'(-v I hereby LMmthat Nero le a cora uctim lending agervy fur Ne perfomanwo(
rLgi� ti
the ark for which ads permit ls issued(Sen.3097,Civ.C)
14 Q Lenders Num
O z lander,Add.
U O I maty Nat I have mad was Application and mute that ft Above Informal.k
D C%aet.I agree to Comply with all city And county onliamCm and later lam misting to
Wilding comwcam..washereby auhode:representatives of this airy to coat upon 0u
[Id shove-mcmioned property for Inspection purports
(We)agme to save,indemnify and keep bannister cite City of Cupertino against
rti(A liabilities,judgmenm,CON and expCmG which may In my way seems:against said City
U in consequence of the twang of this permit /� L
APPLICANT UNDERUANM AND WILL CO00MffAAPLY WITH ALL NON-POINT Issued by: Date /
S i$RE'Ul e /M
Oar li anuC //AA ll Re-roofs /
Si sire of AppHcanvContmctor Omm
HAZARDOUS tIA ^ 9 DISCLOSURE Type of Roof
Will tho applicant or future Wilding acupanagOw or handle hazardous material
As defined by the Cupenim Municipal Cade.Chapmr 9.12,and the Health and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea
OWill tie applicant of future Wilding oe 1pam taw equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove
il haerdnw air conmmhnanu as danned by the Bay A.Air Quality Managemem all new materials for inspection. ,
District?
❑rte �t
I haveread the havndtam materials requimrtrnu seder Clupmrd95afthe Cidifon
nim Haalthk Safety Code,Smamu21505,25533 and25534.1 urdvswd thmi(the hwldieg
don tot..a,have a It k m bit tY W. cite a¢upant of de
require 0whchto tpda of Cerarmatear Signature of Applicant Date
Owne a horimdgcm Mae' All roof coverings to be Class'¢"or better