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01100007 (2)^f ' --- _ .. • OFFICE CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 21267 STEVENS CREEK BLVD 01100007 OWNER'S NAME: APPLICATION SUB DATE JEFF CARVER 10/01/2001 PHONE: SANITARY NO. CONTROL NO. re0 zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO ;U� L ELECT PLUMB MECH H z LICENSED CONTRACTORS DECLARATION Job Description 1 h arm dill am littnsed Order forms Wain of Chapter 9lcommeneing 001 Diri>iun icorthe Buainecs PmfnsionCo femme DEMO. y - with Seuf of cold s , .idmy is in once and effect. 5 7 _)01 TI a< ase Clae. _ ue. x% oIt comm"m- AHCllln SDECLARATION `\ I unJcrsunJ in, Plate shall W mcJ ns public remNa Professional pLittnsm OWNER, RATION at 1 hereby viSee shat 1 e.p,E from the License law for the from she Cession, ? < ions Code: Any easy or county 1. , Business Cook: following anon. 7031.5, Business and C ve de which rtquimx o permit [o rnnarucl, alcor, improve, Jnnolish, or repair any svuvmrt permit to 3 - prim) n. uitt, 1. reg the appla'mllmsvch pcm[ilmfkaugnm s[memem, _ .. _ _ _ _.-_____ ___ _ .. ...... ) Sq. •Ft, Floor Area-a \T 4 '" ' '< 1, `Z '' I 'e fl' li a Uat100 : sharne' 1 eased p rc ant to the provisions of the Consmnols License lax IChapmr 9 ]1)(101 f Div 3 Professions endo) Item m ng,wnn Scmm� ascot 0l e a kiia ea ave or that he is acmpt [hcafrom and the basis !m the vllegiil cadmpum[. Any violation _ 5� 1 of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of nm mme than Five hundred dollarsf WI, 32 111 A Kq um erOccupancy Type 01, as net of the pm,ury, or my employees wain wages as their sale emmpemmlun, will do the work; and the-strucuum is not intended or offered for sale (Sec. 700,1:: ' Busincii and Professions Code: The Contmcmr's License Law does not apply to an . Required Inspections mcne, of propcny Who Wilds or improves Bari and who does such work himself f or through his own employees. provided [lint such improvements as not intended or - - - -- I -� -.-- offcad for ad.. If, howmef, the building or improvement is sold within one Year of f . I(� "' - " - , • - - "" - ' me owner-Wilder will have she burden of proving that he did not build or iompletion, mpmvc for purymc or sale.). f9l. as owner or the propeiy7., ezdusivelycomraning with laterad convenors to _ - .. t In 1141:.." c on.amct the projro[ ISm. ]Di,1, Business vnd Professions Cmc:) The Convacmr's - License law J«s no apply man owner property who builds improves thenar,- % with s and who commcu for such projects witM1 a.comraclonsl laterad Wnmm to the, - Cure rauors Lianre Law._--�'- "' 0 lam exempt under Sec. �0&PC for this ..on - Pre, Datc •'• . - WORKER'S COMPENSATION DECLARATION I hereby effort under penalty of ve jucy onv or the following declarmions: 0 1 have and will maintain a Cerodicxe of Con.wm'to self-insure far Worker's Compensation, as provided for by Section 37M of the Labor Code. for the perfmnnance mf the.. for which tris pc.pit •is issued. 01 have and will mairan n Worker's Compensmion Insum«e, as mquiml by Soct ion 37M of the Labor Cmc; for the pertmmanc< of Ihiwork for which this permit is [sue].' orker's Coion Insurance carie; and Policy number arc: _.. 'si;r.I. .- r1:')0 't•''�Ss�l�ls cTsti i(i �C •b1Lv [: [„fix. ': :rL 1 ';CERDFlCATION OF EXEMPTION FROM WORKERS' s4 - . ' --__ _— u' ' (Ib i scn'uiri mem amt be cmnpleie:l ane pert[ I is for cone nundmd dmlkrs i'°sl I`• 111.11 ••: � l n; t , ,Illi 1 s' ($Hu)1. lessJ - mnn irkr <n n rteI . I certify that [ 1 R K -. td.l - Ii t.S iP`-it Cl ,t .a `_.. h .' t.. ^. ..s'e, shall [ e pluynn y mon' t b) I to he workers e' Cmmpcnsauo fB:, . Applicant - - .'E ' . B chi I o"'E NOTICE TU A LICA : If Epyou should • s s "u' 1+ 1': t pens itsubjectm the Worker's Compensation the Lalror Cmc. you mull Oboli forthwith comply with such provisions ur Iris permit shall he deemed revoked. ^.In ' CONSTRUCTION LENDING AGENCY G ; form, I I hereby iffnnlhm lntne is a conomr,inn lending agency r „pedo,mlana oftewokorwhichthispetmil 1 .. __.. ... __. ._...._ .. _ rel 1certify that 1 have read this .,licmion and sum Inco[he obova infonmmiom is [.. mie, 1 agree I. ..,Iy.wilh all city and county b nem ad.t t relmin, O to Wilding cI Ionand h byau[honz presentauves afthis cityto enter upon [� the clause-ancatomed pr perry for inspectionp rpm , 'og LL (We) ague, ) grt 14"t. Memory id kt p harmle ry [le C 1 C pen est if h I' biI I judgments, cost, d eict whvh to ny ora) g_ino Id, i L City n he B rm' p t U E ST S\NOs 0 P WITH ALL NON POINT '', APP Issued by: RCEaE , .tC�_I_0` sienamrco ArdicvMCnmmc .,- •` ."' Date ",.. Re-roofs ' HAZARDOUS MATERIALS DISCLOSURE '`' •' .,' Wll the appliiii[[or.f win Wilding«c pant stem Hamel hazvdus mm nal Type of Roof - s def d by the Cupertino Municipal Code Ch pt r 9 12, end [M1 Health al Safety Cine Sectio255331x) I a • r'i L M.. A ♦ i' . 1.,, ... i.,. .,. h a r , I, I..1 4 . 1• ❑Ye:'''•;^•^,;...,,;' n\ .: \ .:. s ,. Y All,roofs shall be inspected prior to,any roofing material being,installed.. , _ '-Will theupplicemuilLlure but ding«cupIaml use I.of de-vins which If a roof is installed''without first obtaining an'inspectio_n' Il agree40 remove emit hazardous air conmmini I defined by the Bay Area Air Quality Managcmem Di,'riet- - , ,..,,,, , . ., .:. all new materials for inspection. Applicant understands,and will comply with : ore: ,; �,; . , .. k... -. all non- oint source re ulanons, P g , �itn:•.. 1 have he [Safe, ordims menta" d 255 Chepter'erst 2 It d and Lundcrsmm that California actions 505. that k Safny Cme. Sections 251; , i i. at it is ,,mci iGlne n.1 d« acumen hese.¢ 41h'fima.y mspnnsibili[ymnmify the 'e' 'occuppm '1 rnis ie u' ries prionb'issuande'ora CeniMme of a Signature of Applicant Date All roof coverings to be Class "B•' or better m pa a I Dme � 1 ^f ' --- _ .. • OFFICE