08080082 CTTY OF CUPERTINO bra .�>fi'fxa .`z '� '�ibx, �.
BUILDING DIVISION PERNUT CONTI2&CTOR�INFAOR ATION
fi ,r�� 4•' :;yfr�t+a"A?.o
BUILDING ADDRESS: PERMIT NO.
22621 POPPY DR TBD — TO BE DETERMINED 08080082
NEWS NAME: PERMIT ISSUE DATE
mANRARY NO. CONTROL NO.
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
00LICENSED CONTRACTORS DECLARATIONOrdto1 hereby Kinn Nat 1 am licensed under previsions of Chapter 9(commencing Job Description
N"Z� with Sued..7")ofDivision 3 of NC Ilmdr.and Profrssiam Code,and my]I,..I. KITCHEN, BATH,DINING RM, BONUS RM & UTILITY RM
=,,, in full forte and effect.
Yqz License 0. Lina REMODEL 657 ' .ELECTRICAL POWER (RECESSED LIGHTING)
EFp Daic Contractor
epp1 ARCHITECTS DECLARATION THROUGHOUT.
W U
gn 1 uMeraand my pplansshall he used u While records
G t; Licensed Professional
OWNER-BUILDER DECLARATION
.2 1 hereby affirm that 1 am exempt from Ne Contractor's License law for ft
i c O following maven.(Stevan]1171.5.Business and Profcssns iuCode:Any city or county
_ici which.quires a permit to com1.ct.al1u.improve.demulis6,or spur any suuetum
pHo wiuissuanem.a mquiratioapplieant forsuchpermittofrlcasianedsuemcm
that he is licensed pursuant to the provisions ofthe:CommeorfLaw Sq.Ft. Floor Area Valuation
02 (commencing with Section 7000)of Division 3 of Oe Business and Professions Cods)or $385520
NM W u therefrom and therefroand the basis fm the alleged esereption.Any violation of
Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of Number Oceu ane T e
not more than trove hundred dollars(5500). 3 4 212 0 91 , P Y YP
Q I,uowner of Oh pmprny,ser my emploYces with wagesu Oov sets compewtion,
will do the work,and the strctus Isret Intended oroffered fonale(Sec.7066,Businet
and Professions Cade:The Contracur's License Law does not appy to an owner or Required Inspections
poopenY who buildscrunproves thereon,and whodoessuch workhimselfmNrugh his
awn employees,provided Net such improvements art not intended oroRered foruk If.
however,the building or improvement lauld within ars)ear of completion.Ne owner,
Whether will have the burdut of proving Nal he did not Wial or improve for purpose of
rule.).
u owner of the property.w exclusively contracting with linrand contracture to
vett the;.lect(Sec.7Du,Business sad Produce..Code:)The Comm ctor's Li. .
ecus law don not apply to an owner of property who Wilds of improves themon,and
whocontacuforswes mjcmwi amntractar(s)lim=dpu ntw Ne Cont s
Lire Law.
I un exempt and Ste. ,B&PCfas Otic teas ,
ter Due f'O_t_'I'-III'_e`�.'Itw—w_
O 1 E C MPENSATION DECLARATION
1 thereby salons undc papally of peyury one of the fallowing deuarations:
❑Ihsre.M will munhin Ceovfinm of ConttnHo self-insurtfurWorker'scompcn-
utlon,as;provided for by Scedon 3700 of the tabor Cade.for Ne peAannanm of the
work fee which this permit u Lsrued.
❑I have and will maintain Worker's Compensation Insunn¢,as required by Section
3700 of Ore tabor Code.for the pcdarmanco of do work for which this permit Is ivurd.
My Worker's Compensation Insursnx carrier and Policy mark, he:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed little permit is(orae,hundred dollars(SI00)
or lest)
1 canny that in the Performance of the work for which this p,rmit is issued.1 shall not
employ any person in anymannerso beer c 'xtto Nkers
e Workers'Compensation
Laws of Calif i
Appli ant
NOTICE TO APPLICANT.If,alta making this CeniEcato of Faempusel you.Mould
become subjm on the Wohefs Compewtion provioms of On Inbar Code,you mut
.,,z foMwiN comply with such Provisions or this permit shall W domed revoked.
Z O CONSTRUCTION LENDING AGENCY
(~ IWmhYaRrse than ft.a.convection lending agoey for the perfmmnce of
ai
the work for which this permit Is issued(See 3097,Civ,C.)
L Lender',Name
a z Lender'.Address
U Q 1 amtify that 1 have head this application and thus that the above information u
it. F coneCL 1 agree to Comply wmN all city and county mdinarmcu and a=laws rusting to
OrJ Wilding construction,and hereby authorise repmxnuvma of this city to cont open the
above-mentioned;.pert for inspection purposes
F y (We)agree to save.indemnify sed keep harmless the City of Cupenino so=
(A
liabilitiesestuarec of u.eors oming thissawhich may in any very raeeme,galnststd City
V z Aconsequence of granting Ni, WILL
'—' APPLICANT U RSTAN D WILL COMPLY WITH ALL NON- OIN� Issued by: Date
SOURCE 0.EG TI S.
Sigoad rmvm n tor
Ma 40 Re-roofs
H DOUSMATFJt1A19DISCLOSURE Type of Roof
Will the ap;lican or futum W ilding a.upant store oflundlc hnndous matorial
Edell d by z Cupemco Moeleiryl Code.Chapter 9.13,,ed tW Hcuth and error
.section 25533(.)7
p ya, ON. All roofs shall be inspected prior to any roofing material being installed.
Will mW, linntorfor..building ocet rant urn If a roof is installed without first obtaining an inspection,I agree to remove
Pp d P ea Air Quality
Management
g
District?
Nous air contaminants u Je0ned by Nm cry Area Air(Nally Manaacmcm all new materials for inspection.
❑Yrs ON.
I W the baurd osmahrials requirements under Chapter6.95ofNe Calif.
nu Heal ,
D„p- All roof coverings to be Class';W'or better