08070081 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTRA.GTOR INFORMATION
BUILQ16ICyAgIjRPs� PERMIT NO.
N DR MG CONSTRUCTORS & ENGINEERS 08070081
OWNER'S'S.NNA4MEE: INC PERMIT ISSUE DATE
^: ROSARIOL IDA 15650 VINEYARD BLVD STE A 09/05/2008
-TIIEFE:
919 SANITARY NO. CONTROL NO.
AacxrTEcrfwcTl9Em: REMODEL—REPLACE FIREPLACE & BLDG BUILDING MMU117 MB MECH
0 0 0 0
O iJ LICENSED CONTRACTOR'S DECLARATION -
I thereby affirm that I am thermal under provisions of Chapter 9(commencing Job Description
MN Section 7001,B of Division 3 of the Business and ofcasinns Code,and my license is
H in full fora and ensat p, R Lld.g (� 0 5 8
5qz ueonm Cl a Y
Dauc Conussbr MQTK R, gafron
ARCHITECT'S DECLARATION
U 1 understand my plans shall be used as Public recards
yo,vv,, Licensed Professional
x OWNm-BUILDER DECLARATION
I I bere".'. I m
that am exempt frotad Canvawots Liana law for lie
r 00following mason.(Section Tin 1.5,Business and Professions Code:Any city or aunty
which reposes•permit to c r t.educt.improve,demellsh.or wpatr any mmeturt
prier In its tuuana.also requires the applicant fou such permit b file a signed statement
€p that he is liamsed pursuantn the ProvW.of the Cenuectods Licesu Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 of the Beat.and Profeaiom Code).,
$ that he is eaem,t therefrom and the basis for the alleged esempdan.Any violation of
Section 7031.3 by airy applicant for a permit subjects the applicant n a civil Penalty of APN Number Occupancy r+,�
mw
tmethanfiw hundouldoBars(m). Pency a]Pe
❑I.es owner Of tad ptOpcny,car my emPlayca nth ages u do's sok ampemadm.
will do the work,and the awcmre Is twtimended oronered forsak(Sec.7044,Business
and Professions Code The Conu mors License Taw dwset t appy anw
to oner of _ Required Inspections
property who Wilda orimproves ther amm.amd who dnesaneh workhimmlforduough his
wast employees,provided Nat such improvements..I,imm�de t oroRered for sale If.
however,the building or improvement u sold within one you of completion,the owner.
Witter will have the Wrden of Proving dist he did ort build or improve for purymse of .
❑1.as owner of the property.w em uovely contracting with Batued contractors ut
construct the project(Sec.7044.Business and Prafessiam Cede:)The Coovaemts U.
arta law does not apply to an owner of p,.,n,who Wilds.,improves demon.and.
who commea for such projects with aoonuamor(s)Iianscd pursuant to the Comtrmtors
License Law.
0 Iameaemptundw See ,B&PCfwthisraeum
w Dats
WORKS 'S COMPENSATION DECLARATION
I hateby aBbm under penalty of perjury one of the following declarations
❑I hsw and will maintain Cenficamof Comets to m151nsue for Workeda Compen. _
noon, provided fou by Sanson 3700 of the labor Cade.for Uuc peRormamx of six
work for
which this permit is ratted. '
❑I have and will maintain Worlteh Compensation Insurance,as wyuirtd by Section .
370)a dm labor Code,for the peoparmarceofdoe work forwhkh this permit is Wool '
My Warkees Campemmlou Insurance carder and Policy number art:
Carder. .rilp}C COMO Policy No.: —1130014e19d1
CE MC—Clo aii,MON FROM WORK ERS
COMPENSATION INSURANCE
(Thissccdne red ntbecanPkuctl lobe pctmitafaone huMrtd dolkra(3100) .
orksa)
I anih that in the perforcut.of the work fa which this permit a issued.I shat)WE
employ any person in any mannerm as to Wcamc subject to the Wortraa'Compewdon
Laws of California.Date
Applicam
NOTICE TO APPLICANT.TL after making this Certificate of Exemption,you should
become subject to the Wodmej Compensation provisions of the Low Cede,you mum
.,O forthwith comply with such provisions w this permit shall be domed revoked.
'Z5; CONMUCTION LENDING AGENCY
F IWrebyaRrm that there teacomes,ction kndingagacy,for Chep offorreaneE of
llvi the work for which dos Permit u issuW(Sec.3197,Civ.C) '
W Q landefs Name
�
Z) z Lender's Address
U O 1 certify that 1 have wad this application and sate than the above information k
gy corrin I agree n amply with all city and county Inclinometer and state Ian miming in
C) Wilding cansuvclion,and thereby actual'wPwsenutiws of this city n entwupun to
4g7 above-mentioned propertycosts
for a penes purpowhich es
-
„ C1. (We)agree to saw,indemnify and keep hmmless site City of Cupertino agatimt
Z inconam,judgmf the&ctsand expenses which mayN say sayaanx againm said City
U z in consegwneu of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by:96i Date
SOU f ICA7s.,�,l
"""" `7�3�°8 Re-roofs r�
Sngmllfure ofA,li ant , Date US MATERIALS Jason,DISCLOSURE Type of Roof
Wi0y CuXniwfuture Wilding ottvpmtsnaw handle Health and
u defined by the Cupertino Municipal Code.Chapter 9.12 and the Health and safety
,p"W 25x'21"7 �'No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the aPplicnt car future Wilding occupam sec equipment w dcNm which Pe
e0msitthhaurdnm err, ominna m de, cd by to Bay Arm Air Quality Mlft%SC mnl all new materials for inspection. .
❑Yin No
1 have read site huaNmss mamdsls requirements under Chapter 6.95 afthe Califor.
nu Health&SafetyCode,Satips 255(15.25533 and 2S534.I anderstaM tam ifdo Wilding
dons not cu r emly haw a mnml that it u m§mapomibiliny to tntify the occupant of the
mquiamen ' muuan'ipdor inuctrccofacrnifeaucOfocap cy. Signature of Applicant Date
Y U FJ
Owner car nthod,ed.gent aE All roof coverings to be Class'W or better