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HomeMy WebLinkAbout00040032 CITY OF CUPERTINO PERMITNO. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: 000q,0032— 6U -DING AY'DRB55: ' \�, q�� �-. L1 r� SANI'IARYNO. APPA ON SUQ TALL DATI Qq S*40)�G VIEN.. 'S NAME: rV��J S�(i'r J (OU),5NIC CONTROLN y'' c{OX L s'l U ❑ RCHITf:CI'/fiNGINEER BULUINGI'ERMIT INFO mad r " LICENSED liven Aum ff p DECLARATION o_o l Wmbr•Rt•N.t I ass heensed redo provi,imrs ar cMpn 9«mnntercmg Job Description ' s,H�J i.NS¢.ce 7000)ofDivixion3of NeBusinrss std Rofnaiom Code.eM mY liana is n t 1 n cans fora an-effort. /lam L' f QS ET �(� C�EA�'C o� L4S K a Lia,c Clau Lic,x O W O Dam Contractor `r L/ m a LL U OJ D EJ CIC[S�r f J Ulf [ / 7�11JG F u.O g ARCHITECPS DECLARATION yrs 1 undemtand mY plans shill h used as public«cads 6 Liamed Pm«u;mu1 P �El_ I 1 \-r}-� OWNER-Cam,,frm din IRLACmIION L:ff G I hereby affirm Nat I w ex,mpt from Ne GOnuxlCud Liamc Law co the F❑ following maven.(Saban 1031.3,Business and Pmkvimu Cude:Any oily m county 5 m which re,uims a pencil to comment,alter,improve,deendsh,or minor any structure Sq. Ft. Floor Area ///��x Valuation primlo iui......also requires the ap,linma for such aturnit to fin a xf sedusate, Nt Nn he is licensed perso, io nro Ne provisns of IW Contractors L;anse law(Chaps 9 «an„ententewith sOON.7 oo)ofmvi.e.3ofIN,Bes;.andForl.smmcade)orpits(Number Occu ane T e vel n<s.exempt th,mfmm and tW basis for ma e alleged empdon.Any v 1mon ar S_ O N P' Y YP Section 7031.5 by any appheaeerm t for a pit tubjects the,applicant 10 a civil penalty of ort Nen Bv<hundmd dollam($500). roof had m my employers with wage.u Weir sole compemadon, Required Inspections" illdolhcwork'and Nestructure is tort intended or offered for oak sec.7044,Business and PtnfeW.Code:1:Conlruclos's I.rceta Isco does rox apply to an owner of pop•ny who Wilds or irepri thereon,and who don such work himalf or duough his own owov'rem,provided r i such impos sold w see ttat intended m offered for m1e.ILouldto illh Wildingunder f,roote is he istant eywafcthron fec ate own,nhuilder will have the bu,en or proving thet he distant Wild.,impove fm pm of,O'nOr [] .u awn pony,w,ndrsively convecdn8 with licensed connotations 10 comruct projmt( .1014.B Profeasiom Code:7'Ihe Convector'.Li. /� / /f / neon wdocs tot Chit to ono nn o! wW W;lasmimpfavesdaumn.ared �y�/(�^ `h��G'�/( (n/�C�','�lC//P on Is far such neve acaomvet r()fcemedp sum ixthecomrutor, a Law. I.W exwoo oder s .B&P C ror this mmmt is IFON o TION 7 ✓COS 508 Sl�� �63 St, WORKER'S COMPENSATI DECIARAr / lhaebY affirm uMerprnelty of perjury of Ne f,lovin¢dmlaruimn: / � (T/� 1 Wve and will t or by ech..37W of the LOW,Codi,for for Workers Comphe Non,e.provided for by Smdon 3100 of the Labor Cade,for he perfonmrtc<of the if 1/Yn wmk for which ill xii.Wis bored. ❑1 have and wall oce,iln he offers Comp.fithe Imuurct.as rtquitW by Section / My oftW labor Code,fm tInurnce canceofticwort fofwMchre: permitui,wed. My Worker Comp,malion Insurance cemim and Policy numb,sure: Comer. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' f COMPENSATION (This xctinn need not W compi,ed ifthe permit i..bounhundredonehundred-Dile,IS BID) l A m lcu. ,v\` 1nniry"I to Ne myna neur,oftM wmkfm which this permitis iu CcIshill trot employ a.f perwnin Mmanneravto beemrc.ubint mtW Warken'Compen- v/ anti aawa of Cilifomia.Daa r Applicant D/ NOTICE TObi APPLICANT:IL after,making this C,mfic,m of E-clues o d you.haul- Wcom,h crush y the Worh pro Coons or t is p.iit bralmad of NO Isom Code,you must foMwiN comply with such provisions m Nis permit shill W deemed invoked. CONSTRUCTION LENDING AGENCY Q I Wmby aRrm But them is a coruwcumt lending agency for the pmfamucce of Ne work for which this pemil is issued(Stun.3097,Civ,C.) Fast n,y lander',Name . [� > 1<nder'o Adamu (ajI cerllfy then I have lead ad.applwmon and.WC N at the move Itd,ratloo is 0. z comet,l a,h, to comply with all city said county mdivnu,an-aur laws mluin8 to .7 Z Wilding cons sod WmyauNmim mpeuntatives of this city to mor upon the U shove rocas-pope for inspmffan puryoas. 4. F~,� (We)agreero,av ind,nm11 nd krc hemnlexs the City of Cupertino against h Iitiee,iudgnem.,,.o ands coy in my wry accrue gains a id City } W consequ,nc,of the g 'Igo is peri f^ n' PI'LICANI'UNDE ANDS 1) .. ( I'LYWIm AI1.NON-POINT f..) Z URCH REG' IONS. -sew �. 3s° 9 0 Signuure of AppliaHAZARanm Dem HA]ARDOUS MAng Occupant 'DISCLOSURC WillyteCu,mtmfutum Wilting e.Chapt nartm handleh oath anss d Re-roofs Cords,dclmd by IW Crp:nino Municipal Cod,.Chaper 9.11,sed the HeaIN aM Safny T e of Roof .Section us3zwl � � YP Vn cl the.ppl«antmfmermW¢dreg«apo,use w•ipmemara,da.which All r be inspected prior to an1h ut y roofing material being ctil Mrudous air,conumimnu ud,finW by Ne Bay Arca Air QraluyMwg,mcm I a rete to remo a as new eaterials for-inspecirst taining an tion. Applicant inspection m t9 1L� g I h,e mad Ne ba W;. stecut mourner CTaper fi.93 aftWC ;. understands an w' 1 y with all non =5: rce regulations. to is IfenlN&S,ny C ,Sectio 505,i5 and 8534.I uravorvand Nn if ,r�.�xL ,n ill n, cum I MI.ry t,tha' rtaponsihilirytonmifY the ace t V_© (J mqu;reneats wN must be,me tots erreofaC if me of Oc<u cy. r • V pplicunt Dale Daa All roof coverings to be Class"B"or better OFFICE