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03080177 CITY OF CUPEwTINO >� 4 BUILDING DIVISION PERMIT • �x� ONTRACTORAINT�©RMATII BUILDING ADDRESS: NICE & RIGHT CONSTRUCTION 6MITND03080177 :7514 HQT,TANQRRW4 PT OWNER'SNAME: 166 EUCALYPTUS DR PERMIT ISSUE DATE NE: (415) 239-2696 SANITARY 0. CONTROL NO. ARCHITEC'UENGINEER: BUILDING PERMIT INFO BLOCELECT PLUMB MECH L 0 10 0 LICENSED CONTRACTOR'S DECLARATION- Job Description Fw❑ 1 h eb ffirm that I am licencedy�er provisions of Chapter 9(commencing P <W with Scnio3 Buf DIvlslon3ofthC BQsinccs and Profcssinns CoJc,end myliccnsc is + LicentxClassdcffca 9z 14 S`s DEMO jtgz Daemc CAas I. Data rn9l— Lt oC cure r A'Icl 221 4Z., + �A;�7. ��•� �O ` S� ARCHITECTS DECLARATION A I U �IYndcrslao Yplam pall he used as public records ,pG .Prot na.. '�.�" S OW NEM BUILDER mDECLARATION \) �n 0 I hereby man .(Scene. e.H am cscmpt from the Contractor's C :Anyc Low for the -po whowingmown.(Sccdut t(DLS, ,msher, and PofdAnnns Cotte:Any cityoccoumY <m which requires a permit m cnnxuuat!altee improve,demolish,or repair any.nmmum �ii• prior to its ixuonee,also requires the applicant for such permit o Glc a signed statement R� Nat he is licensed pursuant the previsions of the Contractor's License Law(chapter 9 Sq. Ft. Floor Area Valuat on e (tum wooing wi th Section 7")of Division 3 of the B usincss and Profcssinns Code)or 36229015 . 00 `t that he is exempt Ncmfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for apimmit subjects the applicant to a civil penny of APN Number .. Occupancy Type not mom than fin hundred dollars(S50D). - ,7 h ra owner of the pmperty,or my employees with wages as their sale mmperustion, will do the work,and tha suuaum is nut intended or offered for sale(Sec.70J4,Business 704 — DEMO And Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections property who builds or improves Nercon,and who does such work himself or through his n employees,provided that such improvements ace not intended or offered for sale.If. however,the building or improvement is sold within one year of completion.the Owner- builder will ban the burden of moving that he did not Wild or improve for puryosc of sain). ❑1,as owner of the profanity,am exclusively contracting with licensed eonaactors to consoacu the project(Sec.7004,Elmore.and Profcssinns Code)The Contractor's L4 cense Law does not apply to an owner of property who Wilds or improves thcteon,and, who co urrem for such projects with a conuactor(s)licemed pursuant o the Conuacor's License Law. ❑1 am exempt under Sec. .B k P C BOOM.mason Owner Data .. WORKER'S COMPENSATION DECLARATION 11...by aRrm under penalty,or perjury one of Ne following dcclmations: have and will maintain a Cenificate of Consent to self-insure for WorkeriCompcn- n,as provided for by Section 3700 of the labor Code.for the pmformancc of Ne - work for which this permit is issued. O 1 have and will maintain Workers Compensation Imuranee,as required by Section 37W of the W bor Code,for Ne performance or Ne work for which Nis p oak is Exact. My Worker's Compensation Insurance carrier and Policy number a re: C er5 t� ,y .: meg^QO7 tett CERTIFICATE OF EKEMPnO ROM WORKERS' COMPENSATI SURANCE (This section need oat be completed if rhe permit is for one hundred dollars(51000 or less.) 1 cantly the in the purformmcc of Ne work for which this permit is isucd.I shall not employ any person in any manner an as to become subject to the Workcri Cion,mawar Laws or California.Date x, Lmam NOTICE TO APPLICANT:If,after making this Cenifit of Exemption,you should Wcome subject to the Worker's Compensation provisions of the labor Code,you must •Z fortbwiIn comply with such provisions or this perm it shall W deemed revoked. Z O CONSTRUCTION LENDING AGENCY I thereby affirm that there its construction lending agency No tW performance of X > Ne work fur which this permit is issued(Sec.1f19T,Civ,C.) '+]Q Undcr's Name z Londer's Addraos J 1 terrify that I have read this application and sunt,that Ne above immorm tion is y Fcorrect.I agree to comply with all city and county ordinances and state laws relating to �U building construction,and hereby suthonm represenrnocs of this city to enter upon the }� above mentioned pmperty for impaction purposes. ^ / r Y (We)agree to save,indemnify and keep harmless Ne City of Cupwnino against N liabilities,judgmenthe costsand expenses thispermit. may in anywayaccrue against Said City J APPLICANT of UNDERhe STANDS of this pmmll. ^t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU E REGULATIONS. Re-roofs gna real APVmaMCmm e r Data v HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupant store or handle ho.d eco momnal as derimil by the Cupertino Municipal Code.Chapter 9.12,and the Hall th and Safety Coda,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yesa Will tit,applicant armor,Wading«capant aver equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Tit Wiamam air contaminants as JCGncd by the Bay Arca Air Quality Management all new materials for inspection. 0d,7 ❑Ycs 1 have mail the hmaNtws materials myuirtmcmv undcf Chapter 6.95 or Ne Calif., nix Health de Safety Code,&come 25X15.25533 and 25534.1 understood Nu if the Wilding dy rmcunen I ha terrane Thar it is my mspamihility m u(y the 'eupant Of the ydemems wbichm tMma pdmtrostanexa ra Ccnifcatc a, kcy. Signature of Applicant Date 5 —�4-a authorimdagrnt Det, All roof coverings to be Class "B" or better CI'T'Y OF"PEWFINO '�"% '" ' � BUILIJIN G DIVISION PI✓RMIT k'C®NTRAGT.ORtINF®RMATION ?: BUILDING ADDRESS: NICE & RIGHT CONSTRUCTION s6MITND03080177 R'SNAME: 166 EUCALYPTUS DR PERMIT IssuEDATE PHONE: SANITARY O. CONTROL N0. (415) 239-2696 ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Ire o 0 0 0 Op LICENSEDCtion, d CONTRACTOR'S DECLARATION GI eb firm that 1 am littnsodd. provisions of Chapter 9(commencing Job Description with Sem )uf Division Jof incmncas and Professions Code.and my license is -oN ifell n auj' sand effect, License $2145$ DEMO =ro Dare rb C. or /yJC y ARCHITECTS DECLARATION T un1,Ahn plans all he used as public records ayU °ori, ' Pn rte , S OWNER-BUILDER DECLARATION <F 1 hereby affirm thaf 1 am czcmpl from the Contractors License Law for the no following mann.(Section k)3I5,Bysinti and Pmfcssions Code:Any City or manly <m which"aim,a permit m mliseua!alter,improve.demolish.or repair any structure poor or its issuance.also reyuircs the applicant for such permit o fte a signed statement a< that W is licensed pumuanno the provisions of the Commeur's License Law(Chapter V Sq. Ft. Floor Area Valua[on �t- (commencing with Section 1000)of Division J of the Business and Professions Cody or Nat he is exempt therefrom and the basis far the allcgcd exemption.Any violation of3622901S 00 Section 7031.5 by any applicant for A Permit subjects the applicant to a civil Penalty of APN Number not mom than fire hundred dollux($5W). - - - --- -- -- ---- _ Occupancy Type -__ Q 1,As owner of the property,or my employees with wages u their sole compensation, will do the work,and the Antrum is not intended or offered Want.(Se..]B4a,Business 704 - DEMO and Professions Cade:The COnaael&A License Taw docs not apply to an owner of Required Inspections property who builds or improves thereon.and who does such work himself or through his awn employees,provided Nal such improvements tie not inmrWtd or offered(or ale.If. however,no building or improvement is sold within one year of completion.the owner- builder will have the Wrdcn of proving that he did not Wild or improve for puryose or salt.). -� ❑ 1.u ..or of Ne ee.7 4 .B Business contracting withlicenseduancies's i- construe the es not apply to an Business and Professions Code:)The es theroun,Li- cave law cars not apply a an owner of protons who Wilds or improves Comon,and who contracts Larn for such projects with a contranortA licensed pursuant to th<ConuactetA Lanae law. \J ❑lam exempt under Seo. ,Bk PCfor this mason Dam WOR KER'S COM PENSATION DECLARATION I hereby All under pcndq of perjury ane or the following dcclaouiime Q 1 have and will maintain a Certificate of Consent to self boure for Worker's Compen- ounn,As provided far by Section 37W of the labor Code,for the peormoramer of that, _ work for which Nis Permit is issued. Q 1 bare and will maintain Worker's Compensation Insurance,as required by SeNon 37W of the labor Cote.for Ps performance of the work for which this permit is issued. ' My Worker's Compensation Insurance carrier and Policy numbers r S�*� TilF"�1 pnycy/aa.: m 2 Q p e�I CERTIFICATE OF E%EM�Pr_I, FROM WORKERS' COMPENSATI SURANCE (This Accrual need not W completed if the,Permit is foronc hundred dollars(SIM) or Ica) I certify Nat in the performance of the work for which Nis permit is issued,I shall Out employ any person in any mannerist As to become subject to the Workers'Compensation - Laws of Caliumia.Dam Applicant NOTICE TO APPLICANT:If.after making this Ccnifcam of Exempion,you should become subject to the Worker's Compensation provisions of the Labor Code,you most �2 forthwith comply with such Provisions or Nis permit shall W deemed m.oked. ZO CONSTRUCTION LENDING AGENCY 1 toothy alfrm that Nero is A construction lending agenry for IW perfurmanec of 1v7 the work for which this permit is issued(Site.3197,Civ.C.) .4 AUndcfs Name 3 z Lenders Address J C) I unify that 1 have rod this application and sum that the above mformmiun is - .i H correct.1 agree to complY will all City and county on inanas and sure laws relating in JU Wilding construction.and hereby entbome rcpwycmauwc tar this city to enter upon We /q� purp D.1 i'hove m consequence the grin for inspectionhiPe mit. :. r / / a. (We)agree to ave,indemnify and keep harmless one City of Cupertino against t l liabilities,judgments.costs and expenses which may in any way acemc against aid Ciry ;)Z A consequence of the Ranting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REGULATIONS. �C OitaR Re-roofs gra rc of App reanVCom ell Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazan ous material defined by Ne Cupertino Municipal Code,Chapter 9.11,and the Health and Safety .Stenion 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 161Ju Will the applicant of future buildingant use e If a roof is installed without first obtaining an inspection,I agree to remove scup a Air Qu or devices which g emit hazardous air contaminants az defined by the Bay Arca Air Quality Managcmcnt Dinner' all new materials for inspection. 0 yea 1 have mad the baaNthas materials requirements under Chapter 6.95 of the Califon .is Health lk Safety Coke,Sco au 255115,25533 And 25530.1 undcrsund that it he Wilding Jyea"roQuaen0y M1a mnmk Nm it a my respuvihility m lily the capon'of NA u which. Wren priorto issuanceofs Ccnifcam Oce cy. 5.., Signature of Applicant Date wncr or a dhmired agent Date All roof coverings to be Class "B"or better SEITY ODE OERTINO* . 3 77 CUPEkTINO PERMIT APPLICATION FORM • APN# 7 O Date: Building Address: 6 L- Owner's Name: Phone#: M '2 . � r� t� s , crlfN Contractor: License#: MICE �. f'Z� tE't COYJST, Contact: Phone#: Applicant/Contractor: Bu' Permit Info: Id Elect Plumb Mech Job Description: Pie)Tto Residential: Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: Type of Construction: Occupancy Gr p: Apoty . lica le Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG 2