04060082CITY OF CUPERTINO
BUILDING DIVISION PERIVIIT
IcM Mr
BUILDINOADORESS:
HOWARD WRIGHTM CONSTRUCTION
LRY7`64060082
0330 STEVENS CREEK
OWNER'S NAME:
FBRIM1T ISSUE DAM
SYSMANTEC
PIER 9 THE
E:
SANITARY NO. CONTROL NO.
(206)447-7672
ARCHDECTRINGINEER:
BUILDING PERMrr INFO
PLUMB MECH
O]ELECT
O
p LICENSED CONIRACTOWS DECLARATION
Job Description
1 herby a?ten that 1 am licensed under partial.. of Chapter 9 (cammuming
with SAghou; 1)of Division of the Business andCodo.md,eyIicuseis
Trans
infallh andellen-
Luanne, awILto
= —
TI --COURT
Date — Con r
ABGE2 N
d p nt sit
U
Lkcnted Professional
OWNER -BUILDER RAnON
I hereby .Rite that m thce ommast License Law for the
exempt Item tie Cssion
Cl
O 1. ull Cade: My city or minty
mo mama. TBT I.S, Bufim. and
anow
emtim
Improve. de
which reyulrea a acmes re contuuct sitar, Impmw, demuldh,a repair any
which
d tameut
pdoruitsiuuance,alw requites lha aPPliunt fanueh panni, to RM atigmawmon
law(Chmpta9
Sq. Ft. Floor Area
-
Valuation
pmvisiouoftheConuactarYlJ
OthssMislicenaadpurwenitoUe,ense
(commencing with Suction 700(R of Diviaor.7 of the Boameaseand Prafemioru Cade) or
that he is eumpt thw(rom end the bull for the alleged exemption. Any vlolatim of
Occupancy Type
Section 7031.5 by any applicant fon permit subjects the applicant to a dHl penalty of
na orae than five hundred dollars (SSW),
v
❑1,uownaofthepmpmY,amywployenwithveruuft4nie rope m,
Required Inspections
e
will do the work, and Wewnt. is mal Intended oroBered foruk(Se.704r. Business
ant apply th an ownof
and Pmresdnm Cade: The Comae m's Liaise Law don s
q P
property whob, impmw themq sstdwho doe aauchw oromlorWough his
man provided m for sale
impmwmwt in netyear
lecon,ffered
ofintended
theuilding or imps veh
Owner..
however. Ne ownr-
however, Ne building or Impmwmvin is mid Whin one year of mprove
fn.
builde WB law the dvden of proving that ha did not ddb m improv fa purpose of
tall.).
❑ I, u awter of the property, sec exclusively contracting with licensed contractors; th
-
mnuuct the project (Sea. 7044. Buloeu mod Pmf esmas Code:) The Conuacwfs U.
cents law don not apply to an owner of property who beliefs or Wharves,latero, and.
who contracts for such pmjens with a canaectoofs) licensed pamant th the Customers
V ,
LMeme Law.
C3 Iam aempt uncia Sec. . B & P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penally of pal ay ane of the following ductandattc
1 he end will maintain a cardOum acansen u mlM1inmm rarwme escompen-
sada., u pmvldcd fa by Smdon 7700 of the lahor Code, fm the peAarmaee of the
work far which this pmol, is luucd.
❑ 1 hew And will maintain Wakefs Compensation Insurance, u required by Section
37W of the Labor Code, for that performance of the work fawhich this permit it ismed.
My Workce Cam sad unite and Palicy n_um4q en.40o3y
//y�t/��,,r�a,te,�¢ce�
Carder. =kc rw�t Polity No.: tYY /�
CN—MCATE OF EXEMPTION FRO�y WORKERS'
COMPENSATIONI 11
(Iltkt ecctim macd mat be completed if Ih pemitd forama hundreefdollsn(SI W)
nrlcas)
I cowry Nat in the performance of the work for which this permit M issued. I,hall an,
employ any person in my mmuran u to become subject to the Warton' Compenutim
Laws of California. Dam
Applicant
NOTICE TO APPLICANT': If, after making this Cenincae of Exce pdm, you should
became subject th the Worker's CompomeBon provision of the Labor Code. you muss
Z foMwith comply with such provision a this permit "I he dimmed revoked.
CONSTRUCTIONLPNDINOY
Thathi thearitmlending agencyter the perfurmence of
'Ne dark for which this panno, k issued (Sm. 3097. Clv, CJ
? Leeh Name
lamdeh Address
Z
1 cantly that I haw reed tido application and state Ne the show Information is
cortex I mgme ve comply with all city sic county mdimmaa and sue dw missing to
JWilding construction, and hereby muhorira representatives of Nis city to ems upon the
show.mendond property for impecdoo purposes
y (We) agree to saw, indemnify and keep l umleu de City of Cupmino armee,
/) Iiahilitin,ludgmems. cow ale expetuu which may d my way areae mgdnnaid City
,
in consequence of the granting of this fourth.
APPLICANT WIDERSTANDS ANO ILL COMPLY WITH ALL NON -POINT
Issued by: Dat
SOURCER L TI
Re -roofs
Type Roof
—
Sign, of APpliunVContncmI am
HA2ARDOU3 MATFAIALS DISCLOSURE
of
Will the applicant or Room building occupant exam or handle hawdou material
.
as nned by de Cupertino Municipal Code, Chapter 9.13. and the Health and Safety
Code, Smarm 35573(s)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu gime
' If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use apartment or devious which
It hazardous aircmtaminants as dcnncd by the Bay Area Air Quality Management
all new materials for inspection.
Disuict7
❑m Lfau
I have mad the harndnus materials requirements under Chapter 695 or tie Cali foo-
nu Health&SAfetyCode.ScLdm255W.35573ud355N.luaknund Nuifde Wilding
dust rot mammly haw a tenant, efm I, u my responsibility to airy the accupent of the
nouitemeno w' bemetpdorm' a oraccrunexanor Ocmpwrey.
Signature of Applicant Date
Z6-�
All roof coverings to be Class "B" or better
Owner In m orimd a en, Data