04080049 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR IIORNIATION, -. .
BUILDING ADDRESS: MASTER BUILDER & CONSTRACT ffIII"'04080049
OWNER'S NAME: PERMIT ISSUE DATE
JM & LMS
E:
SANITARY NO. CONTROL NO. '
(408) 866-0999
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EI.ECr PLUMB MECH
0 E (�
u w. LIC Oat I am ONTRd under S DECLARATION -
u I WmbY affirm the 1 am 0NTRA under previsions of Chapter 9(commencing Job Description
W with Section 7")of Division 3 of the Businesses and Professions Code.and my license is
mfull m«,wef N,24at3� TI--MUSIC STUDIO \
5'q. Lieanaelae u,.6 (SHELL ONLY)
�'o Dam g - - GanlranOr
�q� ARCHITECTS DECLARATION Y(
I undersand� m plans shall W used as public reemdste .rc.•a-'D2'�- r*h�t1 gra-cQA T.3� �Jfes.
;a� Licensed Professional v
OWNER-BUILDER DECLARATION
F.00 I Wmby.(Sect on 1 I.S.exempt from Ne Cssimemo License taw for tW
F.p o following moon. emit t ](DI. Business and ere.d arms Cod,:My tiny rat county
$ which requires n e.aim re woven(,,Ilea nt fmve,demolish,or repair any umnure
Oat toils issuance.alaerequires Ibeapplicant for suchPermit rofilensigned stammem
Oat he islicensedwit
Section retie of Division
of Neheenuuar'a LJmMcLaw
ons(Charter 9 Sq.FL Floor Area Valuation
QFC (coOat
exempt thenioareadd of luesison3 of meBedasss and Professions Any violation
or
� Net W u exempt Ncrefrmn and On bmh for the alleged exemption.Any violation of $51200
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more Nan Bre hundred dollars(5500). P Y YP
El L as owner of the property,or my cmployea with wages as thelrion compensation,
will Or Newark and Ournroctute is rte(intended croRereci forsah(Sec.7044,Business
and Profoashes Ce se:'Ih,Cmundsu rs Lt..law does.1 apply to an owmr or Required IDSpeCC1OHS
Property who builds orimpmves Ounce ,andwhodoeasuch work himself"naugh his
ownemployvs,provided Nal such improvements are not intended confined forsale If.
however.the building or improvement is old within one year of completion.the owner,
Wilder will have the touched of proving Out he did non Wild or improve for purpose of
sate.).
❑1,u comer of to property am exclusively convecting with licensed convecmra to
comuuct the project(Sec.7064,Business and Professions Cade:)The Convectors Li- .
come Law does not apply in an owner of property who Wilds or improver thereon,and
who contracts for such pmjccn with a contractor(a)licensed president to the Contractors
Lice(¢Law.
❑1 on exempt under Sec. .B&P C but this rumen
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
haw and will maintain a Certificate of Consent to self-insure for WorkcrsCompcn-
u provided for by Section 3700 of the labor Cade,for Ne peKmmana of this
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Imurancc,m required by Section
3700.f the Latest Code.for the perfinon a of On work for which this permit W issued.
My Workers Compensation loan...carrier and Polity number are:
Carrier. aS-ia F %x , Policy Na.:713-ilyl
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This unity((ad nm W completed if the permit is(orae,hundred dollars(1100)
or It..)
1 certify Na(in the performance of the work for which this permit is issued,)shall not
employ any person in any manner an as to become subject in On Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making his Certificate of Exompoon,you should
become subject in use Workers Compensation previsions of On tabor Code,you muse
.JQ fordwithemaidy with such pravims.or Nu permirmall he deemed revoked.
Zy CONSTRUCTION LENDING AGENCY
F+ Ihereby aRum Na(thea is a construction lending agency for the Performance of
1d On work for which this permit is issued(Sec.309].Co.C.)
W�Q Lender's Name
Z Lender's Address
U O 1 certify Na(I have rad Nis application ave stave that the move infmmauon u
t2.F counter.I agree to comply with all city and county ordinances and slow hors relating to
0U Wilding construction,and hereby authoma repmsmnutives of this city in enter upon the
property
purpo
r U] aove.menudgm judgments.mus
for indirection,which a
(,py (We)agree to save,indemnify aro keep hannlua the City of Cupertino against
UZItabiliees,judcofthecrannor mxPcmerwhpch may in any way acemc against said City
in certsequcncc of Nc monolog of Nia PCrrnil.
^ APPLICANT ONCE TA DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R`ULATIANS.
1
Signature oApPhanK- - - - Dow
Re-roofs
H
Type of Roof
Will the applicant or future building Occurred store or handle hsaardues ro mrial
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,Section zs532(a)7
❑Yrs J�No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant urs,equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
Irha andeus air communities u defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes KNO
[have rew Ne haraNmum neredr nquimm restooke'Cligor 6.95 mthe Califory
niaHalN&S,fc(yCwc,Sccuom35X15,35533and]5534.Iundcrswnd Nuif N,Wilding
docs nut currently have a pound,Nat it a my mspomihilay to notify,de mcupant of Nc
rcbomenona whl h me W mel prior w issionm of a Certificate of Omopancy. Signature of Applicant Dae
Owner Or aumwb.d Date All roof coverings to be Class "B"or better