04050147CITY OF CUPERTINO
CONTl'tACT.OR INP'OR1�T.�ON
BUILDING DIVISION PER
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BUILDING ADDRESS:
SWINERTON BUILDERS
PERMITN%4050147 -
10800 TORRE AVE,
OWNER'S NAME:
PERMITISSUEDATE
CITY OF CUPERTINO LIBRARY
1995 LAURELWOQID RD
09/0q/2004
E:
SANITARY NO. CONTROL NO.
(408)450-7018
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm lNt L em lieeased under provisions lir Chapter Y (commencing
with Section 7000).&Division 3 ofum Budnessand Prolcasions Code, and my license is
in mu force andeffem.
REVISION --REVERSE AQUARIUM AREA
License Clear Lt..0
Date cmanseter
NO NEW PERMIT ISSUED/ORIG. #03020069
ARCHITECTS DECLARATION
NO FEES FOR CITY JOB
I understood my plans shall W used as public records
/J
Licensedencs irnal
OWNER-BUIER DECLARATION
LD
I hemhy affirm that 11. exempt from the Cansns Law the
Any
Code: Any city
Cc : county
following mason. (Section ]onstr, Business and professions c co
der .1 s
a permit ra construct, frow, demolish, lir repair any ttmclure
whichisIssuance,
srequires
mgnithe pro inion cal ter BUCK rGTlil m EIC a Law (Chart1Cn1
nt
[be applicant
prat! m IIS cense CC, pursuant ofNcContsiness Lic.aselaw(C er 9
That
Sq. Ft. Floor Area
Va do
Code)
(commencing with Section ]000) of Division 3 of the Business and ism Csnl.) or
me cingwitpSectio 7")ofDivisio
$98
on. An
Nat he u exempt therefrom and the basin for du alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by tory applicant for a permit subjects the applicant to a civil penalty of
nal more Nan rive hundred dark. (5500).
❑ I, a owner of the property, or my employees with wages as does sole compen.don,
Required Inspections
will do the work. end the awcwm is an, mankind or offered for aide (Sec. 7044. Business
and Professions Code: no Conuacmra License Law dm not apply to an owner of
propenywho builds orimpraves Iherman,andwhod(iessuchwork himself orthrough his
awn employees, provided that such impravementaam nftimended oro02rsd fmaele. If.
however, the building or improvement is sold within am you of completion. the owner.
builder will have the burden of proving that W did not Wild or improve for purpose of
sale.).
uting with licensed contractors to
zl a owner of Nson e property. sexclusively cmu
stmet the project (Sec, 7044, BualneV and Prefiss ans Code:) The C'arbonate's L6
cense Law does not apply in an owner of property who Wilds or improves thereon, and
who canruts for such pmiecu with a contractor(s) licensed pursuant at the cmarectors
License Law.
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❑1aamm ecae/rep Be. B&P.0 for Ras ...a
/s�tder
Ow yr/! //A+� Dau ILZI Lw
WORKER'S COMPENSATION DECLARATION
'
1 hereby affirm under penally of perjury one of me fallowidydec✓✓// leratimu:
have and will maintain. Cenifsnu of Consent to self-hntlem for WarkerSCompen-
..., as provided far by Section 3700 of the Labor Code. for the peRarmanee of the
work for which this Permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of NC Labor Cod., for the performance of Ne work for which this remit is issued.
My Workers Compensation Insurance earner and Policy number am:
Cartier. Policy No.:
+
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cros section need notbocerplemd If the permit is fora.e hundred dollars (g1IX)
ar ass.)
1 certify that in the pentarrance of the work for which this peamit is issued I shall not
employ any poison in any mannerso as w become subject a the Work..' Compensation
Laws of California. Dew
Applicant
)
NOTICE TO APPLICANT: If. after making this Condition: of Exemption, you should
became subject Io the Worker's Compensation previsions of the Labor Code, you must
forthwith comply with such provisions or this Permit shall be deemed mvoked.
CONSTRUCTION LENDING AGENCY
1 hereby &Man Nat than, is a construction lending agency for the Performance of
the work for which this permit is issu.d (Sec. IIS], Civ. C.)
Condors Name
Lenders Address
I certify that I have road this application and stow Net Ne show barometers is
curtecl. I agree to comply will all city and county ardiamces and sure laws relating to
building construction, and hereby someone representatives of Nis city to color upon the
about -mc e) agemed Property for inspectionindemnifyagainst
(We) agree to sew, indemnify and keep harmless Ne City of
mi keep theories;
.Cupcnst
ofPcnseawhich may in anyway accroe against will Cily
Ileconsequenc
ofthecostsand
in s Permit.
of DERSTANDS Agranting of tND WILL COMPLY WITH ALL NON -POINT
APPLICANT
Issued b Date
y'
SOURCE LATION
Re -roofs
Type of Roof
�-
Art App icantr0m raemr D
HAZARDOUS MATERIALS DISCLOSURE`
Will me applicant or future Wilding occupmtswrc or handlglt ousmausnal
as defined by me Cupenuo Municipal Code, Chapter 9.12, and'4(rc Health and Safety
Code, Scceen:ss32(a)7
rl Yes VIN.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
pWill Ne applicant or future building occupant use equipment or devices which
it ha ,d..a air crouminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
Diarict7
❑Yes gp Nu
I haw mad one hmdmsmalonals mquimmenu underCWpwr 6.95 of me Caliror-
niaHcalth&Safety Ca ,SCctiom25M5,25533ud25534, Iundcnund thatifthc building
_
des oat currently haw nal that it is my responsibility to inufy the occupant of the
mquimmcnis whit in be mel pyerl=m or a C.nificalo or acupmr.,4
_-
gnatureo Icon Date
S
All roof coverings to be Class "B" or better
Ow
r or amho in.d agent oma