01070112 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
t
PERMIT NO.
a}IIJ,DJf.'S'z9DMATA WAY EVEROWNED DEVELOPMENT CO P01070112
C�'l. 'W YUEN 531 NORTHLAKE DR AOPP�ICyS�IQN�2001
PHONE: SANITARY NO. CONTROL NO.
(408) 725-8822
s.4ARCHITECDENGINEER: BUILDNG PERMIT NFO
00
t BLDG ELECT PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATION
y 1 hercb firm,tum I am accused under - J b De cription .
ya pmuPronssionsCmr9lrommencmg TEMPORARY POWER ho
with Senformil defectDivision3ofthe Business nna Professions Cale,and mylicen
6 is in full force and effect. se
i o 6 D Date Cla. Lic.N
Dam Comm tares
3'r ARCHITECT'S DECLARATIO
1 understand my plans shall be used as public records
e N
a.rc o O Licensed Professional
°' OWNER-exempt R m the Contractor
h Z ato 1 hereby.freta on I am exempt from the Gonion,,Core;e License Law fou the $2 5 0
which re uvma f6cction IDJLS,Business and Professions h.or Any city or county•
E�o
which q a perm I I coaw t vlte prove,demolish' pany structure
i 3 -poo sou arca al req vc du PPI'cantf such pcmuun fl sgncd suumcns. _ _...._ ..
(hath slcenfeit pumuatmN0 Division
Ne the Business
Lc lawrm;Cdc) 3 T f12151WAW r r Valuation
or m ung• uh Sect ]:1001 (Divi' J fine Bustde;s ulon.Any
Code) ar, -1,\� 5 a i V' IWl9„�l�l rte � . y
or thatheIs exempt tmy applicant
and the Pers for the subjects
the
ppi couoo Any violmmn '• ”
o(Section ID3 m by any hundred
oll for a pent,(subjects the applicant m a civil penally
rrrotmarcenmtrvennnareaaonamrs5dol. 304AgN1Ql9MWI ELECTRI AL^'I""'" :<o. Occupancy Type
nl,as owner of the property,or my employees with wages as their sole compensation, 501 - FINAL ELECT}R��I AL ENERGY
,illdothe'worofessi is Code:The neonintended Lienee retedLaw'or does
ole not( ec apply
505 — FINAL EL "f�'&1UkctionS:'-""
Business aha Professions Coda The sthemContractor's License Law does nm apply m df -
owner of property Who wilds m improves thereon,and who does such work intended
t
m through his employees.provided Na suchimprovementst lend d _
.,,at
i . ' _.
completion,the ownc bld will have the b len of proving that he da not build or '
improvef porpoise of satc.). F�Ns� r .Lt+n R•
D1,asownero(the pmpeny axcl ycnnmg wt. _ _ _ . ..... ... —_-, _—. i_.... ---con —
(vel t t tit(tensede mmm- to
,
Users. the does
n(a Ito a Business andpita Professors Cma)Th Contractor's JUL. 2
L I:
License Law dces not apply man owner 1M1 a cony who bat las or tt.pmvcs thereon
_end who commas for such projecu a mmmnorls)1¢ensed Dursuam to Ne.
.;
Contractors L Law. . .. _... .. .. .. _... . ... _ ._-. _._. .. .. _.._.__- .. . .-_.__
❑I pt oder Sec ° " BAPCrnnh,n reason t• rq�I1:, �•
Dwre BVILDIN►(:�
_ WORKERS COMPENSATION DECLARATION
_ 1 hereby afrrso under Penalty of perjury one of the following declaretiona
0 1 ha4c`and will stairsam a Cenirram'of Consent to sell insure for Worker's
Compensators,, as:provided for by Section 9700 of the labor Codc. for the
_ performance or the work for which this Permit is issued.
01 have'diid will maintain Worker's Compensation Insurance,as rx,mmJ by Sectiun
1]00 er the'Labor Core,foo the padmostrce of iM1e work far which this'7rvii'.
issued MyW rkeri C mpe s i on Insum mer dna Pol cy he a :"
UNP Pa rr rvb.`j,.3-oo p fir o(M
„CERTE$EMPTION Oh1WFt
'.. -,-
COMPENSATION INSURANCES ' _.._ - ".._ .___....... _._.
,
i t Thu ucuon need nm w cdmpleted rm
if the peit is for one hundred callus - " _: •"I [)r',:d;
IE 100)or less.l
.n 1.
1cers,fy than in cFroo an I. vie of Ne ar k f which th pi t t s ke l
' Y _fled J
'shall eat anploy any,persrn m any ate, sat alto becamesobject m the Workcri
Compenzmion Lewsof California:Date - "
Pp con
.NOTICE TO APPLICANT If,'afta utak gth C tfcamsfL pt you should , ,
Obee ' bjeumthewrk C 'penst nprr nsofN I_m Cd,you'muu
forth iN rmmply with such pro t Ione or tit s pelta t shall be deemed m oked.
r .__"__.__. ._.. . . ____._._.. _.. _. " .__ _ __ ."._ ._ _. .. _
'rte,rq
'J. - I,CONSTRUCr'ION LENDING AGENCY.
a_' 1 he by R that the c st t IenJing agnnry fo the pe Ponnvnce .. .t _.
W15 'ef th work for whmM1 this perm t ti slued(Sec Jf19],Civ.C
d�Q --Lenders Namr�- v_.
L:cndcr'x Address ••' .. - .... ._. .- _ _ _ _. _ ... . ._.____...___._._ .__._._. __._. "____." _. .. ..__._...
I Os ITT,
0 , I century mat 1 have read this application and state that the h e information s{
Imxrrect.1.,me to comply with all city and county ordinances and state laws miming;
-i:�-f, ,to Wilding cosufor wnion.a,M heathy authorize mprcumuives of this city to
F,0.fn drte met a'
to nm �tion pi cmerume, pom(We)agree_ p � JenfYdk hle he City;f eninongain
irmilitimpidgments.coonsand n
expenses which y 'toy ay cm against said
U z City n tan y ncc bf Ne gmm g f N pc u
APF 4rrUWERSTA DS AND WILL COMPLY WITHAL}NON LNT
so� 61 }23f°� Issued by: Date 0
Elgl.�5roe fApplicanVC races .., Re-roofs
`.H 1Z�IALS DISCLOSURE
:c:7Wil Ne alipliratt ante wilding ommatore«handle huardous matcnal -Typeof Roof
u def d by the Cutes o Municipal Cale Chu 9 12 d the Health nil Safety t.
s C6d OY n355J21fa1 i s r , t 1 ','\ t i', t ;, s l .. ., ) 1 s.:.. a t t t I . . ✓`,, ,cls.
Le- wi" A]l.roofs shall be.inspected prior.to any roofing.material,.being.installed.... __" ..._.
he's, t rf t buinosac p t eegropm torde ces rani If a roof is irtstalled�without first obtaining antinspection,'pagree'[o remove
em t h arJ tar tom nun[ vs derned by tit Bay Arlo
Air
Q 1 ty Ma ag em
I niarrtoYCS '., all new materials for inspection ,Applicant understands and will comply with.. .
y is
all non-point source regulations.,.a ;
I n vie read Ne hu tdo s m¢oats q- me u under Chapin 6.95 of the
Cel fatale Health&Safety Code.Senion 8505.25533 and 25534 I understand than
"'.it the building docs nm currently lrvc am rs�lhsm it is arym,ansibility to rourrymii-
ml-imoreoll-hich musi be met Immot'ssuanc f 'C tar m of
Cc-
colors.;;- cam,- - /Z �. , Signature of Applicant ,- _ - -__ Date
�=
•'Owner or atiffi.1111dage t . Date. All roof coverings to be Class B" or better
OFFICE