08080199 CITY OF CUPERTINO ✓ a K. �- r a 3' -
BUILDING DIVISION PERNIIT CO!!ITR'AACI'Q�ERII�'lt' IA`CI< N
am'y'"QRES§:TEVENS CREEK BLVD TBD — TO BE DETERMINED 34
PE 08080199
lWSS tN�A.SM-JSE: S PERMIT ISSUE DATE
J . VOI.,CKMANN & ASSOC. 08/25/2008
NE: SANITARY NO. CONTROL NO.
ARCHIIECrtENO1NEER: BUILDING PERMIT TWO
WRAP EXISTING COLUMS ,W/ BLDG ELECT PLUMB MECH
O O O O
baa LICENSED CONTRACTORSDECLARATION lob Description
fii I hereby affirm that I are licensed under provisioner Chapter 9(commencing P
X1 with Section 7")ofDivislon 3 of Ne Business and Professions Code,Indmy license is
OnH mfull Co.and on •g Q
J Z Ucenea Class Lk.M :!YA
T
Dam Conionow,
9 RCH=CrS DECLARA N
Ion rid yph,uahellkwaxisepublic,ecorda
JyU
k uat;
Licensed Professional
3 OWNER-BUILDER DECLARATION
<E 1 hereby 17irm=1 L am exempt from the Convectors License Law for the
O O following reason.(Section 7031.5,Business and Pefessiov Code:Any city or county
$ which mqubw a Permit m construct,alter,improve,demolish,nr repair any.=to.
i Z?n Prior to its issuance.also requires the applicant for such permit to rile a signed statement
G thmhchlimvcdpSeed.intim provision Sq.Ft. Floor.Area Valuation
$ that W i nNng with pursuant
Toto).(Division ofMe
Ne Bmsiness end Professing Code)or
S
that To h exempt therefrom and Me but&for the alleged exemption.Any vloladun of
Scc ion 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number - Occu ane T e
,rot mom then fvc hundred dollars(5300). P Y YP
❑1,as owner of the property or my rroployew with wages u Their sok compensation,
will d,the work.and the strumum is not intended or onered for sale(Sec.7044,Business
and Professions Cade:The Convxtors License Law dues not apply be an owner W Required Inspections
property who builds m improves thanow.and who dues such work himself or through his
own employee,provided that such impmvemenu we not Intended motioned for ale.If.
however,Ne building or(mpnnwmenl is sold within one year incompletion.Ne owner-
builder will haw the burden of proving Nat Two did ret hold or improve for purpose of -
uteJ.
❑1,u,caner of the property..m exclusively connecting with flemued contractors be
coutmcl Ne project(Sec.7044.Business and Rofessi,v Code:)The Contractor's Li-
ce se Law does not apply N an,wnerof property who builds or improves Motors,and
who contracts far ouch projects with a contrauRU licensed pursuant in the Contractors
License Law.
l am uempt under See .B&PC(m this retwn
Dam
WORKER'S COMPENSATION DECLARATION
I Mosby aff on under penalty of perjury one of the fallowing declartesiou:
I hew and will maintain•Certificate of Covent to calf-Insure for waitersCompen-
adon,u provided for by Section 3700 of Ne labor Coale,for W performance of the
were for which Nis permit is issued.
To
and
will maintain Wukers Compensation Ivurvnce,as required by Section
700,1 the 11wi odnforthe polmosuceofthe work forwhich thispemrit is banned.- '
yWark�ep.Compound..buumme curia end Pulbry be �/ Q fy�/
Cartier.sus 90W901%P Policy N,.: C? 52S /
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mid,accIt..need not lu completed if the permit is for one hundred dnaan(S 100)
v less)
1 certify drat in the performance of the work for which his permit is Wood.I shill not
unpl,yany pera,n in any maueree a to become subject be the Workcn'CompevNan
Laws of Califoroia.Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject To the Wowers Compensation pmAcons of Ne Labor Code,you most
O forthwith comply with each provision m this permit shall W domed revoked.
,zr(
51 CONMUCDON LENDING AGENCY
w.+ 1Wour aRrm that them h a construction lending"t Y g a gcmy for sire performance,of
Ne wort for which slue permit h issued(Sec.)(197,Civ.C.)
OW. A Lenders Name -
5 z Iendeh Add.
U O 1 mercury Nat 1 have need this application end state Nu the above information Is
I7+ correct.I acme to comply with all city and county ordinances and sum]me mhling To
Wilding construction,and hereby auNorim mPmanudws of Nis city to emcrupnn Ne
W ahove-mendosed popery for inspection purpves.
(We)agree m ave,indemnify ad humlea the City of Cupertino against
wry liebilidea,judgments,caw and expenses ich In any way,cove agalM aid City
U in consequence of Ne granting,(thisno
APPLICAN NDERSTAyyypS ANt"nt WILL M ALL f DN-PO Issued by: Date
SOURCE a TION�/i p�`
FFJJ a Re-roofs
APPIie nmemr D te
N RDOUSMATERIALSDI CLOS E Type of Roof
Will Nva I' Iser future Wadinge.Chaps resile Healthy material
definnd io Ne upenirw Municipal Codc,Chapter 9.13,and the Health end Safety
Sectio 25532(a)7
[3 Yu All roofs shall be inspected prior to any roofing material being installed.
,
Will the applicant ortum building occupant use a pulp rsom or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haaardna air eom winaets a de0ned by Ne Bay Amo Air Quality Management all new materials for inspection.
District? /t
Ihammaf Nehaerdcuseeartals diem rounder C'Lapter S95ofthe Califv.
ma HeslN&Safely .de.Sceti.v25505. 533m 534.lunderstsnd Nulfho building
does..toren ave a tenet.N s it i Amit entry de.c pent n,Ne
requirement s b.mq q, o p ' cat .filo Signature of Applicant Date
owner a rixed a6 I V D All roof coverings to be Class'%W'or better