Loading...
05060206 CITY OF CUPER7'iN0 .�l 't «x�� BUILDI DIVISION PERMIT 'CONTRACTOR IIYFO,RMATION x SUILDINGADDRESS: LAWLOR OSTEVEN C PERMITN005060206 a CT ImER'S NAME: PERMIT ISSUE DATE LAWLOR STEVEN C PHONE: SANITARY NO. CONTROL NO. ARCHITECGENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �Oo LICENSED CONTRACTOR'S DECLARATION w I heoby affirm Nat I rm limenud under irwivou of Cbapmr 9(commencing Job Description i� with Scction7M0)of Division3ofthc BusimxsaMPof=ions Code.andmylicc=is in mummeandeffcel. REMODEL MS BATHROOM ff�� ? Dam Claes Lim.ra f/�//�f��\�\ _ 1/i© w Dale TS DEwr �tl ARCHITECTS DECLARATION �y z< 1 undersand my plans shall W used as public mourds JyU 3 LiccncJ Professional?ssas OWNER-BUILDER DECLARATION �p 5 . a�n 0 I Wrthy affirm Not 11. ,Bumps frac the fe nuas Co License Law for my )(,J)(1 ry�� p o following sazon.(Sectien 7(131.5,Business and Pmfeuinn Code:Any city ter county llc(�1�/' p K m which mquims a permit w cninumin,alter.improve,demolish m mien,any..to. fly#§ },q fl �� 0 4 prior its issuer¢.also requires the applicant for such permit to file a signed summent - NalWislicensedpursuantmtheprovisionsoftheContractorsLittnselaw(Chapter9 Sq.Ft.Floor Area =/go �((� luation xo (commencing with Section 7(M)of Division 3 of the Business and Professions Crum)or �T i at he u exempt thorefrom and the basis for Ne alleged es,mpdon.Any violation of Section 7071.5 by any applicant for a permit subjects the applicant In a civil penalty of 3 50UNbaci-0 0 Occupancy Type not mom Nan fir,hundred dollars(S5ML ' 1,as owner of the property,or my employees with wages as their We compensation. will do the wmlkmd theawcture is not hummed oronemd for safe flee.7W.Business Required Inspections and Professions Code:The Conuacroes License Taw docs not apply m e ns an owner of Ll p property who builds or imp,nves thereon,and who docs such work himself or through his own employees,provided that such impmwmenss art notintended or offered for We.If. however,Ne Wilding or improvement is sold within one yev of completion,the owner. builder will have the burden of proving that he did not Wild or improve for purpose of .1.1. ❑1,as owner of the property,am exclusively contracting with licensed eomncwrs to coronet the pmjcat(Sec.7044,Business and Professions Code:)The Conoxmr's Li. cense law does not apply to an owner of pmpeny who Wilds or improves themon,and, who contracts for such projects with a conoxctor(s)licensed pursuant in the Contractor's License Law. ❑ loo uc da Sec B k P C for Nisnnmann Dam v WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following dedamimss: ❑1 haw and will maintain a Cenifcom of Consent to self-mince for Workers Compcm eation,az provided for by Station 3700 of the labor Code,for the performance of de work for which this permit is issued. ❑1 have and will maintain Wwkcr's Compemation Insurance,as replied by Section 37W of de labor Code,for the pcdo...of the wort for which Nis permit is issued My Worker's Compensation Insurance Cartier and Policy number am: Carrier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mossuctlon reed net he completed ifthe Permit is future hundred dollars(SIM) or m s.) 1 cenifv that in the performance of the work for which this permit is issued,l shall not ,mploymy person in my manner xambCeom,subject, 9' 'C xionn sn f Cdrtdf�e. Aplicantt \ . NOTICE TEIAPPLICANT.If,after making this Ccoricam of Exemption,you should become subject in the Workch Compemarion provisions of the Lehr CMe,you must ., Z forthwith comply with such provisions or this permit shell W decmcd mvelmd. Z Q CONSTRUCTION LENDING AGENCY 'r. I bunchy alarm that there is a convection lending agency for the performance of !� the work for which this permit Is issued(Sec.3897,Civ.C.) Irl Q Lender's Name DZ Lenders Add. U Q 1 ttmfy Nat I have read this application and sate that the men information is Comm 1 agree in comply with all city and county ordinances and sum laws relating to 0U building constructi011,and hereby authotlx representatives of this city to enter upon the W above-mentioned property for inspection purposes. F C. (We)agree to ssn.indemnify and keP hammers the City of Cupertino against rq labiliues,judgments.eosts and expenses which may in any way acerae against said City U Z in consequence of the granting of this Permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU��" TIONS. Re-roofs azure of Apnicant/Cinuanor r Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle ha mdous material cfired by the Cupertino Municipal Codc.Chapter 9.13,and the Health and Safety Been 25532(a)7 t Yes All roofs shall be inspected prior to any roofing material being installed. No Will the applicant or town,Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit havardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have mad the hzaardous materials requirements under Chapmr6.95 of the Giifor. ria H,slth 65afny GoM.Sccdorts 255(15.235JJ am125534.1 undersand thazifthc Wilding dos not ctioemll haw a mu.4 Nat it is my responsibility no mdfy thc necomm of dic re npdon iniceofaCeNfcamof(kaNm. Signature of Applicant Date Owner or authodaed agent D,m - All roof coverings to be Class "B" or better