01100159 r. v
CITY OF,CUPERTINO" '• - -
;BUIIDINCDtvtstoN '.:.':;.,.'., .pER1VIIT CONTRACTOR MORMATION:
BUILDING ADDRESS:" " - PERMIT NO.
;. 18750 BARNHART:'AVE O,1T00.159
n- ` APPLICATION SUB DATE
GRVP�EH SMITH _ 10/31%2001 ..._ .
HONE: SANITARY NO. CONTROL NO.
•O O ARCHITECTIENGINEER:, - ` - BUILDING PERMIT INFO
t tBLDG ELECT PLUMB MECH
HLICENSED CONTRACTORS DECLARATION" JOb DOSCLIpptlOn '
OZ,,t a' [Ibere7000)oethat l mofthlicensed under prohlolnofChpt 9((commencing ADD' HARD WIRED^'SECURIT.Y LIGHT ON='OUTSIDE
F; tM went14il ar iW fRh l is,
Business and Professions Code and my l(Cwse
KmI it Nfull fortroddel(' _ k - F '.I �,..,i';.v :.,h; �'rs•- r
x s f5< Data Clan '"''1'!' •-'Contractor
N
�(: �• -ARCHITECIjS DECLARATION
�'=N I undemt my Plans shall be used n public records,
EWA Li[e sed P fesaional
,OWNER-BUILDER DECLARATION
m 1 h rtby aflion that 1 am cumpt from the Connector's License Law for the
C Z< (ill mg r et n Section]Ol 5 Business end Profesuom Code Any sty a o my S200
Q whah regmrea permit t n t t slow.improve.demolish or repair eny structure -
$.pito tot issuance,also requires the applicallr ch Permit file a shifted statem t - --- - - -' 'i :::_) _ ,. ......._. _ -
that hF s I tihled•pivatadt ap meprovidons of the Conwemn L c nse Law(Chapter 9 „ aq {{� I Ay$a- s__-. s Valuation
(commencing with Sego 7000)of Division J of the Business mal Profetsions Code)'
or that t e'Ls;llcmP1 therefromanA the,bus a for the alleged ezemphom Any violation
-of Section 7031:5 by any WPlicartt fm a permit subjects the applicant to a civil penaltyi ..
f.mmorcrhaa Bvahundread.11rs(s500) PNjOccupancy Type
'E
C' O1.as owner of Ne property,sur my employees with wages as,their sole comiamoomn. .._ ..
wilt dopne work and the suucnure'is aot intended'or offered for sale sec:luaa.'
Buahr3505 - FINAL. EB�¢flYl�dCtlAtiactiohs'. ;_s 8:;:. e
f YhiM Professions Crate:de:The Contractor's License Low dnot apply to an
owner of pmpsny Who builds or improves mere..,end who does such work himself'
` or thmugh hisown croployess.provided that such improvements an,net intended or _-„ ___.- ____-___ -_ _ _ _ -___ �._ _..-._.
;".Berea for gala IL ho a er the budding ar improvement n sold mrh od2 year df ` : ,s„I+,f s '.0- r ITo!
complaw me awn; bit Ides will have the burden f p g that he did not build or
improve 0f rP Tose of sale)- jr 7 ) ._.._. - .
f]1 as owner phhe propel lits lycontracting with licensed con uact to Y•'T - - d '1 - I. - -
Licensed the pros n (Set Ito a s d P f as oro Cale I mp C tenet {,�h a ✓ s h
License L d not apply to o'n sof PropenY h buildsmP m o �/I(/J �
' and who commma for such prole tsw th ontram (s)licensed p a t to th _ --- ----------
Contractors
- - -- -_ --- -
n Cn tato L ce se Law
.-
a
1 sun a empty oder sec '' B�P C fo this¢asp.
-'Oh ,.
"•Y r y .( OBCpMPENSATION DECLARATION
-1 hehebyalfhrm under penalty of pei3ury one of me following dencharmonx:
h - ❑ I luve}andwill�mamham'aCenifiwne of Cohuvl 5o ulGinsuse for Worker's '
Compensa0on, n+-phov,dN^far'by`Secuon 3]00 of ih< Lithos Cade, fm me - + '.,.• '•
_ - pcdomuihce of tti<work„or which this permit is iswN.. - � - -
❑I hav o il II me ha W ker s Compense0nn Iniumnce m q rttl by
section
< J]tl(1 df the Labor Cade i th pe f• hwe of the work for h ch nth pemh t is ��
kis ed My Wo kerd'Compensat on InsumnLe carrier d P 11 cy number ar< /� )� /�/� � _ _ „” v„�,,,�,
forte(This seen.need oO�PEo SPT�OtJ INS�r NCEt Oone tluhhdred dollars .. L.Y 1�,t It �C
1
?/z1q/0 1.y.�tY
'III/Y 't �”
cr 1.I comfy that in the performance of hde soot(or wMch mis pemmt a rssued'1 - 1 .
''ihall ii,ii employ'anY.pehson in any manner w to become'subled to the Workers' -
' "^ Compemm�ion Wwx of Califemin.Dam' "" "' ` '
. .NOTICE TO APPLIC NT If eller mekadgm eCenlBcam (E Po n You mg.,id 's' ,J
" beconha ubfauoihe Warker'iCompensauoa pm h.hohhi o(SheLabo Cadc"you mut
(] 0 Ifonh th c mplywiih g ch p vahom or this permit shall bed teed ked _
i(llSss 'D 1+ + K`II CONSTRUCf10N LENDING AGENCY. _- - - - --_ - tAx
. l.__ ._. _. . ._ .. _..
^ f he by Rte,that there e n nmcuon lenomg a8 n Y P til pert nn e
bf nh w rk(or soil h ah a permit hs�uu tl(S 109]Qv C)
r7.Z ,Lender x Addre ss h , t :` 1 1 l ,
UC
1 con fy that I have
read h e tppl c 4end u m th n the.bp mf rmotion hs
W rr 2nrtect I H; loan P'lywith ell city,and countl ordinances,and state lade relating
O 6 bit lding consW6,ti n end hent, ru mo ce rtpre entativ a of th s sty fo enter upon
^sheabove-mcnboncdium nyfor,lnepaeonpurposes; -
1 We)agree su
tise:indemnify and keep humorless the City of CupMino against
:Ln H liabilities,judgments,costs.and e.penaes which may emit,,way secure against said
] t.) .'Z: City 1.[.c qumu ofma gmming of this pemhit.
'APPLICANTUNUERST(sNDS'ANDWILL CALL NON-POINT Issued b i DBI;
S011NCE REGULATIONS.;421i.'' ?.....i, I,,.- y
Spdtureo APPLcanucontra,mr. - 'Date - Re-roofs --
''HA ZARDOUS'MATERIALS DISCLOSURE
' ('t Will the upphcant or furore bulldmg mcupant store or handle huardoua methanol .,Type of Roof
n deRned by the Cupertino Municipal Code Chnix c9 12 and the Health and Safety , I'
Code Section 23334(a) tis S s t SI r 1 J ^, 1, t ,••,I '
❑Nn, l roofs shall be inspected prior to.any roofing material beteg installed-------
Al
Will the upphcent,r4fusurc buildingaeu'pant use eq Pmem`or nevi«,wbieh, Ifaroofisin's ed Athout first obtaining an inspecti6h; -agr6e'toreinove
c nu hazardous air contaminants azde0ned by the Bny Arca Air Quality Matmgement,
pita all new materials for inspection. Applicant understands.and will,comply with _
6Ve. I. 1�1 ,qN:i _ I all non-point wucce r8glauons �,•;q,ert, •,.-
I Xa a teid,tha harallous•mitim's rcquircmenu under Chapter 6.95 of the
C I f is He ahN&Safety Coda Senions 25505,25533 and 255M.1 understand that
ifthebuilding dogs nni curtemly have a annum,that it is my responsibility to notify the
,dceul ant of me rcquircmenu which must be met prior to hisuance of CeNB2ate of
Occupancy.; s ... -
Signature of Applicant . _ _. Date- _
ownermetam. nangem Deter All roof coverings to be Class"B" or better
-OFFICE .