00080137 CITY OF,ICUPERTINO •' -
BUILDING DIVISION PERMIT" : ' ACONTRACTOR INFORMATION:
BUILDING ADDRESS - .4 „ PERMIT NO. ,
1 F 11100801.37
OWNER'S NA ' - APPLICATION SOB DATE .
/18/2000
ONE - ,. •i ' SANITARY NO, CONTROL NO.
O m z ARCH]'I'ECTIENGINEBR: - 13UILI)ING PERMIT INFO
BLDG 'ELECT FUME ECH
y LICENSED CONTRACfOR'S DECLARATION
i7 llb> ffrn that I air licenses ander p of Chillier Homme 'ng Job Description -
on 3 of the
usiness and
x3uy, F � ,af 1 9W0)ofD 1. HITLCrBS DECLA Profession,ON Cade un myl ue
in Irnfae" c nfanlar
`� so
YI uneemmod an,plans shall be used as Public records
AGO Icn dP f ,: .d'
t.
OW NF.R I2 DLCLARAl10N _
I hahem'he(,]num es,a pfmII c Cnn,ls I.ce
atmnse naw far the
Cgd .foll g (Section
t )0 70 Bu,in a315 Bu, adP f Cd AY' ) ounty -
"fnew h h rquiresa peranitt construct,t It p di or reportany structure
�aQ
table,it,t,. ac ol. (heIpl'c tl uhpernnrl 'g lsttemett
— deals r . dppr t to tile pi LittleContractor's Lianaw L (Ch pter9 Sq. Ft Floor Area Valuation -
Hamnene'agwith Sec 7001atD'vis 3 1'❑ Bmne dP r,! nsChile -
or Thal he's excreter therefrour and the haso,lot thicallegisd enen pf t n.Any violation
of Section 706 L5 by any npplfcam fora permll suhjects the nPPllenm m o civil penahy ' ..I
of notion.than the handled dollar,($100). - APN Number ancy OdcupTyPe ,
E]1,as owner el the property.or by employees with wages its then ole compensation' -
will do the k and the s t o is n t intended in,offered onside(Sec.7044
Business arttPlefic,,liere,Cel Tire Chat ,rai1 Low does.,it apply to an - ,Requiredinspections`. -
ow fi IwIYWh bId: p ,,thediri laid who les u,p ti-knscll -
r though yl h': tpl Y -,provided th I h' p d not intended or - - -
om 1 for sole.If.ha e er,the ba Id a6 r ndnve negt is n Id stio one year.or 303 - ROUOW " ECHAN I CRL
�ontplemih,owrr,1oI,L,will hese the hamen of Provingmnt hedl❑nol hada ar 30�t — 'ROIIGW ELECTRICAL' - t
mprnae for pmpox of sme): ."
505 _ 'FINAL 'ELECTRICAL
❑I,as ,,ns,.f,hep iti an,lacliensel, volhoefing withlicensed t t .I l
continued tie Petecl(9c 7044 E dP r. . ed ,)Th C Int 508 FTNAI_ MECHANICAL_
I.icenw Law ones not apply to n it ow tet aF pmperly,wno hmld n rf npr vert/hereon
and who cannows fa .ch p jute wish wem(s7 linceewd I n mm or theContractor s License Law,
' ❑1 pt anderS - - B&P C intrusions.. -
Owner Dow r
WORKERS COMPENSATION DECLARATION I (/ /
ac 11 by ii ❑ P '1tY f 1 y of the followingdeclarations:
711 Jll arrianin a Certificate fConsent ro . x
ll' Per
Ca 1 :ai a. p v d d f by S 3700 f th Lane, Code Tor tire
perf once of the wok far wh ch this P t s smea. ,.i - n
❑1 have and will mu Ina n Worker's Conapersation Ie v c ea by
37IXI of the Labor Code for the performance of the work for which thin perrnot ma
l is n _
s.uu1.M Worker'x 'ompenxmion-In,reannn couri��er))inelFell,nnmhernre.
Crier: Policy Na./`r 400 00 /0-
{ S
:R /PIP AlIONOFEXEMIrlIONFROMWORKERS
COMPENSAONINSURANEC -
1 -
Thin section need not be cam IaICJ l the . a
I permit for one hundaxd dollars
'
p pe
(8100)or Icvs) -
1 certif thin in the cd.r ci n1 the work forwhtch this mit is Isne 1
d
Y P Per .
nil not emmanner ,, m mm
ploy any Parson In any anner ax he snljeet In the Worker,'
1
Cal p I n Laws of California.Date -
I
NOTICE ./
>.. 'TO APPLICANT II;after making this Cenifmme of Exemptlnn,you nhoula
become subject m the Workers Coni n,or ti is provLiohall ho d Lunm Coda you they a
Q Q fonhwhh comply with such provisions or permit shall ho deemed revoked,
HV] I - CONSTRUCTION LENDING AGENCY y - • -
a ; .c l hereby ofrrm that there .t i n lending agency for the perfoPnnnee +
W of the wokfor wh chtl pe w'a sxl (Sol,3097,Cv.C) r -
Lenders Name
a z Lena Ale es.,
V Q I verboydraIIave'rrad firs n,lien leanedsur but bove inforthaturnI,
tohne 1 agree in ply -
-' . , 11 ❑county I'm l.t t I faog
tla g opon hereby
e auti c represent.f.en ftl sctynaentcn pn
the b tined property f rinspep Try:es.l, no
^ _ "•
n -
I
0076 ttrienniallyandk ph to e va ,
'A
;
Viab t J f6c d P when hay accrue against slid
City yucnee orae :
grating of prm 1. 4
/,rL_—CIO
Y• Ditte -
APPLICA ST SAN WILL COMPLY WIT(H�A-LL NO/N�-POINT
Issued bv: �`V :
Sigrarbacof Apprcern/Connactor 1 Dole Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the pple'renor future n [ding occupant storcorhandle'h.i7andous triecidd Type'Of
as def ped by ac Cupe don Municipal Coda Chapter 9.i2 and the Heallh and Safety ' t
Code.Section 25532(n)'Oycci .I F1 N( � � '
' All roofs shall be inspected prior to any roofing material being installed.
Will the epprrant or future building eecnpnm use equipmeal ordcvluo which If a roof is installed without first obtainin an ins ectirn, Iaree to i%emove
emit Imzardens atrcanwmmnms es scones by the Day Aron A r Qaarty Manngemem- g P g
D....to,I all�new materials for inspection. Applicant understands and will comply with
°YeS - ElNo allnon-point sourceregulations. '
I have rend the h z I t r quirea Is and Chapter 695 ,1 the - --
CulLib 'a Health&Sof ly Code.Sect ons 25505,25539 and 25534 1 understand than -if he houldid,do t currently have a crI t I it is any c,;p ihil ity to anifythe s
a,ro,daa f the q h h h I prior m fvs f Certificate of
he a,
"a"
p n y Signature.of Applicant -' - Date
oy,eT,l� ee� -Due, All roof coverings to be Class "B"or better -
+' • OFFICE .