03100053 CITY OF CUPERTINO e at ' " •' -
BUILDING DrvlsloN PERMIT ^.ica�V— CTOR'INFORMATION:'
a•.•
auILDINGADDRESS: ALVAND CONSTRUCTION PERMIT NO 03100053
OW NER'S NAME: PERMU ISSUE DATE
NE: SANITARY NO. CONTROL NO.
—
ARCHITECIENGINEER: BUILDING PERMIT INFO
' BLDO ELECT PLUMB METH
u0Z, LICENSED CONTRACTORS DECLARATION- Job Description
[[ I thereby affirm Net 1 am licensedd underunder provisions of Chapter Y(commencing p
with Section 7")of Division 3 of NC Business and Professions Code.and my license is
'niimac humanoid fees. Lic.N REVISION—WINDOWS/FIREPLACE
Date Contractor ORIG PERMIT 02070062 IN HOUSE
ARCHITECTS DECLARATION
I understand my plans'hall be used as public records NO NEW PERMIT ISSUED
a
I Licensed Pmfcssional
I OWNER-BUILDER DECLARATION
ECO 1 hereby.(Sent that 1 1. cumpt from the Contras Cc License Law for the
ECO followwhich
gmresa nocedon]construct,
Business and improve.
Ca dc:Any city or county
k$o, which its isi'a permit m cnnstrum,alter,improve,demolish,or filrepair structure -
-tZY Chier t he ilsiensedpalsurcyuirca sbe applicant foracelt Contractor's
License
ave hapterm
pZ< that hatecingwiit Pumtion7 the previsions ofthehe Business Litems,sho C ode)9. Sq..FI. Floor Area Valuation
a.t (cat he is.Tomb Section7")and of Division lfr of the Business commnd Proficice.Any
Galc)of
i 3$ that he i'campy yang ap il and the basis for the subjects
th d exemption.Any l violation of 82990
Section031.5 by anyreddolltfor aPermit aubjccts the applicant macivil penalty of APN Number Occupancy Type
not more than five hundred'Doan($500). P Y YP
❑L ot owner , the structure
is employees with wags u their sole compenudon,
will do thework,and the ha Contractor's
tended License Law it=
coma apply
Boniness 35601054 . 00
arta property code:The contncmr3 and
who Law don net appy to an owner of Required Inspections
property who build'or improves thereon,and who such work himself orthrough his
own employees,provided that such improvements am are not intended moQered theInitiate.r,
howewnthe
avetebding rden ovement provinhhsold he withinoneyearofcproveforNeowner-
bale.). will have the burden of proving Net he did not Wild or improv for puryau of
sale.).
JJ 1.as owner of the property.am exclusively convecting with licensed contractors to �9
construct the project(Sec.7004.Business and Professions Cade:)The Contractor's U.
came law does not apply to an owner of property who builds or improves thereon,and
whence Lacer for such projects with acnnuacsor(s)licenutl pursuant 10 the ContractorsC \\
License aw.
❑1 am eumpt under Sec. ,B&P 11,this mason
OwnerD
I MAR
It ue
C
C WORKER' COMPSNSXTXkNDECLARATIO
I hereby affirm under Penalty of perjury one he following declarations: \
I heve avd will mainmin aCenifiwm of Co seguff-insuuforWorkeraCompcn-
tion,as bo
provided for by Section 37M of the r Code,for thm
e performance of the
work for which thio permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Warkers Compensation Insurance carrier and Policy number am:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thls section need not hecompleted done permit is formic hundred dollars(5100)
nr less)
1 cenify that in the perfor emc of the work for which this permit is issued,l shall not
employ any Person in any manner so u in become subject mine Woraeri Compensation .
Laws of Califomia.Dem
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker'a Compensation previsions of the tabor Code,you must
.,O forthwith comply with such Provision'mf this Permit shall he detract)revoked.
zt t'-" CONSTRUCTION LENDING AGENCY
[-+ k Bar
rwhichnm that there ice coaSect3W7,lending agency lot the Performance of
C'.>-s theLe work fur which this permit is issued(Sec.J09],Cie C.) -
W Q
Lender's Name
� z Lender's Address
U C I certify drat I have read this.,hemom and scene they the above information is
ly H torten.I agree be comply with all City and county ordinances and sou laws relating to
OU building construction,and hereby sort paimsernatives of this city to enter upon to
W aborc-mcmionedproPcrst for inspection aen purposes.
(We)ague m save,indemnify and keep harmless the City of Cupertino against'
m inconsequenec of the
granting
tsintl of this expenses which may in any way accrue against said City
V z A APPLICANT
of UNDERSTANDS
of this D WILL
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC GULATIONS. i
'gra sea Appli nUConlem r Data �tRe-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atom or handle haeardous material
as defried by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Schen zss3x'Y! All roofs shall be inspected prior to an roofing material being pYea No p p Y g g installed.
Will the applicant or future building occupant use equipment or device&which If a roof is installed without first obtaining an inspection,I agree to remove
it h4vardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
isnrictY / P
❑Yrs eNo
I haw mad the haardousmaterials requirements under Chapter6.95 of the Califon
icalth&SafcnyCmde,Sadoa25505,2533and25534.1.n&c w,dthwiflM building
dnot currently haw a tenant Nat it is my resp mibility m nodl'y Oce occupant Of thc
L
mqufre rats chmu5tbempdo
enruisw a .eccetenrOc
( apanry. Signature of Applicant Dale
owns r authomcdsagcOt Dam[ 7 - All roof coverings to be Class"B" or better