05090217CITY OF CUPERTINO
IPI �RMA'CN hI
B UILDING DIVISION PERMIT
f'dC(Stvh1=12A.0 UIi
BUILDING ADDRESS:
NOVO CONSTRUCTION
PERMrr NO. 05090217
2 RESULT
NAME:
PERMIT ISSUE DATE
GROSVENOR
1042 HAMILTON COURT
1-L/n4/2onc;
PFER'S
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHI7ECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONfRACTDRS DECLARATION
Job
Jab Description
1 hereby atoms Nall we IlaneN under provisions of Chestnut 9 (Commencing
in ulllnforcenu��eectDiwalon3arNe Business and Promsswucode. and mylwenku
TI --NEW WALLS/MECH/ELECT/PLUMBING
LicDa¢�F/
' �Camfular'
ARCHITECTS DECLARATO
10/17/05 REFUND MAILED 10/21/05 $7,759.07
1 understand my plana shall be wed u public records
Licensed Prof faun al
OWNER -BUILDER DECLARATION
1 hereby IMM Not 1 am exempt from the Con0welora License Law for alk
following mnon. (Section 1131.5, Business and Professoo Code: Any city or County
which requires a permit to emwnKt. alter. Improve. demolish, an repair any rtroerure
prior w its issuance, elm required Can applicant for such permit to fik a signed wternam
that he 1, Ecamed Forams antis pmwslons of the Connector's License Law (Chapter 9
Section 7000) of Division S of to Buainaa and PrdfeWu,Code) or
Sq. Ft. Floor Area¢�«y-}
%`3L\.
Valuation
(Commencing with
walanlon
N 9 $2,'37000
Nu he k exempt thertfrmn and the but, fan du alleged emptia. Any Of
Scubn 7031.5 by any appllant for a permit wbjecu the applicant W a civil penalty of
APN Number�'� 7— Occupancy Type
a
not mane than five hMtW udo1W(35003
-�
❑ I.ssawar of tiia property, mmyeeeploy ed with wagn utheirmkeampewdon.
^
will do the work and theauwtore is mtimmubed car offered for,ale(Sec. RM4. Badness
61red,In�peCiIODS
and Pmfeadom Code Tse Camusc ah Users: Law dao rot Apply 0 an owner of
Property who build¢«improroathereon. and who doessuch work himselfor through hisman
``�I}}
7
inktWedaraRDedlw aak.ir,
Nnuchimprovematain
however, Can or i oromat smld onve afasple
bell&' the
a did a build for purpose of
w11 haw dm buNa of proving Nat h did nal build or improve (car pupou of
have ba order
ale.).
ark.).
❑ 1, u awrcr of the property, am exeludwly advancing with licensed conaectms to
construct the project (Sec. 7044, Business and Profusion Code:) The Contractors Li-
am law dos vat apply to an owner of pnopertywhd builds or improves abandon. Md.
who Convects for such pmjem with a anuacoc(s) licensed pmuam to Ne Coduamdrl
Lkene Law.
❑ I as exempt under San . B d P C for this musen
u Dam
WORKERS COMPENSAnON DECLARATION
I hereby aabs under pevalty of penury and of the following dminmota
I ism and will maintain aCaNficomaf Cauent to self-luum for Worimes Compen.
smo. u provided for by Section 3700 Of der labor Code, far the performance of alk
wank for which this permit is iaum.
❑ 1 hero and will maintain Worker, Compensation luuraa, u required by Station
3700 of Care laborC for the perfamunaafdte work for which Nis permit k Inco
My Workers Composition Insurance artier ad Policy number art:
I
Carrier. Policy No.: 2-520q9
9
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section dead rot be completed UNe Permit Is forenehundrtddolW, ($100)
or kis)
I astiry that in the performance Claim work fn which this pemtit 4lnum. I shin not
employ any penin in any mutcrm at k become subject to Ne WoheKCanpenailon
Laws of California. Data
-
Applicant
NOTICE TO APPLICANT. IL afmr making this Certinam of Etespmet, you shot
beeo rm subject in the Workers Compensation providou of than Lahan Code, you most
forthwith comply with such provisions or this permit shut be dammed revoked.
CONSTRUCTION LENDING AGENCY
1 herby aRirm This Nes k a connotation tending agency for We pedumtence of
d(Sec.30
alk wank for which Ns permit 4 issued (Sec. 31197. CN. C)
'
Landers Name
Ladder, Addax
1 1 certify that I haw rod this application and sane dm do above information is
'
contact. I +gram to amply with all city and county ordinamus ad sank laws mlating to
building construction, and hereby authorize representatives or that city venter upon the
gnaw-mCotiood property for inspection pmpokA
(We) agree to saw, indemnify and kap Unnatural the City of Cupertino agalml
j Ilabilitin judgmens. toss and eapaus which may In my way amus against said City
in cawegarce of the gnnddg of this permit.
' APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON -POINT
Issued by:9 Date ii -4 �
SOOR E ULAn N .
6Y9
Re -roofs
Type of Roof
Signet oI'AppiicadtlCantnetor Due
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant car future Wilding occupant store or handle haaalloua material
as defined by the Cupertino Municipal Cade. Chapter 9.11, and the Health and Safety
vs3z(a)1
All roofs shall be inspected prior to any roofing material being installed.
W.series
❑ Yu QAa
If a roof is installed without first obtaining an inspection, I agree to remove
WIII Ne applicant car future building occupant use equipment car devices which
emit hmuMw air amoiwnu u donned by the Bay Ama Air Quality Management
all new materials for inspection.
Dimict7
❑Ya eNU
I have mad the haumGusmakuastequiremenu untan Chapkrd.95 ofthe
Cede, Soctiam25505.25533 am125534. I understand thkif h. Wilding
Jest net currently have a teat. Nu it s my repenthility to dairy the occupant of the
mend. Inch muuubemepiartowaaaoneeninakoraeapumy.
Signature of Applicant Dale
l/- 'orf
All roof coverings to be Class "B" or better �.
LkwMiror authorized agent oak