07100017 - DUPLICATE (DIFFERENT ISSUE DATE) CTTY OF CUPERTINO ' ,
BUILDING DIVISION PERMIT ���������������¢�
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pERMIT NO.
BUILDING ADDRESS:
20900 MC CLELLAN RD FLORY C'ONSTRUCTION INC. 07100017 .
PERMIT ISSUE DATE
�ER'S NAME:
NEW LIFE CHURCH OF NAZARENS 2325 VF:RNA CT � 11/06/2007
SANITARY NO. CONTROL NO.
PHONE:
(510) �:83-6860
BUi[,DING PERMITINFO
ARCHI'IECT/ENGiNEER:
HLDG ELECI' PLUMB MECH
0 0 � �
a p p LiCENSED CONTRACTOR oECr.nenr�or, Job Description
� I hcrcby afGcm that I am licenacd unJcr provisions of Chaptcr 9(commcncing
�z� w'i�hSccGon7o(w)atDivision3ofihcBusinessandProfcuiansCodc.andmy�icense TRUSS (:ALCS IN ERROR 10/10/07. SHOULD HAVE
��z LiceouCleande[ ��x `' BEEN ��'1���1fi TRELLIS. THIS IS NOT APPRV & STILL
�---
_-° °atc ��'�� � AR H �crs DECLA A770N N PLATJ CHECK.
��� t undcrstand my plans shall bc uscd u public rccords
a
; u. y Liccased Professional
» y � OWNER-BUILDER DECLARATION
1 hcrcby alTirm ihat 1 am excmpt from thc Conuaaors Liccnsc Law for �hc
� p O following reuon. (Scction 7fY31.5, Busincss and Profc.ssions Codc: My city ar county
K,°, � which rcquims a pcimit to conswct, altcr. improvc, dcmolish, or �epair any swcture
'� Z y prior w i�s issuancc, also rcquims �hc applicant for such pertnit to filc a signcd s�ammcni Ft. Floor Area Valuation
� _ � that he is liccnscd pursuant to thc pmvisiona of thc Conuactor's Liccnse Caw (Chap�cr 9 Sq' � 1 � � �
x F- (commencing wilh Sccuon 7U00) of Division 3 of ihc Busincss and Profcssions Cade) or
y�� Nat he ia a:anpt thccefmm and the buis Car ihe allcgcd eumpdon. Any violation of
Section 7031.5 by airy applicant for � pem�it subjecu ihe applicant �o a civil penal[y a( Number Oeeupaney Type
not morc than five hundeed dollars (5500). 3 5 9 2 0 0:? 9.`
❑ I, u owner o[ tlie pmperty, or my employca with wages u the'v solc compensation,
wi11 do the work, and the s�cuctme is not intended or offeced forsalc (Sa. 7044 a�� Re uired Ins ecdons
and Pco[essions Cade: The Conuactrn's License L.aw docs not apply tn an owner of 9 P
propeny who builda a improves thereon, and who does such work himaelf or through hu
own employces, provided ihat such improvemenu are not ia�ended or oReced for sale. if,
however. the building or improvement is soid wilhin one year of complcGon, the owner-
builder will have the bueden oC proving �Aat he did not build or improvc for purpox of
sak.).
❑ I, as owner of �he property. am exclusively conuacting wiih licensed rnnusctors to
conswct We projea (Sec. 7044. Businas and ProCessions Code:) 7Tie Coauacwr's Li-
ccnx Iaw docs no� spply W an owner of propeny who builds ar impmws themon, and ,
who comracls for such projects wi�h a conuactoKs) ��a�d purswnt to �he Convactor's
License [.aw.
i arn eaeempt under Sec. . B dc P C for Ihis reason
.+ner Date
WORKER'S COMPFNSA'I70N DECLARATION
I hercby affitm under penalty o[ perjury om a[ ihe follawing declarazions:
❑ 1 hsve and will mainlain a Cenificale ot Consent a self-inswe for Workc�s Compen-
sation, az provided for by Section 3700 of che Labor Code, for �he performukc of the
worlc for which this permit is iuued.
� I have and will mainuin Worker's CompensaUon [nsurana. as mquircd by Scction ,
3700 of the Labor Code, fw ihe pedormance of �he work for which Nis permit is issued.
My Worke�s Compensa�ion insurance carticr and Policy number azc:
--' �r '� �S
Cartier. ��,A�. �T 5% A' ��-Poli Na:
CER'17FIG17'E OF EXEMPTION FROM W K RS'
COMPENSATION 1NSURANCE
(iLis scction need not be rnmplctcd if the permit is far onc hundred do��ars (5100)
or Icss.)
1 cenify �hut in thc performance of thc work for which ihis pertnit is issued, 1 shatl not
employ any person in any manncr so u w becomc subject to the Workcrs' Compensation
Laws o[ Cslifomia. Dam
Applicant
NOTICE TO APPLICAM: If, afkr making Wis CcrtiGca�c of Exemp6on, you shouW
baome subjcct w ihc Workcr's Compensation provisions of thc Latwr Codc, you muu
�,� foMwilh comply wi�h such provisions or this permil shall bc dccmcd n.wokcd.
z O CONSTRUC170N LENDING AGENCY
[- ►�-� I hc�cdy afLrm Uut thcro is a consuuction knding agcnry Cor thc performancc u!
ai � �he work fur which Ods pem�it is issued (Scc. 3097, Civ. CJ ,
W Q Lendcc's Namc
� � L.cnders Address
V � � ce�i(Y that � have road this spplication and su�c �hat UM above informatiun is
w F comct. I ageee w comply wi�h all city and counry ortlinances and sute laws relaung w
0 U building consuuction, and hc�eby authori�e ecprescntaGvcs of ihis cily to cntcr upon �hc
� W abovo-mcnuaned property for inspcclion purpates
a (We) agiee to save, indcmnify and kecp harmless �he Ci�y of Cupertino against
�� liabilitiu, judgmcnls, costs and expenses which may in any way accrue againsl said Cily
V z in conaequence oC the gnnting of ihis permi�. �
�"� APPLICANT UNDERS7ANDS AND WILL COMPLY WITH ALL NON-POINT Issued ty: Date
SOU REGUL NS. �
��� / — d Re-roof �
S' uro ofA IianUContract � T of Roof
i HAZARDOUS MA'fERIALS DISCLOSURE YPe
�11 Ihc applicant or futurc building occupant sarc or handlc ha•rardous ma�crial
�fined by the Cupertino Municipal Cadc. Chapter 9.12, and �he Heal�h and Safcty
a�. Scction 25532(a)? � All roof s shall be inspected prior to any roofing material being installed.
❑ Ycs
�11 the applicant or futurc buildin ant use equipment or devices which
If a rool' is installed without first obtaining an inspection, I agree to remove
emit har.ardous air conuminanls u by lhe Bay Area Air Quality Managcmen� all new materials for inspection.
o�s�;���
Q Ycs Nu
I havc rcad Uu heiardous ma�crials requircmen�s undcr Chap�cr 6.95 of ihc Cali[or-
nia Hcalih & Safcry Codc, Scc�ions 25505, 25533 anJ 25534.1 unckrs�and thaz if ihc 6uilding
does not curtenUy have a �enm4 Ihat it is y responcibility to notify �he accupant of the
myui ntswhichmustbeme orac�r�e�oro�����r. Signatu;•eofApplicant Date
� �� All roof coverings to be Class "B" or better
O cr or autti '�cd agcnl ���