00080078 (2) CITY OF CUPERTINO - PERMIT No.
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
;ARCHITECrfENGlNEER
UILDING ADDRESS:
SANII'ARYNO. APPLICATION SUBMfITALDATI
1.17115$5 SANTA 1-1-ICIA RD TOMARK COMPANY 011080078
WNER'S NAME:
NIC CONTROLp
iONL: Y 1081, SIJFFOLV WR El08/11/2000
(650)960-4044 RULDING PERMIT INI'0
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LICENSED CONTRACIOR'S DECLARATION
O — Ihercb,a0ifm and,Iain licccued under Provisions of Chapter 9(<ommemins Job Description
oN—o
F_Fv: wiN5atio000000Q77of on3r1' eBust
a7cd Po/cuiry Crdc,ud mYliuve is
u E In NII fore bV —
ao DEMOLITION OF HOUSE
mSSu' D
S DECLARATION
E 1 undelfand my plana shell be used as public records
a xis. O utme d Professional
W y OWNER-BUBIDER DECARATION
G 2 r 1 hereby offs.that 1 am exempr from the Contractors License Lew for the
0 following reason.(Section MMS.Bvim.aM Prof iou Code:Any city or County
a3
� wMrlcccgmim.Pemridm=°°.w,,.liar•imPr°K•aem°liaa°=rep•ti.nY'm=°°a Sq. Ft. Floor Area Valuation
prim m its iuvence,ads°ccuuires the applicam for such Fomdt mile a sigcxd aunmert
Nal he is licensed Poor...t to Ne provisions of the Contractor's Limn.l-aw(Chapter9
(commencing with Setion 70M)of Division 3 ofthe Butinw and Profession.Code)of APN Number Occupancy 1TfOB00
But he is compo therefrom aM da basis for the alleged exwnptiod.Any violation 9r
Section 7031.5 by any applicant for a pcudt subjects the applicant to a civil poultry of
pm more then five hundred dollars(5500),
1.a.°lonerofthe propen,,otry emao,ae.wits.,.astheir ]acompcwtim. 3421.70091-149031nspections
will dronework,Co the he Contisclotintendedoolfered form ,ly ]014, onera
end arty whiob Crile:The uvo thetmS License do des mo apply to if owner h
his own who builds Prvided tathenhn.md callous are n inrk himself ofered for NO ASSIGNED INSPECTIONS
sualehis own owever the Provided r u such im d is sold w are no intended.offered for
cat If,however will
Wilding the g m impronment t Cold within one Wild
rimprove
m rove for the e
wino We.)r will here the burden of proving that he did not build o improve for For
-
Form of soden
(]I,as.due p of the See 7 an exclusively and crnbadong with licensed Contracamorcomn m
crneumt Ne project(Sec.o an own.
oft and Addis Wi Code:)The Comuacmr's and
cense law ems rot apply je u with
ar of pfoPeny who amides or immovhe thersove.end
who crnt.Cls for such projou with ecmorxto(0licend punuam m the Contrumr's �/
❑
0 do law. //
1 am<xemq order Sec. .B 6 P C for Nis donors
loner Date
WORKER'S COMPENSATION DECLARATION
1 hereby aRmc oollo persky of parjory one of the following declantiov:
1 have and will maimin•Cenificaa of Conunur self-ivum for W°rkeh Compem
cation.as provided for by Section 3700 of the Labor Code,for the parfomunce of the
work for which diva pemtlt is iasmd.
❑I have and will motion Worker's Co n samemon Insurance.as required by Section
3700of the labor Code,for the terformmce of Inc work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(This section n d net becompleded if Ne permit is fo=orchuMrW"Ina(SIM)
or lest.)
1 certify Out in the peAmmance of Ne wok for which chis permit is issued.1 shall
on,employ any person in any mermen°n to become.obj.Or the Wo kern Compem
.tion Isws of California.Data
Applicant
NOTICE TO APPLICANT:1f,attar making tris Ceni&ra of EaemlRirn,you should
be,cmm subject to the Worker's Comper.tior provisions of the labor Code,you must
Forthwith comply with such Provisions or this .if"I be domed revoked.
CONSTRUCTION LENDING AGENCY
Q Iherebyalfinn Nu them is a con(Secstruction lending agency for the perfomunce of
Z 2 the wok for er
which this pmit is nrZ .3097,Civ.CJ
5Iem
nder'n Nae
j 1<anre,Addree.
Fk: I certify da 1 have al this appdicatlon and assn than be aboveu
inforrtion is
0. Q ncornet.I agcy to comply with an city and county omicunee.anytime laws awing do
.7 Z building construction.arta hereby autborie,mWmutives ofthis city to mar upon the
U above-mentioned property for inspection purposes.
fa F. (We)agru rove,indemnify and keep lonsid n the City of Cupena.ageiut
C.1 liebilitin,lmdgsunu,cvuard expenses which may in any way asecrm against said City
y W in c°nu,,.. of tpe g.n ing rf Nis permit.
rp APPLICA I STANI ) f I .NON-POINT
SOURC
Sdgrnturt tractor Dare,
�.OSDRE
Wrcantorfuturtbuildingeecupenos¢neorfNenawdovmaserial Re-roofs
as defined by the Cupertino Municipal Code.Chapter 9.12,end the Mae1N and Safety Type Of ROOF
Code.Section 25532(0' yP
OYes ONo
AII&LWill Joe apDlicmtm fumrt building mCup.,use equipment or devices which All roofs shall be inspected prior to any roofing material being
wt haardry eircrmaminants as defined by the Bay Arca An Quality Managemern installed. If a roof is Installed without first obtaining an inspection
i,mct? I agree to remove all new materials for inspection. Applicant
❑Yes [I No
Ih. read the rctafdam.mawi.da ar,iremema under Clvparfi95 of the Cash-
lesions Helm&Safety Code.Sectinrw 25505,M533 add 25534.1 mrMnWd that it the
bur it vcamnmt.da is Ility tomtit,dx occupant
of the rty calm c of Mificea of(kcupmx,
Signature of Applicant Date
Dan
All roof coverings to be Class"B"or better
OFFICE