01060170 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7825 ORION LN 01060170
OWNER'S NAME APPLICATION SUB DATE
r• B.K. DEVELOPMENT CORP. 06/28/2001
PHONE: SANITARY NO. CONTROL NO.
o od z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
z u_ G ELECT PLUMB MECH
Nim L _ I._] L_] U
a
LICENSED CONTRACTOR'S DECLARATION
a��z I Second 7")
affirm that I am licensed under provisions of m.ChapterCode sed my Being Job Descripti n
<NFo wiN$ec11orceandefect. nlofth<BusisaessaadPmfessionxCoda.admylicerta DEMO
a ca m P is in full force and ellen. 1`
od, uan,e eta. Lie.a L''t
3 y Dae 1" Contractor
f m �� ARCHITECTS DECLARA ON
1 undemmnd my plans shall be used as public mcoNs
r
np O Liccn¢d Pmfcssional
LL OWNE in exempt
Rm the Contractor's
x
R—' I hereby.(font that 1 a Business
from eche Cssion, a License Law far the
7 following circ,(Section]OILS ri.altcss td Profcssians Cade:Any city sawuure $15000
T i which require.a Permit mnstnma,ah¢improve.Jemniish,or repair any stmnurc
J 'lmars _.aio
doth .ricin,with
- a t00 Prf Di m fthadContractorsL Law(Chapter9 $tea �f ,�J(kOI p�ga ValU8h011
(can o is 7000) aw n3 fNa Basne: din fAnyviCute) r s 3(5d'1_S'tJj1 ,'IJ V,[sj-•• s _
or that he 7 exempt therefrom and the basis for the subjects
the(exemption.Any violation
of Section]OJ t,5 by any applicant for a Penni[subjcas Ne applicant to a civil Penalty 4pp�,7�t����aayy�s��sgqp�-�,s
of our momthan five haunted dollars(S!500). NO 'A%� MiMD INSPECT ONS Occupancy Type
D1,asowner virtue pnspeny,nr in,employees with wages su heir sole compenxaion, +
will do the work,and the amnurc is not intended or offered for role(Sec.70LI.
Business and Professions Code:The Contractor's License law docs not apply to an Required Inspections
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements am not intended or _-
offered for sale.If,however,the building of improvement is sold within one year of
ompiner-
ion.the ownbuilder will have dre burden of proving that he did not build or
improve for ffm,wa of xate.7.
61,as owner Imthe pmpcny,nm exdusisely convecting with licensed convectors to
mnswa the pray no(See AHa,Business and Professions Cade:)The improves
tneon, t
License Law d«s not apply men owner with
prnpeny who builds s improves therron,
and who contracts for such projects with a conmenons)licensed Pursuant ao the . .._ . . .. . t. _. . . .,
Contractor License Law.
Dl am cxc p'u cI I ' .B&P C for his rcasma +
- . Owner- Date —I 2
W' COMPENSATION DECLARATION
1 hereby oRrm/nder penalty of perjury one of the following declarations:
D 1 have and will maintain a Certificate of Consent to all-mvum for Worker's
Compensmion, as.provided for by Section 3700 of the Labor Code. for the
'pertminance of rhe wank for which this Fermi!is issued.
D 1 have and will muindin Wnrkcr's Compcnutinn lo,asm.as required by Section
J]W of ra,Lam,Cade.far the perfurmunee of doe work far which this permit is
sawed.My Workers Com lenatmis Insurance artier and Policy number me:
camera!i1<.�C1 Yu^%ktl ''`Policy No.:2slt
'CERTIFICATION OF EXEMPTION FROM WORKERS"i
COMPENSATION INSURANCE' .. ..._.....__ _.....__. _.._._......._...,._._.._.._.. __. .. _. .. ....._...__._ _..._._........
r _ .
"(This scctitin need not M:n+:npinW If Ne pcnnit is tor arta M1undrcJ dalton
(5100)or lets-1
-'.I ccnify Not in the perfarmmrce of the work for which dr,permit is issued,I n vk till F t'
cmnot employ any person in any manner so 0 .becyme subject m the Norkeri
Appiicnsmion 1, +f C99ilbrniusD:nc '1' . "
Applicant I1 s[C 'Y<Vi•`e.itb.eu - t:M•. - .. __. ..
NOTICE TO APPLICANT:if,after making Ceniticatet Exemption,you should '
Owbe .xubjen to be Worker's Conitemiumi provisions of the Labor Cade,you must
forthwith comply with such provisions or this permit shall be deemed revoked.
F ^ ,,I ° -CONSTRUCTION LENDING AGENCY
C 7 'I hereby dfErm[ha[Ninerc is a e,mmamn Imdur,agency(.,,the pera
tomnce
of Ne work for which this lts slued(Sec.'3((Yl],Civ.Cd
yc 'Lenders Nam l:� 'YLns Su4. d>< Y-
= Z Le,far's Address
V -1 certify that 1 have read this aPiiCation and state her the above information is
tobuild I agree to comply with all city and wnnry,adl rives and scare laws rtltivg
Q f, he ahaing wnsvucton.and hercbyauruuux,eufm,cnmtiva of this city to enter upon
y the ubn("'a) innuJ.,a.nd for ify ad W pn armed
es jualgman,scau,an indemnify which
hannlas he City y r ctim rri a against
Iiabiiiaies,judgmenu.coxa and nPenses whrth may in any way acerae ngaina said
U,Z, City in cmi,,i encs tithe gmnting of Nis mum. _
,SPPLCrMT 19.RSTA.'I) �.NDss' LCODIPLYW'ITHA LN N-POLYT Issued by
Date
_ S n W nEAaan%Cnntf ✓ j Date
11 U LATER U
Date
g Jlthe6 lifamor wr din occupant some or handle Re-roofs
r IAL§DISCLOSURE
pp g material Type of Roof
ii'der, try eche Cupertin M1Lmicipal Cwlc.Chapter 9.12,and the HeaIN and Safety
I"
tide Seen..25532la +n
❑Ye. ,'•;,Goa .... All roofs.shall be inspected.prior to any roofing material being installed. ._..._ .
Will the applicantar lumrc Wilding accurym ua eyvipmem or devices which If a roof is installed without first obtaining an inspection, I agree to remove
nl1 ha-dw,airI awintml,as defined by the Bay Arca Air Quality Manegcmem
District. all new materials for inspection. Applicant understands and will comply with .
ore. , ON. all non-point source regulations., ,
I have'read'the herwdous materials mquircmems under Chapter 695 of Ne
California Health&Safety Cade.Scnions 25505:15533 and 25534,1 amdcmend that
'if the building does not cu sly have a tenant,that it is my responsibility to notify the
ocmcbpant of the requirements which must be met prior to issuance of a Cenificate of
o"apatr. Signature of Applicant _ - Date
Owner mauthorized ugwt DateAll roof coverings to be Class"B'•or better
OFFICE
1. . . .