00060102 CITY OF CUPERTINO , ` -
BUILDINGDIvtslorv_ - EFRIVIIT CONTRA�CTOR44diMATION.•'-
NUILDING'ADDRESSi' r;' ^ ^ ' �• - PF.RMIFNO_
WNCR S NAME. APPLICATION SUIT DATE
10656 AMULET RL .LAMES bHR3STIE ELECT IC INCO00601021 .
HONE: - . SANITARY NO CONTROL NO,
WOOD GATRICIR' C� 1455 E FOXWORTHY AVE' 06/15/2000.
m 2 ARCHI'I'FC'1'/ENGINEER: - •BUILDING PERMIT INFO
.` �O❑O❑ ',• '• (.4018) .;x69-8566 BLUC ELECT PLUMB . MECH �.
al dyW k, ice,..
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LICENSED CONTRACTOR'S DECLARATION . ,. ..
� lhereb amrn that[,air,rdnood t,ae .m Ch, ler 9 . Job Description
-
thereby Wy❑v{ whM1S i ]WOJ I dlf ''/ —Cod2e n, YI(commencing
erxc r it, It
3 a Dw y7/'1e,�r/
Cl , N
ARCk11TCCI S DLCLARAI'IO
rkodead na,firms shall be used us Public recods- i REPLACE 125 AMR. SUS—F BNFL
c o
Liacmoccl vrores:Dual
OWNhR BUIL t DCIro ON -
1 thereby B" ' exempt
R that If theC CorI I I I _ For the r' '^
Q .1h vc de oro oast
.1huh nu cn, m 11 sup di n bra Pit return
on,,,I t I. q pr iiii tf hp „ 11 good l nt _
that n licensed p . nm m p I m ( sur r, r 1 renes cir S,q: Ft Floor Area 'Valuation
pa w , bwith5 ct it 7000) [D 3 at B .' df f.' Code) „ ..
otrust heI ^,np,Reardon d the fast too, h rte d exemptior.Al einhaden f
of Seunn 7031.5 byanyapplcan fora permit sal,fecustlicapplicaut toodrivil pc alty - `
or nm more than r,c Immhc,l dollars($500). APN Number . Occupancy•Type
.of,.snwnernrineprcpmly`nrmremN'yer wnnwng�'asm u1«uupemmmm. _ - $2600
will de,he work,and the structure is not intended or offered for kale(Sw.7044, - - -
I3A s d Pr f n. Cited TheContractor',I' Law does not apply t Required Inspections '
owner of proper,Whohr'Id. 'npmve,Ihnc .std who does such work moseli 32 43059. 00 '• ' '•
. . .. JG.r
b rix tbmugh h6 own employees.pbuilding or,such vement menu are intended or -
uttered
aphaini aalc if bowarld the building improvement n Ia ll' y Y
enmplet nn,the owne-huilJu w 11 hnve,ti burden of proving that he J'J nm build nr ,
mi for parposcor.me). '� - 304 —' ROUGH ELECTRICAL -
❑I f thep p IY exclusively connecting it r I , t
toeproject(Se 7044 to IP r . Code)Th c 501. , FINAL ELECTRICAL ENERGY'.'
Lie L 5apply, 'd property who builds tummies m . . 505 — FINAL ELECTRICAL
and 'I conduct,( h p ,, „with roured�,),I d p "nt t ,h
Cunt 1 1 L L
0 exempt unde,S It&PC FarInto r' „ �o. .
u,
me
Owner WORKER'S COMPP,NSA'fION UHCLARAIIONto
• _ • , k
1 Lcrcb anmvunder nenmty'orpeaD onebneruwim ,rmr„ion
'. - ..
❑ I have and w ill maintain a Certificate of Con
cut , 11 o far Wn kc : -
Cnmp .err p d d f by Section 371111 f the L M1 'C U fo the
pert f fic work for which this perm,is issued!' • _
have ad ''II caundri Wotan',Campeau,tried]it urancno rcy'el by Station -
47W of the Labor Code,for❑o p rl r 'wn k f which h bart s �� �: •/
issued,My Wnrk C P t re carrier
aad Today o .Ids c n
Cartier �{Y �Policy No..&60 [ NLO ... O�
,CERI'IFICAI ION OF EXEMPTION FROM WORKERS'-
' COMPENSATION INSURANCE ,
(T6,,eclim need not be completed tf th p nn is Ibnme handed doll '
`1 certify that in the performance nI In,work for which thi,p anis is issued,I - - -
ehall ma car,play by pc,,cn in any remain in a,to became subject mlhe Workers'
Comp 'ttr Laws tl Calfernn On
Appl. ” .. _ ..
NOTICE TO APPLICANT:IL'af,er making,hln Cettificme of Bxemp,ion;you should - ' ' ,
z
become subject to the Workers C cremation IT kiii Labor Code,you nuns,• - y
Q
famooidt comply with such pookions or this perant shall be deems revoked 'j"• -
_wy ti COr STIRfare vCT10NLunion rIA gF rc
.1 hereby waffuradin's,Nm there is csued S inn lending agcney for perfmmnnca rof c j -
Q. ,
Leader
k f win't,In,p 1's sued(Sec 3097 Clv.C.) t -
G Lend rvNm � �. .�
Lend r AJJr ,is
r v�
V'0 Icer fY ldtld Jth:'ppl t d tt O ,Ih b 'nf rn', 1 i t•
kT+'. d be, I g t ply t II ty d ,y d root d , : I' , g -, - -�
Q V in a building i t dM1 by ec p t 'v. .1 city in t p
g] the b t Jproperty f 1p t nP P :. I
put (W)ng , t' ndexpense.,
xpY Ik ph 1. ,hcCq PCpn ngan., �,
Ln Ct liabilitiesludgme ,' , J p cs which stay ,mayway ......- against
r, City on:eyucnce of 11 ,roof hi penny -
APPLICANTUNDEI ND ILLCO LYWITHou, N PO Issued by: . - -Ddte r
SOURCE REGULATIONS. ^;` �� V •, y. '
SlBwwrenf Ambernucial,emr - .. Duo Re-roofs .ted
HAFARIDOO'MATERIALS DISCLOSURE _
Win lneapprea l r t hbmh,g 1 t store talboutheh....dms naerd Type.of R'c
as d fi ed by,the Co t M ipal Cod, Charon 9.12.and,n a hh and Safety
Cads ion 25532(,)
4Y e All roofs shall be inspected prior to any roofing material being installed.
-Wild o 1' ' , f h II' Inst e<t t J vwh c6 t
pp gweap•n I n - If a roof is installed without first obtaining an inspection„I`agree to remove
mnithzallouserui.murensa,defined by the By Arca Air Quality N& emen .�
Dint - _ i . all new materials for,inspection. Applicant urd&rstands,and will comply with,
0- all non point source regulations.
I h read IM1e h d m req t' d CI np, fi 95 r th t j,-
California Health&S f Safety Set :25505 25533 d 5534, 1 a Id t �. - - �•�
itthbuildingd t currently have , tthtit varyie :hl'ryt Ifyd �� QV5
Occuoce.pant f,h 1 I hch mm,h ,p' nu sero f Cerilct 1. i., of _ : . . .
G 1 SigmtureApplican `.r. Date ,
, '.
own,matthan, age Da,u - All roof coverings to be Class "B"or better,
r OFFICE,
t 4