08020070 CTTY OF CUPERTINO �P
BUILDING DIVISION PERNUT Cd
PERMIT NO.
eU1LTT0T`dREs$,: DE ANZA BLVD HOWARD S. WRIGHT 08020070
PO BOX 34449 02/12/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 903-2054
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
1= 0 0 0
�oo LICENSED CONTRACTOR'S DECLARATION lb Description
1 hvshim cny aWal I we li¢nxd under proviuw aof Chapter 9(mmme. o0SCr3p
ing
with Smdon 7000 of Division 3 of We Buvnesi and Professions code,and my ldemeis DEMO OF INTERIOR FINSHS & SELCTV LNDSCPNG @PRK PL
n
in full twee and effect. ala'O1 V
uemat clue Llo.g RST
5 Data
Aacxr7EcTS rsDEDECLARATION 2500 SQFT
4( I undersand my pims Mal rte used u public recmae
p
g ted Licensed Professional
h OWNER-BUILDER DECLARATION
sato
ZOO 1 naso .(Seto that 11. uempt from the cations o License Law for tap
ZOO which ng mown. emit u]031.5.Buelroas and Pmfessiuns Code:Any city or county
9�+ which its issuance,
a a e,and ra can s;the alar.apprawnt form,h Permit t or mash ed stracsump
um
y
prior loitsisaua.tarart to the thovisioc of for rvchpermeoLm Law(suum¢t
o thatnerncemcdparrvam7Othepmwiaipwpfdta eB..I rwaaamiswsCode)9 Sq.Ft.Floor Area Valuation
$ that Wislogwith Section7000)of Di Win for
or the Winged
Any Professions )of 25000
Net ha r mucaurn313 b thuefmm and the aper for tie subjects
the exemption Any it violation of
Sectimp.1..0314.becamellwmfmapumprvbjeeu the applicattoaavllpmaty of Number Occupancy Type
.t mart ihae fins hundred delta($500). 36901064 .�
❑1,aowoerafthepmpeny.mmyemploycuwithmtaudxtrsakcompenudon,
will da tha work,and the structure is rmthmanded or ollemd foraale(Sec.7060,Business
and Pmfcsdaw Code:The Coruscate,Limme Law door but apply to 40 owner Of Required Inspections
proper who buids ter im,mves thereon,and who doessuch work himself or though his
owe cmPlaym,pmvidrd that such impmwnumis art not intended ar offered fur aaln E,
however,the buiding or impmwement is mid within ons year of americans,the awmen'
builder will have We burden of proving that M did no,head or Imutons far purpam of .
tele.).
❑1,an owner a the property.am aclusheely mancovint with amasses contractors In - -
aanstrvct the project(Sec.7064.Business mud Pmfwdow Code:)The Contractors Li-
mau law dna out apply to an owner of property who builds or impmw n dare.,ted,
who contracts for such projects with a contrular(s)Ilcen.¢d pursuant to We Contractors
License law.
❑I am eaempt under See ,B At P C for this moan
Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing decluWons:
❑them pad will main taineCen3700 of ContenttoConn.for forWafkeM1Cempen-
waian,r provided far mi is issued.3]00 of tins lab.Code,for W performance of the
wont for which this permit is lewd.
0 1 have and will maintain Wortrls Compensation Insurst¢,as required by Section
3700 of the tabor Cade.for th0 pmformsme of the wake furwhich this permit Is Issued. '
My Workenes Compensation Insamsce carrier and Policy number art:
C,nierUalla9her paacy, :WL (q 27-109(-4 4
���5��Cg.nFTCATE OF EXEMPTION FROM WORKERS'
L}f'JI-)COMPENSATION INSURANCE
(Thr it.need senimmmrletad If the permit[,far..hundred dollars($100)
or less)
1¢nary Wt in the pc Ili rmencc of the work far which this pe-mit Is issued,I met not
employ any person in my rn.r w as to bemme subject to the WoMeW Compensation
Laws of califomia.Dam ,
Applicant
NOTICE TO APPLICANT:If.after making this Conificatc of Exemption.you Would
become subject to We Workers Compensation provisions of the labor Code,you must _
OO forthwith comply with seen provisions or this permit mail be deemW revoked.
'�
CONMUCrION LENDING AGENCY
[r I hereby alfmr that Wert is a construction lending agency for the Performanceof
r(.> the work for which this Permit Is lesatd(Sm.3097,Civ.C.) '
kl Q Lender's Name ,
z Landers Addrum '
V Q I mtifY War 1 haw mad this applkati.aM sum and the arose information in .
Ip, conmtt 1 atree to comply with all city and county Mammas and state laws telsang to -
.� building construction,and thereby authorise rtprtunudws of this city to enter upon the
W shave-mentioned property for Inspection Purposes
ty,,LL (We)agree to save,indemnify and keep hnmlw the City of Cupertino against
Ley liabilities,judgmmW coats and expenses which may in my way acme against said City
C)Z in con".of the panting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued Date
z1Z�n Re-roofs
Signature of ApplicauConuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie applicant or future building meanest mare or handle haardow materia
as,defined by the Contra.Municipal Coda.Chapter 9.13,and tie Heath and Safely
Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
War tiro spplicut or future building Occupant use equlpms at or daviw which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardoua sir cmumiwns as defined by the Bay Ama Air Quality ManMgenreft all new materials for inspection.
District?
❑Yes r(kTNu
I have mad the weallous materials mquimmenu undcrChapur6.95 of the C.Afor-
nu Health h Safety Cada,Sections 25505,25533 and 25534.1 uMvauM theif des building
noes not currently haw a smwo that it in my rcryortsibility to Mary the occupant of the
re/gairements wales mute�
Z j Z�O�Jh
- All roof coverings to be Class"$°or better
Owner or wahomcd agent Data