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00020134 CITY OF CUPERTINO - PERMR No. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: O O 13 UILDING ADDRESS: �\vQ (J�- (� ^/7 J o 1 1- ' / U 1 //� /!1� l� //�� / 111 llxt,--s�{ly-,C M.R�I1 SANITARY NO. APPLICATION SU MITI'AL/�DyfpTl i.WNER-44. \✓ 11UV 38� �rJ Vm'.M r�t\�sv Rd � ©V u NIC CONTROL# • fro ZZ3— 318?) SAtJ JOSE GH 65111 ID ONC ARCHITECI''IENGINEER (4 013) OlLDING PERMIT INFO__ W y. UU �6a LICENSED CONTRACT'OR'S DECLARATION FOFyFyg e¢ am6d.mkrp v f .of CM 9(umJob g ' � plion -m withSec70 .fDivision3ofcBmineasndfemionsCa .arIcmet NII foc �f1 d ClendecnLic# 17 ns wiec Co..., AR HRECT'S DECLARATION $ 1 undcrtud my plans Mall W used as wblic rewfds mor c.i O Licensed professional R OWNER-BUILDER DECLARATION 1 hereby aRmn that 1 mueaempr from the Conuacm's License Law fee due z a Inkno ng ru,an.(Section 7031.5.Business and professions Code:A,city ce mum, Sm which regnirev a permit to construct.alter.improve,demolish,of tepa'v my,atacom Sq. Ft. Floor Area �^V'T'1luation pri«to its imuencc.also re9mre,the applicant fmsuch permit to file.signed starmem 12 �VV that he in lumscd pummam to the provision.of the Contractors License law(Cheer,9 (commencing wirb Section 7")of Dividan 3 of the Busineas and profession.Coclor -APN Number Occupancy Type the,W is exempt therefrom W the Wmir for the alleged exemption.Any violation of U 1 Q P Y YP Sections,703M by any applicant for a permit subjects rhe applicant nal t to a civil permit,of L out mere Nen five hundred dollars($500). ❑I,uowneroffieproperty.ormyemployse.withwagesurhm"ntecompensation. Require nspectl0 will do the work.end Nememcce i.e.intended or olTaed for We(Sm.7044 Business and professions Code:The Contmctor'a Liunu law does nor apply to an owner of property who builds or improves thereon,and who don such work himself m through his own employee.,ymvided Nm such iminewme nm an,not invaded of mleted fee sale.If,however,the Wilding or improvement is sold within one year ofcompledon,theZX conner-Wildle,will have the huNen of proving that he did nor Wild or improve For qts- / pose n!adeno / 1,as owner of the property.am exclusivelyong professions with licensed comnor's i- cer swd,d projem(Sa;out m.7044 Business and professions Codes The Contractor's n� O cemefawd«or wchplyman ithaon"cuny wed Wuaxmimgovw flueContra.m'% Q who umn.Law.for sucM1 projmu with a contnnorfs)licensed wnuem m the Conuectorx L cense law. 1 nm exempt under Sec. .B R P C for this reason owner Dem WORKER'S COMPENSATION DECLARATION ' 1 hereby affirm under penalty of perjury,one of the following drclarauofu: s]IMveand will melnmm.Ceninexeme ofConuosef-imure forworker's Comgm .noon,as provided for by Section 3700 of the Labor Cads,for the qdo..of the work,for which this permit is issued. Ig(have and will maintain W.rkKs Compensation Insurance,m"uoed by Section 3700.(the Labor Cade,for the perfmmartce of de week fm which this permit is iaxund. My Work r'a Com matfenir'� �In ranrrpamtt end Policy nulnj�emhrYb.,.& My Wo Poliey No.:t12L,) Nf]V fu g CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE (This section need nm W completed tithe permit is for.ne hundred dollen($100) or Ina.) I cenify that in the perommrtce of the work for which this pemut is issued,)shall nm employ any person in any manner..u to become xuhim,t.the wmima'Compco- mumn law,of California.Date Apphraot NOTICE TO APPLICANT:If.after making this Certificate of Exempoon,you ab.uld became subject to the Workers Cnmpewtion provisions of the labor Code,yen must forthwith comply with such provisions or this permit shall W dimmed revoked. CONSTRUCTION LENDING AGENCY W Lc OQ I rbyofirmrharthcr, wmtru isatharlcndingageneYfmthe perfmu meeof Z 2 to work for which this permit is issued(Sas 3097.Civ.C.) mkrD F, s Name D jLondcra Addrtxn ,rsl I unify that i ply rend ilii city and court and sme Jut ted above iNommu..1. FEB 1 6 2000 4 La corning agree mcomply with y coy and county eaise,Of and aur lawsrioting to U z pudding co.,tmctionert borer authmimrrives of tlJs city to enmruwntW _ U 0 above(WO a re propane for emspecfiankeep hpurposes. (We)agree ro ave,indemnJy and keep hefmlcss the City of Cupertino agsimt O fU liabilities.judgments.costs am expenses which may in any way accrue against said City BY } Fti in e......0 of ting of this permit. o (•" AND STANDS : APPLICANTUNI ' ..COMPLY Will]ALLNON-POINT _ 1 \ SOURCE REG 11 k TINS. a- -o 5ignsruruf Appli an o m Dam OOUS MATERIALS DISCLOSURE Will Jm.w iunt or fume Wilding«cupent nnrt or handle havNous memrial Re-roofs a m defined by the Cupertino Municipal Code.Chapter 9.13,and the Hedth and Safety L`�- Cade.Seen.25532(f)? Typeof Roof — ❑vea �a Will the applicant or future Wilding Occupant use minimum or dcvico which All roofs shall be inspected prior to any roofing material being mit hawdons au commoimnuas defined by the Bay Area Air Quality Management installed. If a roof is Installed without first obtaining an inspection °i°° I agree to remove all new materials for inspection. Applicant ❑Yea I have r+E the trrud.r9aimmems.ndc,Cha erb.93nftWCdi- un erst . and w' comply with all non point source regulations. roma Health&safe C s«tion,ss5a5,us33 and us34.1 uMmtmW tNt if the _a(O Wilding dors fid<u Oy veamn it is my responsibility m notify thr.ccupant (�Gf V of the rtyuirc ts tpriorm issuitomf.c.- OSignaturekAKicant Date Owner or euthnrized eg Dam All roof coverings to be Class"B"or better OFFICE