07090131 � TCfR Z��T������.
CITY OF CUPERTINO ��Tr RT'�' �,,���� • pERMIT NO.
BUILDiNG DIVISION
ltl►,u 0709013 '
BUILD A � WELKIN INTERNATIONAL IND IN PE � T �� DA �
�'� �� U SFLORA VI STA AVE ____
R'S NAME: 19 9 2 r j STI � VENS CREEK BL CONTROL NO.
SANITARY NO.
MR XIE
PHONE: BUILDING PERMiT INFO
BLDG ELC? PL� 1 " 1 �
DEMO 1 �TORY SFD. L�
ARCHITECTl�NGINEER: JOb DeSCTIpL10(1
i O Z LICENSED CON'IRAC'COR�S DECLARA'170N�r y(commencing
� I hcrcby a(Ci[m that [ am licenscd undcr provisions oC Chap I�censc is
'V
: z � with Sccuon 7000) of Division 3 of ihc Busi^css �d �ofcssiuns Code. and my
�< a in full force and e[CecL L � . *
j� Z Licenu Class �---� Contcacw�
O �a� qRCHITECTS DECLARATION
:'� lans shall tx us�� as Public rccords
i a a i undcrstanJ my p
jaV
: Q N l.icenscl Pcu�cssional �W NER-BUILDER DECLARA'I'ION
a t trom thc Convactors Liccnsc laW �or thc
��'� 1 hcrc6y alTrm that i am excmp VglU3U
air any swMU[c
� p o [oilowing 2ason. (S�c�c�°W�c anp � li. h�r��cpy city or caun y c� Ft. Floor Area
�' which ccquires a 1k ��� � app rtnit to fiic a signcd statcment
, �icant tor such pc
u= y rior u� ��s issuancc. alsu rcq Occupancy Type
'?< ihat hc is licensed pursuan� �o thc provisions o[ the Contract�r's Li�ens� �w (�aptcr 9
� $ i �� fr � �d � buis (or the alicged acempuon. Any ��o��a� 01 ApN Number
F �(commcncing with Scction 7000) of Division 3 of thc Busincss f� V;�� af
i�,, that he is exe�P a a I��t for a pem+it subjecu �he aPP
Section 7031.5 by �Y PP �
not more �ha� five hundecd dollars (5500)• az �� compensation Required Inspections
�(, ss owner oC tl�e propettY. oc my employces with wa8�
wiII do Ihe work. and the st:uttuce is not mtendtd or o We a�o��� Pp w�sn� owner of
and Protessions Code: 'R�e Conuacwrs l.icense 1-a or otiered [or sala I[.
Pro �ny who 6uilds oc impcoves th�re�n. and who dces such work himult or thmugh his
own emp�oyces:providcd ihat wch impro�m�n� � not intended
y� 5 rovement is sold within one yasr oC comptetion. ihe owner-
however. Uu bmld�ng or imP vc Cor �� a
builder will have the burden of pmving �a� hc did nM b�ild or imp� W
sale.). wi�h I"kensed rnnvaanrs w
� as owner o[ �he proP�rty am enclusively conuacting The Convacm�s IS-
rnnstruct the Projett (S�e. 7044. Business and Pro who bui ��i PfOVes thneon, aod .
cense Law does aot apply to an o�er of pcoPenY ursuant to the Conuactars
who coMracu for such projec�s `+'�� a con�caao�( ��u°�d p
License Law. . B dc P C for this reaso�
n 1 yn ezempt undu S�c ` � L
1 �� � . Date
"* WORKER'S COMPEN A'�'�ON DECLARAT[ON
16ereby �i� under penalty o[ p«7��Y a� o � following declara6ons:
�► h;re and wilt main�ai Se uon 970U o[ che [ab°T Code� for�th� °��
sation, as pra��ded for by
work tor whicd this pertnit is iuued. tion insuran«. %� �luircd by Section •
� I�,rc y�d wiU maintain Wo �o�ancco f � w�� for which this parn'ii is issued.
g7pp o( �hc labor Co ��� carticr and Policy numbcr aze:
pqy V Compe
Policy No.: WO � S �
Cartier. •
CERTIFiCATE OF EXEMPf[ON FRO
COMPENSATION INSURANCE
�is sccaon need not be complcted i[ the P��'�� � �Of °nc hundccd dollazs (51001
nr Icss.} rtnit is issuc4 I sha�l not
� Workers Compansalion
1 cenify ihat in thc perCo manncr so as to bc o r� hib ��h�s pe
employ any p��n in� Y / tl
Laws of Cau�o � uon. You �ouiJ
ppplicant tliis CcrtiC�cate of Excmp
N�pCE 7'p APPLICANT: If. aCtcr m �t�on provisions of � 1-a�r Cod¢. You must
become subject la �+c Wo��s v s ons or this pecmi� sha116c decmed ��d.
z forthwith compty with such pro
� � CONS1'RUC7'1
F„N.., 1 hcrcby affirm U� et� s ss c ic�d (�Sc�ua�nCivgC.� cY
�� thc work (ur which this P
W Lendc['s Na+na
p.i A C,cnder's Address
r� � � ��[y �hat 1 havc rcad �his application and sia� thal �� a�ve informatiun is
V � cortcct. I a rce �o camP�Y M''�' a�� ���y and counry ardinances and stata �a'�s ��atinB �o
�'' E"' building conswction, and hcrcby authoti�e repres�nuu� of �is ciry to cn�cr u�n thc
Q(� ro rt for inspccuon pur{wses. rtino against ������
abovc-mcntio�cd p P� Y ,,, c«r a� ��a. Date
,�+ W (We) a6ree �o save, indcmnify and keep
H p " liabilitiu, judgmcnts, costs and expcases Which may in any Way accrue aBa'"S� sa'd City
in con:equencc ot �c g�ang o( this permit.
V r' APPLICAN7' UNDERS'fANDS AND W1LL COMPLY �'41TH ALL NON-P01NT ISSUE d}� �
SOURCEREGUL.A'n�NS 'i le7 (( (C7 Re-r�ofs
�2��.. ;� oe Typ,; of Roof
Signature o ApplianUConuuar
HpZpRDOUSMATE an
�yp� the aPpGcantor futwc buildi�S °��°P �� 9 12 and th� Hcalth and SaCety rior to any roofing material being installe .
All roofs shall be inspected p ree to remove
'efincd by th� CuPenino Municipal Code. C1�ap g
Ch 3
C, $ection 25532(a)? � If a roof is installed without first obtaining an inspection,
❑ Y� which
µ/ill thc app����� or Cuwrc building oaupant usc cyuipmcnt or dcviccs
cmit harardous air contamina��s u cfcfincd by thc BaY Arca Air Q����Y �`'�anagcmeni all iew materials for inspecrion.
Disirict? No
� Ycs
tcr 695 a( �hc Cali�a�-
1 havc rcaA the ha'ard`ws ma�crials reyuircmcn� undcrChap Date
nsibiliry to notify ��up�� nf thc licant
niaHcalih&SafcryCodc.S����u�5'Z5533and7S534•�undcrstandUw��« ���d1O$ Si� nature of App ' or better
docs not cucrcntly havc a tcnan4 rior w issuan ��[ a Ccrtificatc of Occu h'•
rcyuiremcn�s which must be met p �� All roof coverings to be Class ��B
� � � Da�c
[lwncr or authorized agcn�