03100019 F"CITY OF CUPERTINOBUILDING DIVISION PERMIT � C®NT=RACTORANFORMATION�zOLDING ADDRESS: PERMIT NO03100019
335 20LLINGER
U'S NAME: PERMIT MUE DATE
JLYPHONY MUSIC ACADEMY 2 O5 2003
NE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERM R INFO
BLDGELO PLO MO
+OQ LICENSED CONTRACTOR'S DECLARATION
F u u I hereby affirm that I am Ilcensed ander provision of Chapter 9(enmmcncing lob Description
with Section 7")of Division 3.1 the Business and Pnfession Code,and in,license is
infuumrceand effect. TI- - (1796E3 SQ. FT . )
,�Q Licence Class Contractor,
FIN/,ALE®
f„W Date 7S DECLARATION (ja4
IQQ As shall k use DECLARATION
2 u I understand my plans shall W used as public rcmNs
U LicensedPmfcsomod FEB 3 2004
"0iS
g OWNER-BUILDER DECLARATION
<P I hereby affirm that 1 am exempt from Ne Contraaons License Law for the B pp
00 following reason.(Secfiun 7031.5,Business and Ptnfeesions Code:Any city or county BUILDIN
w which requires a Permit to construct,alter,improve,demolish,or repair any structure eY
poor art its issuance,also requires the applicant for such Permit o file a signed statement
eZp that W is licensed pursuant to the previsions of the Comment's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
rt— (commencing wi lh Section 7")of Division 3 or the Business and Professions Cada)it
$
that he is exempt Nemfrom and the basis for the alleged exemption.Any violation of p�.n
Section 7831.5 by any applicant for a permit subjects Napplicant e applicano a civil penalty or 3 9&R 3\11iln 0 Q
not more than five hundred d.31ars(550)7. cr Occupancy Type
❑ Les n,war sf the propcny,m my intended
with wages az their ale compensation,
will Pr fie work,and the structureCont is not s Lica de Law do for sale(Sec.anDana Business
and Professions Calc:Thc nsbercons License Law does not apply lf an owner of Required Inspections
property who builds or improves thereon,and who does such work oroff redthrough his
own employees,provided that such int is improvements;en not intended mptcoed for Owner.
however.the building or improvement is said within one year or completion.the owner
builder will hart the burden of proving that he did not Wild or improve for purpose of
alcJ.
IiJ.as owner of the propt am exclusively contracting with licensed contractors to
construct the project(Sec.7W,Business and Professions Code:)The Contractor's Li.
cone law does not apply to an owner of property who Wilds or improves daemon,and,
who contracts for such projects with a soar amm(s)licensed pursuant in the Conranor
License Law.
❑I am exempt a der ,B h P C for this reason
I
ORKER'S COMJ rNSAT4 DECLAR T •a
1 batch,.nmr under penldy of perjury ane of the following declarninn:
I bare and will maintain a Certificate of Consent o self-insum for Worker's Court
Car, as provided for by Section 37W of Ne labor Cod,,for the performance of the
work lar which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3788.(the Labor Code,for the performance or the work for which this permit is issued.
My We
Compensation Insurance artier and Policy number am:
Cartier: Policy N..: _
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becamplemd if ole permit i=for.nc hundred dollars(S1IX)
or Less.)
I eenify that in the performance of the work for which this Permit is issued.I shall nod
eonPl.y any person many manner so as to assume subja0.the Workeri Compcnation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenifiadc of Exemption,you should
become subject to the Worker Compeaadon provisions of the Labor Code,you mod
=O forthwith comply with such provisions or this perm it shall Co deemed mwked.
z CONSTRUCTION LENDING AGENCY
1 hereby anion that there its construction lending agency fes the Iarformance of
hal the work far which this pont is issued(Sec.30Y)7.Civ.C.)
W p Lcndcr's Nam,
Leader's Address
Z
U C 1 comfy that I have read this application end cute that thc above information is
W F correct.1 agree n comply with all city and county ordinances and stale laws relating to
�U building construction.and hereby subsonic representatives of this city to enter upon dre
above es.judned property for inpcnion purposes.
H y
(WO)agree to save,indemnify and keep harmless the City of Cupertino against
fn Iiacomexcruceo the granting
sind cxpcnccmit, may in anyway accnc against aid City
U Z
in of UNDERSTANDS
ing Sthis permit.
APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG S. S �
gnalum.fA ds Re-roofs
Date
HAZARDOU A2:=ALS DISCLOSURE Type of Roof
Will the applicant cartoon wilding occupant store or handle havaadoo material
defined ay lac Cupertino Municipal,Code.Chapter 9.12,and the Health and Safety
.Section 25532(.)?
❑vee qN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment If a roof is installed without first obtaining an inspection,I agree to remove
P q it Quality
g P
7Dialdcl!
harardnn air conmminans as defined by the Bay Ana Air Quality Managcmcm all new materials for inspection.
A.Vf
❑Yes XNo
1 bare read the ho-adnus materials axpoicmems under Chapter 695 of the Califon
ealth&Sefety Calc,Sectors 25N)5,25533 and 25534.1 undersand tau if the Wilding
nod curcmly ha a tnant that it is my Isparta iltry n notify the d cu t ofthbef' mod ' rtoissu .r.Ccnlficateol cupanry Signature of Applicant Date
la K 03
'J",
so
'J", Dare All roof coverings to be Class"B"or better