04060159CITY OF CUPERTINOx'sm:u«"s'-_�°'%°
BUILDING DIVISION PERMIT'
CONCRACTOWINFORMATION :
BUILDING ADDRESS:
NATIONAL CONSTRUCTION RENT
IT N004060159
18801 ARATA WAY
NER'S NAME:
PERMITISSUE DATE
MARY TRAN
1355 FILIPE A
NE:
SANITARY NO. CONTROL NO.
(818)221-6057
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CON'TRACTOR'S DECLARATION
1 affirm Net 1 am BO antler provisions of Chapter 9 (commencing
Job DesCflptl0��
ion 7 (rho
with Section 70RB) of Division 3 of the Business and Prafcuions Codc, and my liccns, is
Fl
infaBformandeff«I.
TEMP POWER POLE
®'
Licemse Class Lic.10
Date CmT'S rf D Wr
ARCHDECLARATION
J' 2 �- 2004
1 undcmund my plans shall he used az public rtnrds
gA.essiona
1111���'��
3
Licensed Profl
OWNER -BUILDER DECLARATION
ss
1[va
1 hereby vffirm that, 1 am exempt from the Contractor's License Law for the
pVl
following reason. (Seed.. 7031.5, Business and Professore Code: Any city Or county
which requites a permit to cnmtruct, alter, improve. demolish, or repair any structure
$500
prior in its issuance, also requires the applicant for such permit W file a signed Mammal
Win is licensed pursuant W the provisions of the Contractor's Licemc Law (chapter 9
Sq. Ft. Floor Area - Valuation
(commencing with Section 7") of Division 3 Or the Business and Professions Code) or
Nat he u exempt therefrom and the basis for the alleged esemption. Any violation of
Section 7031.5 by any applicant for a permit subjects We applicant to a civil penally of
3Br(]CCU
Occupancy T
P y ype
not mote man Eve hundred dollars (5500).
I,avow.erofinepropny,mmyemployceswithwSnUth irselecompen=tion.
will do We work, and to, sweum is not intended oroffered far sale (See 7044, Business
Md Pmfessiotu Carlo: The COnuacmru License law does not apply in an owner of
Required Inspections
property who builds crimposes thereoa, end who doca aueh wmk himself or through his
Own employers, provided mat such improvements are not intended or offered for sale. IL
however, the building or improvement is sold within one year of completion, the ower.
budder will haw the I uoem of proving that he did not build or improw for purpose of
sale.).
1, as Owner of the property, am exclusively contracting with licensed contractors W
true the project ism. 7044, Business and Professors Code:) The COnwactors U.
cru law docs not ap y to an owner of property who Wilds or improves themon, and
whocormacsfms jeer with aconwxtoRs7limved purtuantWthe COnuanofs
License Law.
❑lase eacmin See. ,B&PC this reazan
er, �Date
S COMPENSATION DECLARAAY4pR�
I hereby affirm under penalty, of perjury one of me following declarations:
.
orkersCompn-
J I have and will maintain aCertificate of Consent to se f -insure fm Worker's Co.,. -
son on,
sonon, as provided for by Section 3700 of the labor Code. for the performance of We
work for which this permit is issued.
tJ11 haw and will maintain Wofktrs Compensation I.Nranm, az 2gU1Rd by $Ceti..
3700 of We labor Code, far me rerformanm of the work for which this permit is issued.
,
My Workees Compensation Insmame artier and Policy number are:
Cartier. Policy No,
,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed if the permit is foram hundred dollars ($100)
car 1.)
I certify mat in the performance of the work for which this permit is wood. I shall not
employ any person in any mamerso as in become subjmuo the W.rk,rs'' Compewtion
'
Law, of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject W the Workers Compemason previsions of the labor Coale, you must
forthwith comply with such provision or mica permit shall W teamed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm mat there is a construction lending agency for the performance of
We work for which mu panni, u issued (Sec. 3041, ON. C.)
Undoes Name
Lendces Address
I sonify mat 1 haw rod this application and stow that the &how information is
correct. 1 agree W comply with all city and county costumers and sure laws relating to
building construction, and hereby authors represenutivv of this City m enter upon the
abev,-mentioned pmpeny for inspection purposes.
(We) agree W saw, indemnify and Imp harmless the City of Cupertino against
/
.jud me often.vs which may in anyway accrue against said City
We grCosts
m convey cof the granting of this .it.
mS
in cabutitiaCTV
APPLIC' UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:. Date
SOU G ATIONS. /
Ln ���cQl a�
Re -roofs
ore
Si a plicaHAZARDO Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or room building mcupents,ore orhandlc hn.aoous materiel
u dclinN by tbe Cupertino Municipal Cade. Chapter 9.1x, and the Health and Safety
e. Oti.nxss3x(a)7
a
All roofs shall be inspected prior to any roofing material being installed.
�Na
which
Will m, air
or f ore b.firml ea
If a roof is installed without firs[ obtaining an inspection, I agree to remove
mans
slyMdevices
harardnus air conuminanits az dcfin,d by th, Bay Arca Air Quality Managcmcnt
by We Bay A Air Gaudily
all new materials for inspection.
sicG
0 Ycs art
`
Ihawrad ehvaotvxmawruls rcquiwmenu under Chapwrfi.YS of the Califon
ria Hcahh&Soft Co ,Sccdosx5505,25533wdx5534.1..tk undthmifmc Nilding
data not curt, i haw a wren, that its my respensibility W notify the occupant of the
Oct.L K UN bC me( prior W i31uyICC of a L'Crllftaw.f Q.p
Signature of Applicant Date
SOY
All roof coverings to be Class "B" or better
Owner ora.th.d.ndagent Date
r�
CIN OF
UPERTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
APN # 7 /_ / z
b
Date: r S/ oy
Building Address:
Elect. Permit Issuance
ELECTRICAL
ItR61 AULTA
VAY CLI i
BUILDING
OwnersName:
Phone #:
M A
(40`1�—Sc(o e3 S3
Contractor: N n
C,,,4-,,_.h,,,Phone:
License #:
—S-o3s
jai
Contact:
Phone:
Cupertino Business License #:
ttnz_6k_—
SC/ O— 01
0 100 0—P
Building Permit Info:
Elect �]
Job Description:
%�. 'TCMI'a✓taivy (�dz�r�-IL ('oto
Residential
Commercial ❑
Cost of Project:
50-0
Qty. if
ADnlicable A
Fee Ili
Far. Tlacrrintinn
FPP �in11T
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
310
it