05090100 CITY OF CUPERTINO
BUILDING DIVISION PER 1,CUIVTRACTOR-ANF,aOR' MA.TION
BUIL DING ADDRESS: PASCAL TECH DBA AAA TECH FERMITNo.05090100
440 LINDSAY AV
OWNER'S NAME: PERMIT ISSUE DATE
-
PAUL FILANOWSKI 2998 SCOTT BLVD 01/05/2006
E: SANITARY NO. CONTROL NO.
(408) 727-7225
ARCHITECT/ENGINEER: BU[WIND PERMIT INFO
BLDG ELECT PLUMB MECH
• t� t� t� t�
300 LICENSED CONTRACTOR'S DECLARATION lbDescri tion
rd I hcnby affirm that 1 am licensed under pmo
rovishms of Casino,9(e0
mencin{ p
m with Sectlan7g10)ofDlvi.km 5 ofdta Busineasand Professions Cook, pe amy license is
n imfull fenemdeffecl. � REVISION--CHG BEAM/ENLARGE WINDOW,
LiaClass
Ua.
Dann, Contractor
R ADD ROOF BEAM IN BEDROM
EC
ARCHfTECi'S DECLARATION NO NEW PERMIT ISSUED/ORIG. #05030005
1 underwnJ my pkm.hall he used u public ncards
3
h ud�
Licensed Professional
OatNEmBUILDER DECLARATION
+�a i 1 hereby.(firm on 11. exempt from the Cssion o License Law for my
i o o (allowing won.(Sudan]0313,B. Imas and Improve.
Profession Code:Any city o,aunty
3 rti which nquima issuance,p"mtr re camruca alar.improve,da mania t ri e a sig any munuro
—ZC pdarmiuensedpakurego the the applicant for suchPermit to rile Le.(Chapter
mm< tharWelicavcdpurwanttoNeofDialomoftheComraxrkndProl do Chadt"9 Sq.Ft. Floor Area Valuation
F$ (tames inS exempt hecOon,and the
Division r the
al egad ess xempt on.Any.su Crede)or $2 14
Net he u sampan therefrom end do bole for las alleged exemption.Any violNon of Y
Section 7031.5 by a"applicant for a permit subjects the sppleant in a civil penally of APN Number Occupancy e
.rt man than five hundred dollars({500). P y�'p
0 1.u owner of tte Property,a my cmpkym with wage a deeir sok eanpmeadon,
369 will do the work,and the structure is not intended a aflsrad for We(Sm.7010.Busiau Required Inspections
and Pmfeesfi ns Code:The Conuacxr's License Law does Inst apply m an ownen$r of q p
property who buildserimprows thereon,andwhadoessah work himselforthrough he A
own employees,provided that such improvements ares not intendW uraB"ed fmaale.If.
however,the building or improvement Is said within ore year of completion.the owner. \
Wild" 'B have the burden of proving dot he did eon build a improve fa purpose of
ate.)
u awns,of the property,am exclusively contracting with licensed mnuacten x
mown the project(Sec.]Old,Guiness and Professions Code:)The Contractor's Li-
ceme law docs not apply he an own"of propeny.who Wilds or Improves thereon,and
who contracts for uch pmjecu with a conuanow Iia dpuausmeothea Contractor's
License Law.
0 lam exemplu B6,P C fNe n
Owner Date/
W KER' CO S ON DECLARATION
I hereby aNme under penalty of perjury arc of the following declensions:
w and will malmaln a Condiment ofCmuem to wlf-insum for Workers Compan.
u provided for by Sudors 3700 of the later Code,for she Performance of she
wart for which the permit is Issued.
❑1 haw and will maintain Warker's Compensation Insurance,as required by Section
37000f the later Cade,for the performance of the work for which this permil'ts Wad,
My Woron's Compensation Inmnnce carrier and Policy number an:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Dussm tied need rotbecamplcwd If the permit Is faow hundred dollars($100)
or kis)
1 certify that in the perfume ea a Sea wo k for hick this permit is Wwd,I shell not
employ any person n seat rsw E tab Seim lWWorkcrs'Compamedan
Laws of Caiifomli
Applicant
NOTICE TOAfPrJOANT. f,aluarlmaking this Certificate of Exemption,you shoo
become subject m the Woken Compensation provisions of the labor Code.you muss
,J z forthwith comply with such provision or this permit that[M deemed rooked.
CONSTRUCTION LENDING AGENCY
[—I I hereby effirm that then is•ronsuucthm lending agency for the perfmmenn of
C the wok for which the Permit is bound(Su.3097,Civ.C.)
aQ Lendcfs Name
z Lcmenes Address
U0 I certify tint I haw road this application and soon that the atew Informatim e
Iy,;•", wean.I agree to comply with all city and county ordinames and state laws mlaring In
0 SV' building construction,and hereby tuNodn nplmeouldwS of this city x enter upon Nc
W above-monfioned property for inspection purpose.
gy csju egne m saw,indcmnif and keep the City of Cupertino igalnar
y Ihbilidu.Jedgmenu,eau which try ensue agalmt aid City
t.)7 in comequen�UN
of a permit
APPLICAND AND W OM WITH.ALL NON-POINT Issued by: Date
Re-roofs
Signature Ol ApplicareVCantranar Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant nom or handle hawdom material
as defined by the Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
Cada,See 25532 Q7 No All roofs shall be inspected prior to any roofing material being installed.
Willi
the applicant or future Wcc
building Oupant use equipment a devices;which If a roof is installed without first obtaining an inspection,I agree to remove
h xard...air cenoominanu u def by the Bay Am Air Quality Managementall new materials spection.
0 Yes u
Ihaw nal the hug W313.dc
r Chapter 6.95 of the Califon
.is Hoelth&S.rety ,Seed .I undcmend Nuifthc building
does amt turn a tenhy m nudity do=owl of the
mquireentau nidnnofoccupancy. Si6rpdtureofApplicant Date
Owner Or authorized agent Data All roof coverings to be Class"B"or better