04120040 CITY OF CUPERTINO
riulLlnnc DIVISION PERMIT-~_- CONTRACTOR INFORMATION
.,.. .. . 4. , ., .;.
BUILDING ADDRESS: RON PARIS CONSTRUCTION CO ITN%4120040 '
10455 BANDLEY DR # 200
OWNER'S NAME: - PERMIT ISSUE DATE
EARL SUTTON/SUTTON SWIM SC OOL3575 STEVENS
Et SANITARY NO. CONTROL NO.
(408) 296-5926
ARCHTIECT/ENGINEER: -
BUILDING PERMIT INFO
' BLDG ELECT PLUMS MGCH
uoo LICENSED CONTRACTOR'S DECLARATION
Job Description
-
I hereby affirm Nes 1 am IiaMad under provisions of Chapter 9(commencing
with Satin] e) Division J of Nc eusnrss arW Profcssiom Code.end my liccmc is
�� imfull to=and
effect. REVISION--IN HOUSE USE ONLY
'q'' Date etasLica NO NEW PERMIT ISSUED/ ORIG. #04050116
n n p Lt. Conlracwr - -'-
Z� ARCHITECTS DECLARATION
y-e I understand my plans shall he used as public records
�Iu3 O
O
Licensed Professional
OWNER-BUILDER DECLARATION - -
iy I hereby affirm that I am ucmpt from the Con.utoh Liansc law for do - --
O O following mason.(Secuon 703 1.5,Business and Pmfesiuns Cade:Any city or county
x m E� whichrequires a permit to construct.altar,improve,demobh,or repair any structure -
i1-'^ prior to its issuance,also mquima the applicant for such permit to rile a signed statement
•�=< that he is licensed pursuant to the provisions of the Contractor's License,Law(Chapter 9 Sq.Ft.Floor Area Valuation $0
XFG (commencing with Section 7")of Division J of the flushes and Professions Code)or
i $ Nat M is eaempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by ata applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
nor more than rve hundred dollars(ssoo). 32633102 . 00
I,az owner of the property,of my mooday=with wages"Nair sole compenandon,
will do Ne work and the smctum is notimended mattered forsale(Sec.7014,Business
And Profession,Code:The Conmemra U.Law does at apply to an owner of - - -� -'Required Inspections
Propertywho builds m improves ulermar.rd whodoesauch wart himself.,through his
ownempmyeu,prwided Natsuehimprovemuuarenotim.^n.n oroffertd forssle.If.
howeve,.thc building ar improvement issold within oneyear of.,redon.rh.cuum-
builder will have Ne burden of proving Nat M did not build Or narrow for purpose of
salc.)
I.a owner of the property.am uclusively conuaaing with licensed conn um,on -
- corrstmct dee project(Sec.]Ma.Business and Professions Code:)The Cormufr's Li- ,. ..
certse law does nm apply m m owner of proper(who builds or improve Ihere.n,andcontracts for such pmjecu with aconuanor(s)Iiancd pursuant bNe Conuanors --- - - -
L e
W.
under .Bh PCfor this
/WORKER'S A NDECLARATI -
I hereby affirm under penally of perjury are of the following dcdantiorn:-
-
LJlhawandwillmaintainaCmuriamofConsentt.self-insum for WorkersCompen-
sation,as provided for by Section 3700 of the labor Code,fm Ne peRotmana of Ne
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as requited by Section ---- ------- -- - -
My Workers Cumr Cpcaasdca,tifoonr thInewpnert,moermcarrier
oand Policy
fnumber
h
Are
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(TTuamdoo meed not he trmplemd if de permit Is foranc hundreAdollara(5100)
or less.)
I unify that in Ne pe,(a...of the work Tar which this Permit u issued,I shall nut _
employ any person in any manner ser as to borome subject o the Worsens Compensation -
--
LawaofCalifumia.Da¢ _� -- '- - - - - —�---- - -
Applicant - -
NOTICE TO APPLICANT:11,after making this Cenificato of Exemption,you should
become subject m the Worker's COMIRASadan previsions of the IaMr Codc,you must
Z forthwith comply with such provision or Oda permit sh ll he doomed nwked.
zO CONSTRUCTION LENDING AGENCY
�--,4 I hereby affirm that there is a convection lending agency for the perfa marom of
Qi > Ne work(tar which this permit is issued(Sec.3097,Civ.C.)
G 0 lenders Name
ZLenderss
Lender's Address;
V O 1 unify that I have mad this application and su¢that the above infoonatiun is
U. E-' corm.1 agree to comply with all city and county ordinances and sum laws relating to
V building construction,and hereby aufforin representatives of Nis city to Color Upon the
W .hove-meneonaa propcny for inapcmon purposes. /
,^ gy (We)agree to save.indemnify and keep harmless the City of Cupcnina against
N liabilities,judgments.costs and exec Which may in any way accrue against said City 11//
U z APPI,I A cUNDor ,ER$TA oS the jmmrt COMPLY WITH ALL NON-POI Issued by: Date
sou Ff'iuLATId
C Re-roofs
nazure of
HXZ ApPlicasea r D
H7CZARDOUS MATERIALS DIS f15yyRE Type of Roof
Will the,applicant or future building acc,utam smrc�Mndk hmardon material
as Mrincd by M Cu,ormo Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)9 All roofs shall be inspected prior to any roofing material being installed.
C]Yea
Ovete the appuam.r metre building Occupant we equipment or devices wmen If a roof is installed without first obtaining an inspection,I agree to remove
il havardnus air comaminama as derived by Ne,Bay Area Air Quality Maoagcmcnt all new materials for inspection.
District]
❑Yes
I have mad Ne ba;n�l
uuyPials mquimments under Chapmr 6.95oftheCalifor-
niaHealth cty COM5115,2553J anJ]S hu undcrsundthmifthe building
dos not u tly haw t' map.nsihilily m n.tily Nc 'cupanl of
requireLs which ar Tam «araceNfiam.r ignature of Applicant Date
,o cr onuthorisd agent m All roof coverings to be Class"B"or better