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CITY OF CUPERTINO �3*,g�
DIVISION PERMIT
T,1AACwTOit' NFORMATION
BUILDING
A ONt
"'TL d,5d",%RRE AVE
KOSITCH ENTERPRISES, INC.
gEMM98
OWNER'S NAME:
PERMIT ISSUE DATE
AVENUE PROJECT —NO 11
TWO
5700 BOSCELL CMN
05/30/2008
ONE
SANITARY NO. CONTROL NO.
(510) 657-4460
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EI.ECf PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm Num accused -auder Pan uru Cf Comet, 9 (CommeaCut
with Section 7O(U) ofDivisoa 3 of NC Busine,s and Professions core. and my Rcenx is
REPLACE 250 KW GENERATOR WIT 150 KW GENERATOR.
14 full Tome and effect. 10 �QA �!D
GENERATOR TO COMPLY W/CITY NOISE ORD. AS IT
Lie..
Data
Dam Corurecisr DECLARATION
CHITELTS DEC
PERTAINS TO MAXIMUM EXTERIOR NOISE LEVELS.
1 undcrsunJ y Plein doll be uxd u public rtcnrds
-
Licensed Poefessinnal
OWNER -BUILDER DECLARATION
I hereby tonin Not I am exempt from the Contractor's Liecnx Law for the
fallowing mason. (Section 703 L5, Business and Pbfeetiom Code: Any city of County
which an a nus a permit to co Wuct alts. impofn. demelkh, or repair any awcum,
! prior to its issuance. Am xquires Nc applicant for such permit an file a signed statement
he is licenced o the of the Consecbri License Law (CTupter9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
(ccenno mng with Sutton 7") of Dwirian 3 n( tW Businum and Prolessimu Cade) or
$89000
! dw be is exempt Overstrain and Ne basis for Ne alleged exemption. My violation of
Section 7031.5 by airy applicant fu a permit subjects the applicant to a civil penalty of
36902027 Number
Occupancy
not mom than live hundred dollars (M).
.�!�Type
❑ 1. u owner of the pvputy, s mY soPlaycn with wage u BUG sole cunpensatim,
Required Inspections
wits de me and N u rot bowed uoRuw fore as Busircu
The Com
and Ptofusiou Code: The Contrxbra • law don mol apply lf tt owmr of
akess t apply ho
pmpenYwho ndw
Nemanandwha doessushenot mooself ed forsal his
ides. pdsafimpraasu
oodled
owv cmploynu, proHded Nat such impmamenu art not in¢ww uoRcmd forsale U.
bewevs.Nc Wildinguimprovementu withinmUyesCompletion,Neawrcr-
sailder adB have Oee burden of pressing Nats, he did ret build mor improve (or puryoxe of
sale J.
0 L ssawns of dm pray rty' am exelusiv dy convexing with licensed Comvsoa to
Construct the Pmlea (Sec. 70th. Business and Profession, Code:) The Consraebrs Li-
.
came Law door not apply ban nwmr of progeny who builds or irepro. Merton, and,
who contracts for such prejeets with a convamor(s) licensed pursuant b the Convectors
License law.
O lennexcmpeunds Sec ,B&PCru Nisreaxa
-
ner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perju, One of the following deed mhos:
0 1 have and will malnuin • Cenffiorte of Consent he self -Insure for, WartchCompen-
sexton, an ProvidW for by Sudan 3700 of the tabu Code. fm the performance of Ne
Wok fu which Nu pemnit is iunN.
_
0 1 have and will maintain Worker', Campcuatinn Insurance` u myuimd by seeded
3700 of the labor Cod. for dm Puff ceo Nu permit is Caused.
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�vp�rdh%h
My W ricer's Co nsation Iwsn r B art:
Carle . • tsi R Policy No.: 95 Z�.27S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu xsiu recd not be conpleud if the permit u for one hundred doBam (g IM)
or less.)
I Wryly Nal in dU pernmenturece of Ove work for which this permit is issued, l shall nm
employ any Person in any manrUreo as b buomC subject to the Weduaremapensation
Laws of Caliromia. Dau
Applicant
NOTICE TO APPLICANT: IL after making Nu CutiEcam of Exemption, you should
become ,ubjax to Ne Wonkeh CamPemation provisions of Ne labs Cad, you mu,
foMwith Comply wits such previsons or Nu permit shall be scanned muted.
CONSTRUCTION LENDING AGENCY
1 hereby alfsm that Nem u a Conswetion lending agency for the pstumamx of
the work fm which this Permit 1, issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Add.
I certify that I lase rad Na application and ,am Nu me above infomuuun is
toms. L agree to comply with all city and county ordinances and suer laws relating to
building consvuction, and hcmby sumodre mprexnuiw of this city to tour upon Ne
mm-seeationed pmpcny fu inapemlu pmPmCL
(We) agree to ave, indemnify and keep humku Nc City of CuperGna agand
way"Conc, agalnsLsaid City
list, lot ad Ls,M—Y
int conxqumc of Nc
APPLICANT UNDE WITH ALL NON -POINT
�
Issued by: Date
SOURCE
Re -roofs C7
SignatumalApplican/onvamor Date
HAZARDOUS MATERIALS DL SURE
Type of Roof
Will Ne applicant or too. building mcupartatom or iuwln humdou amodal
u defined by the Cupenino Municipal Code, Chapter 9.11 and the HcalN and Safety
Code, ElYu:ss3z(El a)7 No
All roofs shall be inspected prior to any roofing material being installed.
will the applicant or future building ucupam tax cyvipmem or Jcviccs which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hommou air contaminants as defined by tbe Bay Arta Air Quality Management
all new materials for inspection.
District?
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an amfic.mPfOOCuAncy.
Signature of Applicant Date
All roof coverings to be Class';W' or better
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