00100076 (2) CITY OF CUPERTINO
RUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADD$ii9b47 TWILIGHT CT - - CAL—COAST REGIP fr No, 00101130/t,
OWNEII'S NAM.E;:7`7
SARGEANT ROBERT D AND I ABET_ N 1371 TITAN WAY nrrl.lcnnoN. IA ;
IorvE:
(714) 578-5090 SANITARY NO. CONI Rol,No.
C reZ ARCHITECT/ENGINEER: Hllll.1)1NG PERA1IT O
00
Iti,nG ELECt PLO M11 r:CIl
7 I_I
56
h LICENSED CON'rRd mider'S OEalme.f 'ION
I herehY eTnn tam I um licensed umber provisions of I,C ic9 ander,
blerng Job DOtiCII_ptlOn
eeren�nrxn��fDi�i.lnn�„nheon.inex.nnJPrnfn.,;mtxe�,nr.nnJmrrcen.e _ PLUMBING RE—PIPE
r—CLL in've nom and rfJ+s't.
z — I.iccnse _(,/ Lic.p
°w. _PJx / Cammetnr — T
u 3' lin /�• �AHCHI"I'ECI"S UECI-AR
G I P le,,ond my plunn ahull ac nwA ns public recone
l
Y
In
p T,icernuJ Pndcsxinnal
o OWNER�al1lLUlilt DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Taw for the
I-,Z G roll oving maom.(Seaton 7031 s,Rutins,and Pmfrstians Core:Any city m ,emay
Y=C which requires a permit it)construct.alter,improve.drnadle I.or repair any structure
prior to its issuance,also requires the applicant Ise such permit file a signed statanent
i'z
that he is ran.rd Rursuar,m he nmramts of the Cammeorfs License Law(Chapter9 Sq. Ft. Floor Area Q i.21
(comm caring with Section 7000)of Uio kind 3 or the Husl nest and Professions Gnir) /
or that he is exempt therefrom and the basis for the alleged enamption.Any violation
of Senior 70315 by cony apfllcont for a Pram t.object,the ,I train m a civil.µnae, APN
ofsen more than Gas hundmd dollars($50(d). §P(nbef035. 00 oQtt}cy Type
❑I,asownet or the operly.or my ennpla,mc an wage,as I relrrole amtprnamion.
will do the work,and the orucmre is not intended or ohared far tale(Sec.70W. - ,5 ,� _ eGt![a61MB I NG
Hrsntasx and Pmfcoiaat Codc:-one Contractor s License Law does and apply to an 20e UNbafggdd(hp R
r of proper,Who builds or improves therom,and start docs such work hlmsdf
lir
-net his own cmployat.pmrided that turn improvements aro no intended or 301 — ROUGH PLUMBING
allured for sola.IL aovar,a.tar h riding or iutpmveurm is sold within nor year at
cndpleion.the owner-Wilder rill have the burden ofproving that he did not build or 5502 — FINAL PLUMBING ENERGY
Improve for purµsu of sulc.).
507 — FINAL PLUMBING
❑1,as do ser,of the popery,am ambi,vel,enmraeing with licensed cotnraears to -
noruct the pntj,,,(Sri.7("4,Hr, nd Rod. x Code:)The Gmmmtor'a
[,I cense Law does not apply bo an owner of property who hand,or impores Inroad,
and who contracts for such pnojeas with a enntracmg9 licensed pursuant to the
Contractor's Llccnxu Law.
❑T um t semen under Sec. .Il&P C far thio reason
Owner Dom
WORKER'S COMPENSATION DECLARATION -
I hereby allirm trader penalty ab perjury one ol'the following declaration.:
J I have and will maintain n Crnihcate of Cement m self-insure for Wars
Compensation, ;is provided for by Section 3700 of the labor Code, for the
pe,ramunu at the work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurm¢c,as required by Section
97011 of the I,aN r Code,tar the pe formanm of the work for which this permit
i.
iswrJ,My w`kris Contµnwunn In w artier tr'o�d,i'-ol/icy number are:
�'�,y No AI II%p OOAW
CEN I'IIIC rION of;E%EM19'ION FROM WORK'RS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars
($11X0,`lets)
I act ify that in ne'perfommnce of the work for which this permit is issued,I
shall not nnpley may person in any manner,sat Lit et become suhjat it, he Worker,
Compensation Lows or Carboni..[)are
Applicant
NUI ICE 10 APPIJCA N ':It,trRdt narking had,Crrif,de of Earmpdon,you sanuld
become subject o the Workers Condensation provisions of the Labor Crate,you must
fnnhwin r,aldy with such pmvitiuns,,this permit,hall be carried nwoked
,
F .^moi CONSTRUCTION LENDINo AGENCY
1 beohy union that there is a construction lending agency lin the pcif..nacre
. fsl of the wad,for which this permit is issued(Sec.3007.Civ.C.)
A Lander',Name
z Z lender',Address
V 1'salty tam I have real this upplinninn and Stam that the uMwe inrometion Is
Ls. E... coca I agree ts amply with all city and county oNimnacs and starw.Ite la
Q (, mhuildmgcon and hereby authorize representatives of city center upon
} rye
he at c-n nit cd operty rat Inspection pnrpaaes.
F 6r (W' agmcu wive,indemnify and key mdse the City If Cupertino against
cn In,ha us, ud,na ,coos Lind ixprnses only in any way acme against said
U Z City' c ",act ante grunting o' panda Ili,Q O
A LIC NTU ERSTANDg 11.1.COMPLY WITH ALL NO -MINT Issued by: Date
)URC LATIONS.
Signau afappGcamtennitatior - 4l [-are -roofs
IIALARDOUS MAI'EItIALS DISCLOSURI!
W dl the."he at of future building occupant store of handle hvunhus material Type of Roof .
Ls dchned by the Caµmrd MandOpal Calc.Chapter 9,12,and the Health and Safety
Gale,Section 25532(al:'
0)'es 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the apdieammmare bnudiagrneopantmicgaiprrad levim—likh If a roof' ns alled without first obtaining an inspection, I agree to remove
sena hazardous air contaminants as defined by the Ray Arca Air Quality Mamrgcmem
hold"! all new iter' Is for inspection. Applicant understands and will comply with
❑Yes ❑No all no -point ource regulations.
I have ed It locarol I,omnia,ngwmmrms order Chapter 695 of the
CulifnminH th&. ILny Cele.Sector,2550 33 and 25534.1 undcdmadthat
it the holdit doe" t currrmlyleocamnat , rt i.,my moidarobilby to reify the
cupanl o the re danti which must c t prior to is--,of n Cenilir:ni of
f are Sign ture of Applicant Date
All roof coverings to be Class"B" or better
o t -rd ugmv — Doe
OFFICE