04100191 CITY OF CUPERTINO - - ra'+-" "'^' ex'""
BUILDING DIVISION PER CONT ,',T,
.9s13' :xws..-__�cv.2,i.a_s- s :9:..v.,.u•._ec;k:.;rfs�°
BUILDING ADDRESS: PERMIT NO.
ATLAS REMODELING COMPANY I C . 04100191
290 nENTqC)N Air
OWNER'S NAME: - PERMIT ISSUE DATE
CHR
a (4nR) 9q-:i--9r,1 '7
E:
SANITARY IROL NO.
ARCHI'fECT/ENCINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
�Oa LICENSED CONTRACTOR'S DECLARATION
e❑U mb )of DivisionJof NC Bu' Nd Profaaions Codc.and my liccmc is Ob DAOS�CaTI IIhOn _
—
ith n
ruS, rm-t.y plaAnRs CsMHlITl WGCTuLcs,ueSmd Druacpmiur blic AereT�cIoOr9dN/s aS
In
L O CONVERT PATIO TO IDJI`/[gtYw'
SQ. FT. )
Zg,
�'y
'mount
FEB 2
005 --
- '
-
3 o y Licensed Pmfcasknal --
3 OWNER-BUILDER DECLARATION _
+� 1'hcmhy affirm OhotW 1 OWNER-BUILDER
from Ne DECLARATION
Contractor's License law for he
i a O following mason.(Sado.913 L5,Business and proficted. s Code:Any city m county _ -
x m�+ which requires a Permit to construct,elle,improw,demolish,or repair any structure
'I''^ per,to its issuance.also requires the applicant for such Kranil to file a signed Rammer,.
innn
that he is licensed pursuant to the provision of the Contractor's Liecse Law(Chapter 9 Sq.Ft. Floor Area VaID LIO❑
�F (commencing with Section 7")of Division 3 of the Business and Profusions Code)or
i $
that he is exempt timrtfron and de baso for dae alleged exemption.Any violation of
Section 7031.5 by I,.pphnat ter.peprolaubja..the appbeart m.ami penalty of 3142'T�'b-@J�@r00 Occupancy Type
not more than five hundred doll..(5500). -
El I,as owner of the property,or my employees with wages u their sole comperoam r,
will do the work and the"o com is not intended oraffaml f...k(See.7044,Business
and Professim.Cade:The Contramors Lians,Law does not apply m an owner of Required Inspections -
pmpenywhobuildscrimpmvesthemon.and who dassuch work himselformaugh his
Own employees.provided thus suchimprovema.m not intended or Offered for sak.If.
however.use building ar impmsement is saki within one you of completion.Ne owner.
builder will have the burden of proving that he did not build or improve for purpose of
sa ).
❑1,as Owner of the property,am eaclusively contracting with licensed comacmrs in
construct me project(Sec.90x4.Burn=and Professions Code:)The Convacrors Li.
cense Law does not apply to an Owner or property who Wilds or improves Nemon,and -
whocontractsforsuchpmjccawithacontramor(s)licensed Pursuant to the Contractor's
License taw.
O l ismanmp,mount Sec. .B h P C for this mason _
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perm y of perjury one of me fallowing declarations;
have and will maintain a Ccnificam of Consent so Rif-insure for Warkeri Camper-
n,as provide4 for by Section 37W of the Labor Code.for dm performance of me
work for which this permit is issued.
❑1 have and will maintain Worker's CompenRtian,aurora,u required by Section _
37001, NC labor Cone.for me psuform ocrofine work fmodlich outpatient isissueJ.
peri Compensation Insurance carrier and olicyrmberam:
cy a S/a ft 77f"h Policy - m
CERTIFlCATE OF E%EMPnON O WORKERS'
COMPENSATION INSURANCE
(The Rction need not W completed If de permit is torose hundred dollars($I01)
or Ina)
I eenify that in to Performance Of,he work for which this permit is issued,1 shall nus
employ any person in any manner so as m become subject a the Workers Compensation _
Laws of California.Do.
Applicant
NOTICE TO APPLICANT:If,after making Nis Campalm of Eacmp,i...you should
become subject on the Worker's Compenassion provisions Of the labor Code,you mus,
.JZ faMwid,comply wit such pmvisiou or 04 Permit shell bedccmad revoked.
zCONSTRUCTION LENDING AGENCY
�-. I hereby affirm that Nem is a eonumccon lending agency for IM Performance of
r� 7 the work for which this Permit is issued(Sec.397,Civ.C.)
W Q Lender's Name
C Lancer's Address
U p 1 certify Nat 1 have rad this application and sole Nu the above information u
W E' correct.I agree to comply with all city and county ordinances and sate laws mating to
C(J huddling construction,and hereby authorise rapraenlalirs of Nis city to crime upon me
r W .hove-mentiared Property for impectom purposes
(We)agree to save,indemnify and keep harmless dm City of Cupenim against
Fh Liabilities judgments,costs and expanses which may in any way we=again,said City
V zs Permit.
APPLICOUN UNDERSTANDS ANof the granting of D ANTND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. - �_a 9-a ri
!/ Re-roofs
ign re ApplicanUConerm or Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hammus mammal
as defined by me Cupertino Municipal Code.Chapter 9.12,and One Hulm and Safmy
Cade,Semon 25532(a)? —All roofs shall be inspected prior to any roofing material being installed.❑Yes MN.
Will the applicant or future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it W,,arm.air nomminarts u&road by thc Bay Mea Air Quality Management all new materials for inspection.
via?
❑Yea
1 have mad the havardommaterials requirements under Chamer6.95 of 0c Calroi
nu Health&Sammy Cods.Sodom 25515.25533 srW25534.1undcricam that if Nc Wilding
Jots not cormody bac a coram.Na,it is my responsibility to notify the acupant or me
raceimmcnu which mussbe f}pdarmisman=aafa cerin=/rlxapan=r.y Signature of Applicant Date
-cIG,nim d _o
ncr tar authorircJ agent
"Done All roof coverings to be Class"B" or better