08090019 CITY OF CUPERTINO �caaa "" =
BUILDING DIVISION PERMIT
CON'CR"ACTOR`INk'OTtMATIt3N ".
BUIIJ)1 PERMIT NO.
[T!1s "ARIANI DR FLR 1 XL CONSTRUCTION 08090019
NER'S NAME: PERMIT ISSUROATE
A1)PI.L? INC 851 BUCKEYE CT 09/04/2008
PHONE SANITARY NO, CONTROL NO.
(408) 271-2425
ARCHYEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� C= I�
Zoe, LICENSED CONTRACTORS DECLARATION Job Description
1 hereby affirm that m Ilm
at 1 am muter previsions of Chapter 9(mmmmeini
ZZ with Section 7")of Division 3ofNcDevices and Protestant.Code.ahare,license is INSTL WLL MNTD A/C UNIT IN CLOSET
^<o, in full from and encct. .
5q= umnsCl u.g L•fl4¢o
3- DaN�conDEC Yt . G%
pp ARCHRECI'S DECLARATION
W1 to de rid my plans shall the used as public recoNs
0
eQt; Licensed Professiocl
y5 OWNER.BUILDM DECLARATION
f 1 hereby affirm that 1 am tempt from the Contractors License Law for the
y O O following reason.(Safi..7031.5,Bodoess and Professions Code:Any city m county
which requires a Permit to construct,alter,m pm.,dcmolisn,Or repair any structure
_Zi price N its issuance.a WW regYirer ftappiicm,for suchilm file permle a Signed L]Nmrnt
C tharhcislicensed purvtandlothepmvisiocofOne Comreatea'sUmmo:Waw(chapter 9 Sq.Ft. Floor Area Valuation
e� (commencing with Section]000)of Division 3 of One Business and Professions Code)or $4000
5 g that he Y eielnpt therefrom and the basis for Ne alleged mompdon.My vinladon Of
Section]031.5 by airyapplicant fora Permit abjeeu the appl Ware m a civil penally of
tro mart man Bw hoMrea dollar,(OW) 3 6 9 010 2 8 .4 ,$lumber Occupancy Type
❑I.s owner of Ne Oneperty,ee is wployw with wge r they sole mmpecmon.
will ao Ncant.wok dnathe structure is tendedLicense
Lawdeoffend s.1asale(Sec.]014, w.of
aro Property
Wilds Cade The csubescmr,uanan ons rote not app y lf rt rwrc or Required Inspections
Ownem wM o i impao.aeermrwawho aocsuch workM1 roffreddumuih his
ownnan.the ea,ping or Natiucn impro.mmuamnot ear ofdormRered Tor sales!,
however,tiebuilding elmprovemmnlaoldwithinone year of mplowfrme owner,
builder mile naw the buNcn of proving that k ria not bulla or impro.for puryose of
said.).
❑1.as owner of de Pmpeny,am aciciwly eonutming with Banca mnracmn W
Ceramics the project(see.7044,Brained aro Prorexvom Coen:)The Conbamora U.
Once law docs not apply m an Owner or property who builds or impmws thereon.and
who conuaeu for such pmjeeu with a conuacmr(s)licensed persons,to the Comrstora
License Law.
❑Iame.reptunderSee ,Bi PCrorthisrtasm
Date
WORKERS COMPENSATION DECLARATION
I hereby aR'om under penalty of perjury one of the following declarations:
❑Lha.and wOl msinWn a dOn 37()Of the Lid r Code,
a Performance
forst,r,provided for lois$.coon 3'fr10 Of the labor Coac.for the performance of Ne
work for minim mid permit is tetter
❑1 haw and will maintain Workers Compensadon Icueana,n"vined by Section
37r(10 of Ne labor Code.fur the performance of the work fee which this permit Is issued
My Wor`a Compensation Wmeance artier and Policy number m:
Carie.)J)1SwM - •Policy No.: SoQ'�Sot�
CERTIFICATE OF EKEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This xenon need not M Completed if the Permit is forom hundred dollar($100)
Or leu)
1 certify that W the pe+fmmanm of his,work fee which Nis permit W Wined,I slWl tet
employ any Person in my manners as N become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CeniEmu of Eamptiot,ym NwW
become abject an the WortrJs Compem don pmvivona of the labor Code,you must
., O roMwith comply with such provisinc or NW permit Nall W rimmed owlem.
CONSTRUCTION LENDING AGENCY
F Iborwhichrmthat Vert laammmcti30Wnding agency Tor Nc perfortnarux of
CL n>•n the wofk for which Nu permit W issued(Sec.J097,Civ.C.)
0.G Landers Name
O z lander,Aaarua
U O 1 Celery wt 1 haw read the a"liicadm i and sum than de shit.information la
W F coma 1 agree a comply with JI city aha county Ordina ces and sate laws totaling to
.Q r.) building conswnion.and hereby alhoerr rtpeesenadws of this city in enter upon Ne
move-mentioned pmpeny for inspection Purposes.
�•n y (We)agree m a.,indemnify ad kap harmless the City of Copenino agJct
to Au�
dgrecnu.c suendespeccs which may In aywayaccme agalctssid City
U z ce0 Ing it Nu permit"" S AND WILL COMPLY WITH AL N -POINT Issued by: Date U IONS. Re-roofs
'uaH Tactor pateH DOUS h M73UAL5 DISCLOSURE Type of Roof
ate applhyn gLfutwe bWing apay Oc Cupenino al Codc.Chapter 9.1;and the Health and safetyn us3uar All roofs shall be inspected prior to any roofing material being installed.
m
WiR Ne a Brent rte Onmre din omit If a roof is installed without first obtaining an inspection,I agree to remove
pP g W^t use equipment or @vias which g p
eon In tardus Jr cmuminau ftned by Ne Bay Area Air Quality Marugcment all new materials for inspection.
District]
❑Yea Nu
Vwhh�
nu smaterialsmquiammuunder Chapwr6.95ofthchlifor.
n �t5it u my3resposbiHiy._oufynQducimp burt ofthe .
ompr icashavoraCee'B t r pmrySignature of ApplicantDate
DateAll roof coverings to be Class'W'or better