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02070122 CITY OF CUPERTINO - e' ' • - BUILDING DIVISIONPERMIT pIC©�RACOR^&0RMATTON: L BUILDING ADDRESS PERMIT N 20791 GARDEN GATE DR. A PERFECT CLIMATE x2070122 DPHILIb BREWER 10570 S DEANZA BLVD APPLICATtY DA72OO2 i PHONE: SANITARYUNO./ L L/ CONTROL NO. (408) 861-9545 C«z ARCHITECTIENGINEER: µt O O BUILDING PERMIT WO 8 I++ BLDG ELECT PLUMB MECH 'y a i LJ C_J L:7 L_I 5 u 2 LICENSED CONTRACTOR'S DECLARATION Job Description is Iherc63'Ammt thmlum licensed antler provisions of Chapter9 kommeneing FRUNACE be A/C mF with$telion7D9B)n(Dlviiinn3 of the Business end ProlessionsCWe.vnd my littnx - is in full ionic and effect. Wx< Lice u Class Lic.N O a Date Comrennr ILL lin ARCHITECT'S DECLARATION 1 undvmmnd my plana,hall be used as public mcotd, K p o Licensed Profsston.I /S o OWNER BUILDER DECLARATION (/ I hereby African that 1 am exempt Gore the Contructor's LwAnx Law for the ?a following reason.(Section 703L5.Business and Professions Code:Any city or county $6500 A, D which requires a permit to construct,alter,improve,demolish,or repair any structure 63$ -prior to its issuance,slxo rtquirs Uie aPplicem f«xuch permiuoRleasigned statemrnn - _ _ _ _-___ _ _ _ _ thathdia',licinsed puisuird to the provisions of the Contractor's License Law(Chapter 9 �•s,1\ Valuation or (commrncing with Ssti4n_7l%q)ol Division3of the Doainw and Pro(euionx Coda -pIi i_ tt,.• g 1J d. 1. •� i;4� F11 • . or that he is exempt therefrom end the basis for the alleged aemption.Any violation - 4, 1._ L1 of Section 70313 by Any applicant for o permit subjmrthe applicant to a civil MAYty 3 O YiPN N E}H PLUMBING G tdfnotUmeNafvehundreddnnars($5BB), Occupancy Type ❑I,AS ownerof,hA property..1 my employees with wvgex ns iheinole compameoun, 303 - ROUGH MECHANICAL 'win'do Lbo work,and the struma e a not iutendAd'ororferedUFAAle'(Se..7(146f . r, Bbdiness'end Professions Cod,:The Convector',License law does rat Apply to An [jq�t& IF owner of property Who builds or improves thereon,and who does such work himself 501 - FINAL ELE TRI L ANERGY or througgh his own employees.provided Nm each vementem,nta arc not intended or __. ____ -,offs«dfur ale if how the will gonmproof Prov scold he did one year of _ 502 '--FINAL- PLUMBING-",ENERGY-`-"" `- ii)npleufn,pu owner-builder.).will have the bather of proving that he did not build or improve for purpose of Lila.). 503 - FINAL MECHANICAL ENERGY T l5 esow eru(ilmSo " -' `a "" "'�� "-`-"505-----FINAL--ELECTRI-CAL--- - -- ---.• m� pr pert oro a<lusivelyc trocug th Icensedcontra,mrsto L'•:.,'(1 'canxwct the project(Sec.71164 Bus mss and Profess ons Code)The Contract.". 507 - FINAL PLUMBING ei-a �La IP :.I.=,Ce License Law does nota 1 to an owner of x•' apply property,who Wilda or improves thereon, and.who conuncts.fLaw. proi«u.with a.convecmgs).licensed.pauamt.to.Ne_.._......._.___.__SOS- .,.FINAL._MECHANICAL-_:::__..._.. ::.?. CISTA.hLkens,lnw.. .-,,I<'Yitrr'fi.5t '.iL+"+.B ❑I�narx�jeptr''id''er,�SssecB:4PCfonhis rtvson 'WORKERS COMP9WATION DECLARATION I hereby eRrm under penNy of perjury one of the following declamtions: - • ❑ 1 have and will Am,.uin'e Cerldima"ttf Conseni a self-mium for winder's Compensation, as-provided for by Section 3700 Of the Labor Code. for the y perfpmande of the work for hchthspermits ssed. FUN ALE ❑1 h d II mnina W dei s Compo Sauer Ins rohce,is mqubx: by$ztion 1700 of the Labor Code,for Ne,peifotmence of Ne-work for which this parent is iu d My Wo kala Compemsetton Ins ranee cane vnd Policy umber Are AUG Cemerh 4pf r lm i .S lti(Policy No ..r"NUt] 'O"J �©UL .;.. _. .. tCERTIPICATIO OF.EXEMPTION fROM.WORKERSq - ' d5�"r• J..:,,. (t ]r __pi ,. .-, s7.r. -tll _..r m+ •vr a COMPENSATION INSURANCE phis iccti 'nee «dno'hecompleted if the .it for one hundred dollen �`-)�' 'I' ' •-,-• li j.xDl-\ Ifi1>_ (5100)or loss.) 'a;t a1 codify t tin the ped ran c f the work far which'his perm t n issued 1 __,.-_-_._....,,.,....,.._... _,,....._.......,,_. ,... _. hall not eml Anj ., 11. ' 1 '• COM At!p Y Y P< n Y n m t hero a subJen to:N,Work re - I - sofCltfomlA te'•7/Z+•-�g+[•�_ i IM,16 thi A.rkm', ompensmgth wismm,, fEzaboronYOU Should . Z becomes Jento Ne Winch pr Compensation rpm stam,f iLub Mv. you'must. i 0 forthwith comply N Such provrstom or Nu perm t shell bed reed rt k d I F+i z "'a' t t y 'CONSTRUCTION LENDING AGENCY ., t . , a. ° ' 1 hereby eiBmt that N u e cons4unlo I iMm grncY for Ne pert rmence :I.ib- 'I v. -!1 of Ne wv k for whtdh th permit i siueL(Sec 9097�ly C 1 t _ _� PW.I D -Career'N me o,._ .., .....: •,.... ...... .u: _. _ _. .. _ .... ..._._ .,y •,�,� I certify Net I Neve reed this Application end seta Net the above infoimetian is fat.I,y t6rrcct:1'agrce tq comply with dl city dntl county ordinances and sate laws relating � (� to Wilding mnswaion:aria herttiy luNuiixe'xprcxnutives of Nia city to catnupon �x'.W the.above-mentioned property for inspegion puryoses. f�,,,ii',S (we)epree to leve indemnify end keep haiMeu the City of Npenlno�gain't FrtA liabihus Judgmenu,cosu Andexpenus wh ch may,n any way accrue egeinn said ' V y City ncansequence of Ne granting d(Nis permit `" ' APPLICANT UNDERSf \DS.IND WEC[OMPL7?tN ALL NON:POAT 1" SOL a oris , Issued by:;,ZZL Dale g 1 gn nye of ApplcHAZI , Date�,;,y', Re-roofs Will the Applicant MATERIALS DISCLOSURE aid m future Wilding occupant stort&handle huwdous material Type of Roof - r' all j. N Cupertino Municipal Cod Chapt 912 and the NedN end Safety t "- - • ' '- '- -'_ Code Seeupn 2553(e) r - _ _ " f . Oyes t 7v rfa� be inspected pnor_to.any.roofing material being,installed,__.,_ _, �;4i.' Whl Ne pplieent (tar bmltlmg«c pent use equip e t device;which. If a roof is in§talled'without first obtaining an inspection;I'agfi&to'i'etnove emit hazardous au cortionfintaisb defined by thea yAMA Air Quelny Management °ictal all new materials for inspection. Applicant understands and will comply with �� ❑Yea 1 [ rl Y�NO IrRvtn ., _T „' •u:r all non-point source reg P ation5 .. .- ol have^rcvClNe'hazeNous maieriels ngwrtmcnti'unif Chapter 695 bf the Calif.mu Health§Sefey Code,Sections 35505:35533 and 25536.1 undersand that If0Ibuildlgdxanoicu adyh've mntini tht Uri- I yrtspovtbdiry to notify th< wbupant of the requirements which muni tie met prior a tssuawe'of a CmiRcaa of A .1t Signature of Applicant . -. - ,. Date Owneco u TiMi t , -.r v 'It r Dea. .h4 All roof coverings to be Class"B of better +1".k OFFICE