04030242 CITY OF CUPERTINO 4,
BUILDING DIVISION PERMIT WONTM.-OhN
UNF01"', 4
E
'u'�DTNG ADDRESS:
STEPHANO HOMES INC PERMIT No 04030242 '
4 T.TRRRTV rT
PI —-ER'S NAME: PBRMIT ISSUE DATE
I
MALA
E: MENROTRA 43-45, 21 CAMING SANITARY*3�2 9112 qb%OL NO.
ARCHITICTIFNCINEER: BUILDING PERMIT INFO
BLDG EtECT PLUMB MECH
Z' LICENSED CONTRACTOR'S DECLARATION
MI Moby arrime Man I on licensed under prinvisions of Chapter 9(commencing Job Description
wi Division 3cifflea Butimglind Ptalinad...Conn.and my lic.o.u.
11 Sea V— _'Mcl
k It'.- BATHROOM EL
isDa Co
ARCH OW DECLAI AT11
I understand my piano sholl I.used.public records
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�q� Licensed rotational OWNER-BUIWER DECLARATION
I homey Mm that 11. exempt farm Me Contractors License Law for the
02 following moort.(Sued..703 1.3,Business and Profession Code:Any city or County
which nomfires.Permit in cwhrusi.sher.imp..don.lbah.or tricur my M.I..
prior Wits issue=.Atim noiines;Me applicant for such pwronit in rile a signed statement
Fay Sq.Ft.Floor Area Li tj Val-'Xi-i6h
door lor is licensed pursuant to the previsions or Me Contractor'S License Law(Chapter 9
(commercial with Section 70DO).f Division 3,d Me Box.and Points..Cade). 7
that he is exempt Motorman and Me basis for Man alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant M a Civil Penalty Of 3-9WFft"qr0 0 JLG400�ncy Type
net mom than fin hundred delta.(SSW).
[j l,umnerafftpmpnywmympiOyeUwith"Muftirwkro PeRud"-
willdo the work.and the someare bgrarojimanded croffered luaratic(Sec.70".Bushow,
and pmrohm Code:The Cornerstones Licenam Law it==1 apply M In Owner Of Required Inspections
property who buildsor improves twormi,and wharoessunh wait himselfordecough his
.a employ=,provided that such Improvements are notion, armterad for ittle.If.
however,Me Wilding or insprowernaL it old within ons year of completion,the owner.
builder will have Me thrown of proving that W 414 not Mid or Improve for purpose of
sale)
0 1,u Owner of the property am exclusively cornewing with licensed Continuous W
comatrourt Me pmjcm(Sm,7044.Business and profession Carls:)The Contractors Li.
cents Low does not apply to on Owner of property who Wilds or improve Mercer,and
who contracts for such projects with a mourachou(s)licensed prsunt m the Contanciner.
Licimm Law.
I mo exempt under See, ,B&P C for this aware
Dom—
WORKER'S COMPENSATION DECLARATION
I hamby affirm under peaty at perjury One Of the following decorations:
Edon,lint and will main WnaCeorimMofComnttDwlf.imumfor Woftr'&C=Kn-
no provided for by Section 37W of Me Labor Cam,four the performance of the
01�
work for which this Permit is issued.
1 how and will maintain Worlue's Compeomfloo hommunce,as required by Section
I have
of the Io Cade.for the Performance or the woull,for which Men permit is issued.
My�'My arkees Compoemmil rt.a and Poll,number am:
e 2�*�ol It
r ere
r.o!!i1atif� C= Car Policy N
co
CERTIFICATE OF�iEMFTION FRXIM�GEKMS
COMPENSATION INSURANCE
(Thissouion wed not baccompleuxt ittle permit bar froone hundred dollars(SIM)
or In.)
I certify that in the performance of the work far which this Permit is issued,I shall not
employ any person in any Customer an u in become subject in the Workers'Compensadom
Laws of California.Dow
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become Subject in the W.,kee,Contamination pravbi---Of the"War Code,you amen
Ofinomwith rnmply with such parrunwas or this permit trial[be mumard revalued.
CONSTRUCTION LENDING AGENCY
is 1Z) I herany offorn MIL dric.4a construction,bandin,iipencyr froths Performance of
Cls> Me work for which this Permit is issued(See.3097.Civ.C.)
aUnder,Name:)z Lenders Add.
U 0 1 minify Man I have head this application and mw that UK show Information it
Fcoracei.I agree in comply with JI city and county ardimarracto,Ind sulte Iowa mixing to
rj Wilding construcrion.and hereby Authention raponactionfiven of ad,city to enter upon Me
Uj move-mantioneed property for inspecdon frourpormes.
01. (We)agree to an.Indemnify and seep harranden;the City of Cupertino agginSL
Ii bit d j d M or d =a which may in my way accout alahalLsaid City
'A "Ins.no,
U in Immum.211"C'granting. this L
.. APPLICA NDEAND D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE U WNS
Fl�/ !�-4 0) Re-roofs
I on P i VC r — I DA
BOGUS MATERIALS DISCLOSURE Type of Roof
Wilidic pliant connote Wilding OCCUPICLonecorhand'ohicandous material
oaft, Cuperfire,Mannpa Code.Chapter 9.12.and the Health and Safety
A h2do,Seen..25532(s)? All roofs shall be inspected prior to any roofing material being installed.
0y. QNa
Will the applicant or future Wilding Occupant um equipment or devicvt which If a roof is installed without first obtaining an inspection,I agree to remove
credit barred...cif contaminants as Jelled by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yen
I have mad the hasuchous nowthdo requirements undcrChapwr 6.95 of the Califor-
niaHcallh&SJmyC Scti.ns25505,25533ud25334.1.n&mthnifftWildi.1
does not commit,he icrusn"
requirements It on, or bo.own.r.ccm&.w.r O".Urmcy- Signature of Applicant Date
— 1 41z— W y6enzed age
Owner 67Data All roof coverings to be Class"B"or better
stlf"