05030230 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT yeCON,!U TQRffNFURMATION
BUILDING ADDRESS: PERMIT NO.05030230
1375 S DE ANZA BLVD
ER'S NAME: PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BELECT PLO MECH
O
3woz LICENSED CONTRACTORS DECLARATION
@ Yl 1 Mmby aMm Nal l am licensed under provisions of Clesp er 9(commenced, Job Description
Iniall(a za�fRCDIVWan 30rlM Busiress.nd Profession,Code,and mylicnleu UNDERGROUND PARKING. GARAGE
j8Z License Clan Lk.{
' Dam Contractor COMM 8 r 754 ' /RESID 9181
3 ARCHlECrS DECLARATION
o1 understand my plans shall he used as public records
3
t�
Licensed Professional
Oe,NE.enrDER DECLARATION
n Z 1 Mrtby affirm o n I am exempt from die estioncrors License law for Nc
p o which requires
rcuoa.(Section t 7031.5.construct. on. and Nofessiuns Cole:Any ctn or county
$ which!quireae.alo re resthealmsht for soh remit t!!pair and acrund
�y
poor miucensed a.alm requime previsio offor CchpermiuonleseLaJnemmem
g � that heisllceneJForwent mthe provlaionsa(NeConlremriLittnelaw(Chapter 9 Sq.Ft.Floor Area Valuation
q (commencing with Section 7000)of Division 3 of the Business and Profession,Coda)or $444718
that he is ammpl therefrom and Ile basis far IM alleged esemp0on.Any violation of
Seedon 7031.5 by eery applicant fm a permit subject,the applicants m a civil cashy or ATIN Number Occupancy Type
Am mono Dun On hundred dollen(55001.
❑I,ae Owner of dre property,or my employees with wages a Neo Ole compenswon.
will do led work,and lhestrum.m lanat intended or offered panic(Sm.7044,Business Required Inspections
and Psoiessiow Code:The Comraclors License law does wt apply m e an owner of q p
property who builds or improves Nemon,and who does such work himself or Ihmugh his
own employees,provided that each improvements art nonnended ora@red for We.If.
however.the buildtng Ordenofprovinghaid teWinotuild or completion,Ne owner- IDis
howe wi0 haw ale burden Improvement mi that M did not year
or improv for purpose of I(`�/�('
uownerof ct(Sec.7044,
And
confession{with Ii The conactoes - �I
constructI. Of proOal(Bee.7Wd,Badness and PmfeWons Code:)The Canuemrs lr I
ce law docs not eh man owner of propend)wM builds w improver theman,and,
an ronwh projeN with ecanlr¢IartUllanmdpunuammde ConuadoY �I
nse g I 1
1
I hermy affirm under penalty of perjury one err Ne following dalwions:
❑1 haw and will malmuin.Certificateof Convent m self-mmm far WmlmrsCompen-
alion.u provided fm by Section 3700 of the labor Code.for One performance of the
work for which this permit Is issues
❑1 hove and will maintain Workers Compewflon Insurance,as required by Section
7700 of the labor Code.for the performance of Ne work far which Nu permit is issued.
My Workers Compem0an Insurance artier W Policy number art:
Cartier. PoIILy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fra section reed notbecompleed iflM permit is forcer hundred dollars($1 1
w Ic.a)
1 cent,that
must
.J O forthwith comply with such provisions or this parall shall be dimmed revoked.
z.~ CONSTRUCTION LENDING AGENCY
N.
[+ IMmby aflhm Nat Nert l..emuwctmn leming.9cay for de performance err
C> de small,far which this permit Is issued(sec.3097.Civ.C.)
1 Q leaders Name
z Lenders Addrrst
U0 1 artily that 1 haw rad this application and suss that the show Information is
H conn.l agree to comply with all city and county ordinances and state laws relating to
L)U building construction,and hereby authorise mpreenusives of this city to enter upon ie
W shave-menduad properly for Inspection purposes.
(We)agme to un,indemnify and kap hannim the City or Cupertino Assiut
0 Ilahil' ,Judgments.eau Andeape.which may on any way accrue against said Cit
U
se of Ne granting of Nu
Inc UNDERSEA S COMPLY WITH AL NON•POI Issued by:S Date
RDOUS AJATERIA, DISCLOSURE Type of Roof
Will de applicwmfDOL ding acupanlstoremhandle hvardow material
ss donned by Ne Cupenino Muni I Code.Chapter 9.12,and de HuOb and Safety
Section W32f.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yw o
Will the applicant or Imum buil 'n{0` On fee equipment or dcvias which If 2 neroow
IS installed o without first obtaining an inspection,I agree to remove
cull heard...All contaminant,As ncd by Ih0 Bey Arca Air Quality Management all new materials far inspection.
Di.uict7
❑Yue u
DieAll roof coverings to be Class IIBI'or better