00100160 (2) ILN
(kRutTvvc DIPVISION CONTRACTOR INFORMATION:
PERMIT
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ANDERRY Pt:
BUILDING'DIIRESS: PERMIT NO.
WNFR'SN,M APPLICAI'1 AA 99,
ry
PIIONE: SANITARY "C t C O.
q ZO ARCHITECf/ENGINEER: BUILDING PERMIT INFO
kC la— BLDG ELECr PLUMB, MECH
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LCNSD
ZS - I herehy alfilrmEnall am�costo Icmderr pm iolns of Chapter 9(commencing Job Description
RATION
�w Fw with ticclivn7000)of Division]of the Laxness and Proalsions Cele,and my licenw
f in fall farce and effect
W�� lyinmxc clax.x_p L",is_ �_
° Dale enitlaemr lr_{_u— PANEL UPGRADE
3 0 ARCHITECT'S DECLARATION yyy
L4—
!l:O 3 1 understand my plan,dull be uwd n public rscmds
`u�Y
w 6 n Liccmcd I'nllcrsional - /
t?�it Oat I.,a BUILDER DECLARATION
1 herehy affirm that 1 1. exempt from the Cssions o License hw Entire f
Z a whicrfollowing resin.(Section]ammo, t.altmss andimprove,
ve,dirio li h,or Any city or county
FO whichrequiresae.also rvconameLaltar,improve,i,permit
file
anyswcmnt Q
u�3F prior In its lexuuncc,also requirexlhe applicant lar such pemtiuu flensigneA.vlme;ncm
n how he le licensed pursnmtno the pmvhhns of the Contractor's License Law(Chapter 9 a Sq. Ft. Floor Area Va t
(commencing with Section Ag1I)of Division l of the Business and Pmsio
fesns Code) _
or that he is exempt thcrefmm and the Iasis for the alleged exemption.Any violation
of Section 7131.5 by any applicant For it permit subjeox,he applicant to a civil penalty
unto Inure Into rive ItumtrcJ dollars(ssdo). APN Number - Occupancy pe
0 Las owner of the property or my employees with wages as their sale compenxaion,
will do the work,and,he onscmre is or intender)or offered for sale(Sec.IDW, _.
Business and Professions Code:The Contractor',License Law does not apply to an 362260 u3. t 'quired Inspections
rtr of property Who builds idoesproves thereon,and who does such work himself
o through bis own employees,provided ilio,suet intpmvemcals'aro not intended or
offered for sale.U,however,the building or impmvcmcnt is sold wilan one year of 304 — ROUGH ELECTRICAL
completion.the owner-builder will have the harden of proving that he did not wild or
improve bar propose ofsale.). 501 — FINAL ELECTRICAL ENERGY
01,as owner al the proli an exchuively contract,whM1 Ilccmul contractors m 505 — FINAL- ELECTRICAL
1�comet,he project(Sec IIMa,Business and Pmfessions Code:) flue Comtuctor's
icenw Law Joe,not apply m an owner of pmpeny,who harbor improves thereon,
d who contracts for such projcen with a commno(s)licensed pursuant to the
Comment'fa oe Law111 ora exenhpl order Sec. ,BkI'Clm Ilii.,rexmn '
ter We
WORKER'S COMPENSATION DECLARA PION
1 herehy mmrin Immo pemahy it perjury true arms following aemtntdmm
❑ 1 have and will maintain a Ccniliome of Consent to self-in um for Worker's
Compensation, os provided for by Section PIM( of the Labor Code, for the
perbaromm bl'the work far which this prout is issued
01 have and will maintain Workit Compcnsatimt Insurance,as required by Section
B]W of the Luwr Code,fur the perfumers.of the work for which this permit is
ismer.MY Worker's Compensation Insurance earner a77d Policy.nn�uqqu/n�la,
r
C;rriery�� Jr
CRT�,A"IIOXEMM-ION -FRX RM:R --�'
COMPENSATION INSURANCE
(niv section need not he completed if,he hermit is for one hundred dollars _
(%I DUI nr lcxs.h
1 certify that in the parbrove nce of the work for which this permit is issued.I -
shall not employ any person in any manner so as b)become subject to are N'orkars'
Clariamatint Laws of Culit ma.Datc
Applicant
NOTIC1i TO APPLICANT If,aver making this Cer ilicale of lixemption,you should '
twome xubjcet to the Worked Compensation pnwixioms of the LuM1ur Code,you nun
QIimhwi,M1 nmlply with such Provisions.,,his permit shall be seemed revoked.
HLn CONSTRUCPION LENDING AGENCY
a 1 hereby affirm that there is a cnnnrnction lending agency far the pedomance
of the work far which this permit is issued(Sec.LN].Civ.C.)
0. Q Lender's Name
Lender's Address
0 I sen lty that 1 hive read this application Imd Ilam the, It,abase ofnnralinn is -
fy E• correct.I agree to comply with all city and county ordinances and state laws reining '
Q U to buildingcomuuction,and hereby riminnu re rvsvmmivcs nl,his city tri intercom
} r� he shove-nemioned popery for inspection pugmses.
Ir RI (Wa),,gree toaua',indemnify and keep hanalea the Cayof Cupertino agu ma
LI VI liahllries,juagntents,cool,and expeusex which may In any way came agairn said -
U z City in consequence of the printing of this permit. '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT /
SOURCE HIiriULATIONS. Issued by: �� Date
Signature of Applicmt/Cnlant Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future wading receptor store or handle ammunition material Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section 25512(a)'!
E]Yes 11 No All roofs shall be inspected prior to any roofing material being installed.'
Will he applicant orfuture building occupant use aptionem or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Lit f amNoux air conaminam,as defined by,he Buy Area Air Quality Management
Dinrtell 71 Y" opt all new materials for inspection. Applicant understands and will comply with
all non-poim 'aures ul ts.
I have read the hazardous a l atcluicaronts,anderChapter 695 of the
CaliforniaeHealth s Sael, Sent 255(15 dal
d SSS] I d and thin -
iftheb 11 gJ otc trendy hue , t dl yr.pn'ibilly, Lou ry the
Is,Imain f In, q n to tv which null h tet pr'or to'x,o rce of a an I sire of
Occupancy. Si ore of plicant Date
Owner mraamoraed ascot - - Dam All roof coverings to be Class "B"or better
OFFICE