04080105 CITY OF CUPERTINO ". s=
BUILDING DIVISION PERMIT CONTRACTOR INFORRMA iION ,
Bu1LDINGADDRESS: PINEWAVE CONSTRUCTION, INCPERMITNo.04080105
660 RA?NT%TART
t
,WER'S NAME: PERMIT ISSUE DATE
DAVID
NE: SANITARY NO. CONTROL NO.
(408) 245-1816
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
2
00 LICENSED CONTRACTOR'S DECLARATION Job DCSCi1pIlOn
C I hereby affirm Nat 1 am licensed unro
der provider Of Chipset 9(rome
mneing
ambo in Section 70W)of Division Sof thin Business and Professions Code,and my license is
j=vt< InenseClfull aamderce" SFDWL-1 STORY/2 268 _IVING SPACE
License Class Ls. 6Yee
&7, Dam Conuacnr BASEMENT 1 , 130/6A VS�
sJ` ARCHITECTS DECLARATION \®/ s
I understand my plans snail W used as public records �®
eau
;.�
Licensed Pmfcssionel
5 OWNER-BUILDER DECLARATION ^
i Y 1 hereby affirm Nat I am exempt from the ConvacsJ
ors License Law for the UN
00 following mssun.(Saturn 703 1.5,Business and Professions Code:Any city or county
ym K which¢cairn a permit to construct,alter.impmve,demolish,or repair any Somenre OY:/
prior m is issuance.also require the applicant for such Permit n file a signed comment
tb'< that'-ieBterotdprrar.ntmnapm.isionsormeconarsomrsLicenteLaw(Chapter 9 Sq.Ft. Floor Are ep Val 4,4 ,8500
ter$ (commencing with Section 7")of Division 3 of Ne Businmand Prokcsio.Coda)or s�(s-{ O�
that he is exempt therefrom and the basis for She alleged exemption.Any violation of n iY ]!I
Section 7031.5 by any applicant for a Permit subjects on,applicants to a civil penalty of APN Number ay �Occupancy Type
net more Nan five hundred dollars(15110).
C]1.as owner of Ne propany,or my employees with wag.as their sole compensation, 37528001 . 00
will do the work,and the swcwrt is not amended or offered f0eale(Sec.7866,Business
and Ptormians Cade:The Conbsaers License Law don not appy in an owner of Required Inspections
property who buildstarimpmves thereon,and whodocssuch wort him nIritr through his
Own employees.prowund that such improvements art not intended or offered for sale.If,
however,the building or improvement is sold within arc year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
N
sa 1..owner of the property,am exclusively contracting with licensed conuxmor so
contract the project(Sec.7060.Business and Pmfnsiar,Code:)The Contracts ri Li.
cense Law dors not apply to in owner of property who builds or improves Caeeon,and
who contracts for such projects with a cormat Ksl licensed pursuant m the Cmucactors
Lkemes Law.
❑1 un exempt antler Sec. .B S,PP,C�to,thiiss,reawa
�1//t F ��1 wm�G
o ��WORKERV'COMPENSATIONDEULLAAR�AI iuN
1 hereby affirm under Penalty of perjury one of She TOBOwing declanuons: -
1 have and will maintain a Certificate of Consent o sd6balmo for Wrrkcr$CamPcn-
ratio,as provided for by Section 37W of the labor Code,far the pertamamce of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,.required by Section
37W of the Labor Code,far Ne performance of Ne work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the Permit is formic hundred dollars rslol)
or Ins.)
1 certify that in Ne performance of the work for which this Permit is issued.I shall nos
employ any permn in any manner m as in become subject to the Workeri Com irsadon
Laws of California.Dan
Applicam
NOTICE TO APPLICANT:IL afar making this Certificate of Exemption,you should
become subject in de Worker's Compensation provision of the labor Code.you most
.JO forthwith comply with such provisions or this Permit shall be deemed revoked.
Z r"' CONSTRUCTION LENDING AGENCY
rr� Ihereby grim that there is a comsmction lending agmay,for the Performance of
(zthe work for which this permit is issued(Sec.3091.Civ.C.1
LUQ Lender's Name
=z U-Z' AJdmss
U O 1 comfy Cast I have read this application and$tae that the above information is
F cancer.I agree 10 comply with all city and county ordinances and$talc laws relating to
�U building construction,and hereby Salmn<representatives Of this city In enter upon the
Cabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupco eniagainst
F fA
liabilities,judgments.casts and expcne which may in any way accrue against said City
U Z in consequence of the granung of this Permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: I
SOUR�REGULATIONS._ /,
`/J \ _dol_]—.
elunl-l_. Re-roofs
Signature o Dpla HAZARDOUS MATERIALS DISCLOSURE tor Date Type of Roof
Will the applicant or future building occupant store or handle ha�ous maerial
s as defined by the Cupertino Municipal Cods.Chapter 9.11,and the Health and Safety
ode.Section 15532(a)? All roofs shall be inspected prior to any roofinnstalled.
0Y. �u
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an ito remove
mit nzvardo.air conuminms u Jcfined by the Bay Arca Air Quality Management all new materials for inspection.
District?❑Yes �Nn
1 have need the hvsrNms maxerialsrequitements under Chaper6.95 orthc Califnry
ria H.ithdr Safcsy Cmde,Sections 25505,M533 anJ25336.1 undcasand Ihatifthe building
does not courant nose a tenant that it is my responsibility on mutt the oncupmt of an
requirtmc a hick must be met prior to issumen of a cenifca;ofOca tar. Signature Of Applicant Date
All roof coverings to be Class "B" or better
Quvre,or authori zd agentDate