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04090207�OKCOCLK��tt n S ti yJ 4M �p0 W U4 CITY OF CUPERTINO ^:m '' '" ` C©IV' '.12, �'nR�ciNFul BUILDING DIVISION PERMIT k BUILDING ADDRESS: PALISADE BUILDERS INCh PERMIT NO. 04090207 OWNER'S NAME: PERMITISUE DATE g; SANITARY N 0 OL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG EO PLUMB MOP.CH LICENSED CONTRACTOR'S DECLARATION o lb Description 1 hereby affirm that l em licensed under provisions of Chapter 9 (commencing with Section 70M) of Division 3 of Ne Busineasand Profession, Code, end my license is in full force and effect. License Cl ss- Li,g Q„$i3D�f re NEW CONDO -1087 SQ. FT. Dam Comrutor._P .'SsUQL ARCHITECTS DECLARATION 1 undcruend my plans;hal used as ' Licensed Prokoamnel OWNER RATION I em exempt from the Contractor's License Law for Ibe I hereby .(firm from IM on Codc: Any city s county following rosea. (Section 71131.5, ahead and Profession, s,dr which rcyussu a permit construct. ahcn I.prow, demahah, to repair any t. alma requites the applicant for each permit m a signed Chapter t also statement Prior to its Tensed Sq. Ft. Floor Area Valuation ce he pursuant to the Gomnnessand anselawsCodedr9 p (that of Divionsnfthe withhectionefro 7000) of 3 of the Coded or commencing with Business and Prorcesion, alleged Any Net be ts eumpt therefrom and me boa fm the Jlgcd cumplion. Any vlolatlon at that M I, exempt Buis f APN Number Occupancy Type Section 7031.5 by my applicant for a permit subjects the applicant to A civil penalty of not mon than five hundred dollen ($500). 0 I, es Manor of the property, or my e.ployeca with vnges As their sole compensation, 3 1620084.00 Required Inspections will do lhework, and the structum is notintended oroRered forsale(Sm. 7044, Business he Conlofs License law dead not apply m an owner of Brae Profnaiuns Cadc: Tmc 9 P property who hulldsor improves daemon, and who doeuuchwmklei.ulforlh maSh his own empioycad, provided that such improvements are walm ended ora@rad fmsak. if, however, the building or improvement Is sold within one yearof completion, the owner. builder will have the burden of proving that M did rent build or improve for purpose of sale.). 0 1, es owner of the property. am exclusively contrasting with licensed rontneton to construct the project (Sec. 70", Business and Profadsions Code:) The Conwcmr'a U. cense Law docs not apply An an owner of property who builds or improve, themon, and who contracts for such projects with a comnctor(s) licensed pursuant to the Contractor's License Law. 0 l am exempt under Sec. , B & P C for this rcuon Owner Data WORKER'S COMPENSATION DECLARATION 01 I hereby of ins under penally of perjury am: of the rollowing declinations: 0 I he. and .111 ..]main a CertlOcem of Cnnsenl to ulFlnmm for WmkefBCmnpan- s,tion, As providea for by Section 37M of the labor Code, for the performance of the work for which this permit is Issued. 0 I have and will maintain Worker's Compensation Insurance, As required by Section 3700 of the Labor Code, for the performance or Me work far which this permit is Issued. My Worker's Compensation Insurance carrier and Policy number au: Cartier: MlktrS%:� ZT/ C Polley No.: g2E Otm25 CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE f7bis section need notbecomplered ifthe pereat is Fortran hundred dollara($100) or leas.) I certify that In the performance of the work for which this permit is Issued. I shell not employ any person in any manor an As An become subject to the Workers'Compeasulon Laws of Cellfoma, Dam Applicant NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you should become subject to We Worker's Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shell he deemed mvaked. CONSTRUCTION LENDING AGENCY ' 1 hereby affirm the, Were is it construction lending Agency for the performance of the work her which this permit Is issued (Sec. 3/97, Civ. Cd Lender's Name _ Lender's Addmea 1 certify that I have read this application end sans that he above Information Is correct. I agme to comply with all city and county ordinances and cam Ism nhling An building construction, and hereby authortse mpmsemuiws of this city to enter upon the above-mendoned properly for inspection purpoua (We) agora to save, indemnify and keep hernias, the City of Cupertino against liabilities. judgment, costs and expenses which may In any way eu= agtlnn said City In conuencoof the Soaring of APPLICANT UNDERSTANtAIND DSWILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. egy .21' Re -roofs Type of Roof Signatureof ApplearafCon,ncmr Dem HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or future building occupant store or handle hanrdous malarial As defined by IM Cupertino Municipal Cmc, Chapter 9, 12. dna ,he Health antl Safety CiCode, Section 25532(a)7 0 Ye, All roofs shall be inspected prior to any roofing material being installed. 4. If a roof is installed without first obtaining an inspection, I agree to remove WIII the applicant or future building Occupant ecu equipment or devices which hauidavaair canaminants s, defend by the Be, Arc. Air Quality M ... games[ all new materials for inspection. District? I have mad the hazardous maarlabmquimmems under0sidari orthe Califor. me adlih& Safety Cad, Sections 25905,25533 and 25534.1 unJerNM thuifthe buildtng H docs an, currently hew a tenant, that It is my maponsihility in notify the excumat of the requirements which must Alan.m In Issuance of a cerificate or occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Ownereranth a<aegem Date L