05120139CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR I� ORMATJON .
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BUILDING ADDRESS:
RON PARIS CONSTRUCTION CO
fW NO, 05120139
ER'S NAME:
PERMrr ISSUEDATE
ROBERT ALLARIO
5
PHONE:
SANITARY NO. CONTROL NO.
408)296-5926
ARCHITEC (ENGINEER:
BUILDING PERMIT, INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I Money affirm Nan 1 am licensed under provisions of Chapter 9 (commencing
o
with Section 701118 of Division 3.f the Bottom end Profcuiou Code, and my It... is
infull Ceaect. Y 9 a.
DEMO 2 RESTROOMS A'
License Clo
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NA►LED
CLiw#omas
Dave Conuacmr
ARCHITECTS DEC
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I understand my porus abet used as public records
MAY (`
2006
Licensed Prormawmal
OWNER.BUILDER DECLARATION
S
1 hereby affirm that I am exempt from the Contractor's License Law far the
following masen. ($action 70315, Business and Prolesso rs Cade: My city or county
which rumbas a permit in eonwci, altar, harrow, demolish, or repair any structure
JOS6 0 0 0
poor to its issuance, aha requires; the applicant far such permit to Ole a signed smwmcnt
wtM4nanredputsuanunNepmvislouofNeContrsemr'.Liccoclaw(Ch.pmr9
Sq. Ft. FloorArea
(commencingwith Station7000)of Division3ofthe Bu.i a and Pmresaom Code)ur
that he is exempt therefrom anM the basis far the alleged nemptian. My violation of
F 0 0 Occupancy Type
Section 7031.5 by any applicant for a permit subjects she applicant ro a civil putty of
trot mom than five hundred dollen ($500).
❑ I. As owner of the pmpcny, or my employ= with wain As t1wir sets compensation,
will do the work, and the structure Is not intended or onamd for sale (Sen. 7044, Bwincss
Required Inspections
and Professions Code: The Contractor' License Law don not apply m an owner of
property who Wilda orimprovo thereon, and who docs uehvmrk himselro though his
awn employees, provided that such improvements art Trot intended uroncmd roam. If.
however. Ne building or improvement is sold within one year of completion. the Owner.
builder will have the burden of proving that he did not build or improve far purpose of
am.).
1, n owner of doe property am exclusively contracting with licensed conuacron m
construct the project (Sec. 7044. Business and Professions Cade:) The Contractor's U.
ecoe law don not apply be an owner of propeey.who Wilds or Improv thereon, and,
who contrama for such projects with a contractm(s) licensed pursuant to the Conuactoes
License Law.
❑ 1 am exempt under Sec. , B A P C for this moon
er Das
WORKER'S COMPENSATION DECLARATION
1 hereby arm under penally of perjury arc of dean following declanfimu:
❑ 1 haft and will maintain. CeNOamaf Consent mself-lnaum forworktr's Compen•
titan, As provided for by Section 3700 of the Labor Code, for the perfamrance of Ne
work for which this permit Is land.
❑ I ban and will maintain Worker's Compensation Insurance, As required by Section
37M of the labor Cade, for the performance of the work for which this permit is mood,
My Worker's Compensation lowence am" and Policy number yr
Carrkr. sfAr IL I` I r cowl Policy No.. '0010
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
inns section need not becomplemU If the permit m Imam humboddallars (SIM)
or lea.)
,
1 comity that in the performance of the work for which this permit is issued. I shall not
employ any person in any manners An m become subject to the Workers'' Cunpemution
Laws of California, Dem
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become abject in the Worker's Compcmadon provision of we IaMr, Code, you mu,
forthwith comply with such provisions; of this permit shall be dermad mocked.
CONSTRUCTION LENDING AGENCY
1 hereby alfam that there Is construction lending agency for the performance of
the work for which this permit is Issued (Sen. 3097, Co, C.)
Lender's Name
'
Lender's AMmas
I unify that I have mad this Application and sum than the show infoonnulun is
correct. 1 agree ro comply with all city and county ordinances and slow laws rtbtng to
Wilding construction, and hereby aathmiee representatives of Ila city m now upon we
aMve-mentioned property for Inspection purposes.
(We) agree N aft, indemnity and keep harmless the City of Cupertino !gains
liabilities, Judgments, coca and esp. which may in any coy.erne again, aid City
I n can aqua ting of this PcrmlL
APP CAN UNDER$ DS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
50 R ER CULATIONS.
Re -roofs
Type of Roof
J �-)✓/-I LA
Sngnuurt of ApplicaVConuacmrr tine
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or to= Wilding occupatamro or handle board= nowwrial
u defined by to Cupertino Municipal Code. Chapter 9.12, end we Health and Safely
ASection 25532(.)? XNo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
A"haordous all conuminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
Disn'tClT
❑Yes�f'iv No
I hero mad the levasdessmalcoammquimments under Chap er6.95 ofthe Califor.
1Hool at , Sactau255D5.25533UW25534.lu MAMOmifthe building
d IM currently how a at Nan It u my nespotslbility ro amity to reopen of de
q lam uwbichmu, melpdormi,uenceofaCcnibcamuf0cenpm"y
Signature of Applicant Date
1 1 Rlt
All roof coverings to be Class "B" or better
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