01030118C1 TY
ill. I
GUDPERONNo '
CONTRACTOR INFORMATION: ' ;
PERMIT
BUILDING ADDRESS:
PERMITNO,
445 BREWER AV'
DON WADE ELECTRIC
0' • 01030318
OWNER'S NAME:
APPLICATION SUB DATE
W RD
03/21/2001
• PHONE: ,
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SANITARY NO. ' CONTROL NO.
ARCHITECfIENGINEER: 'y
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BUILDIN PEkMfI'INFO .
•BLDG ELECT' -PLUMB .. MECH
" LICENSED CON PRACTOR'S DECLARATION
� -Job Description
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11 ny If no (k I I' f I 1 f CI fe 9 (,urate b
a] -0II 5 I 7000 a1D 3 ❑ aB dpahis, - yl
fill( t r /'
���0�/1 7 �
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IFa n
MAIN SERVICE.PANEL I.IPGRADE 200 AMPS
I r — tCL
Ee, DECL rTIO
I understand my plum shall nc nscA ns put Ie fee
par, h
r
Licensed P..I... cal +' . ,
OWNER -BUILDER DECLARATION
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I labody afford that I an, c.ond,o from the C m,h -' Lnera, Law ma the
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following ut,(Sac( 90315 B sine d Profession,Code :A yctyoroou ly
1 whiela icil cpeudad mn,n-t, after, napace, then hit. on repair noty.... item
prior to its 'ss,ance, ho requires lhevppl onl fnrsucn permh In file sgned,neened
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mat he is licensed pursuant to the erovlsim000he Comruen, been, Law (Cnapter9
- SqFtFloor Area '
' Valuation,
(commenoi ng, no Swann 900ga of Division 3 cf the Bashes. and Pro reti,inns Cole)1.
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or that he is exempt therefrom and the oasis for me mlegell exemption. Any violotion
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nrsedloa9031snyanyapprcumrmapermituunicetsmeappnenl�nnadvilnrnalty
or ant more than iknocked dollars ($500).
. APN• Number
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Occupancy 1�pe
❑ Los .,all of the PmMn(X o, n, employee with wages as med,ole compensmlon,
will do the k J th 'oucdrrb is not intimhod ff J for safeser. 904,1
Bus d P r.., Code : fir C I I.,', L'c e Law does( pply,ta.n
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' ' •" Required Inspections
ownerfproperty Wh n I1: npose pm - lwho d h akh'noel(
throughrhi.. nemployers. p- dedmt: nimprovementsaredtintendedor
- .-304•,—.ROUGM..ELECTRICRL.
offered f If, however di building p issold In me year or
mnilti--ne w rnnlderwllbase0 1 m rlravin,Pla Play,
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- 50l — FINAL ELECTRICAL' ENERGY"
Ise ravel r"oposeofsale),
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co L tr cwner a[mn pmpeny, wn ively withoxg:)eeol wnhnemrs m'
.'505' —,FINAL' ELECTRICAL.' ' - '
d Proving
1nStmertho p Jecl (Sec. 9044, Huxinevc end Prnfessionv Codep'fhe G,alosem's construct
Business
Law doses nal apply In an owner of pmnapeny who ld, it improves thereon,.
and who mmmds parMeets
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such pr with a mnvaFmrt,),licensed pnrsuan( m he
Coal.( 1'C aw
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El till Sri
❑I4Iee pt 1 Sri. ❑&PClot h'
Owner Daly
WORKER'S COMPENSATION DECLARATION
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Ibrlyoffr d I to Is, I(y fp 10' n (lire( 11 yd l n n.
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ID I base I w,d oldroul a Celifty,he of Consent for Worker'she
Cocremation, p f p d J it,, by Section 00 f 39 v Labor Cade, far the
ti Lab
,of daraccoi the work branch IFs peon t'.v vsuad.-
❑ 1 own tend will maintain Worker's Compen,ulion Imormar, , as required by Section
3700 of lbs Lnbbn Code, for the petionnance of the work for which this permit Is
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issued.My orker•s Cora ali/ioonnhearance carrier and Policy' number are:
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Cai'ricr: C<7 JPolicy No V&'`0J I01
y
OOCRCTJ
(TRTIFICATIO )F EXEMI'1'I )N FROM WORKERS' ..
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' COMPENSATION INSURANCE.
(This section need not be completed if the Frimim is for one hundred dnlluns
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($ W) at I";)
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1 certify that inthe performance of the work for which this permit is Issued, 1
shall nal employ any 'cum In any nwnnm Ill as u, became subject In the Workers
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Co apidi,ahon Laves of Cathartic, Dale
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Applicant
NOI'ICH'f0 APPLICANT IL, afmr nicking (his CvniOrum of Hzemption, yen $build
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becoune subject to the Worker's Compemulion pmvi s of the Labor Code, you nmol
tonhwim comply with such provisions ter has perm l shall he deemed revoked.
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e:
' CONSTRUTION LENDING AGENCY'
I hrod, afhmi C that (he, ih a eonnmeium lending agency for tire performance"
el the work for whichthis pamil is ix,vuul (Sec. 3897, Ci¢ CJ
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Lender's Noma
Lender_ '$ Address
" I comfy that l Lava mad this applinnion and state mut the unovv infonnmlan le
rect. I agree Io comply will, all rhy and county ordiamneee and state Inws relming
m building ci fre(lun, and heathy umhoivz,eprewinativev'orthis city to enter upon
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the anovo-mentioned pmpeny firinspee ion pnnpovc.
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1W16 t J fy keepdM1 tnl::Ih City fCupertinoList
liabilities, j dg em costs d expenses l h ny in any ycalls, against id
Ciry mcom g n(ng of flu, p 'I.
A NT'UNDERSI NDS AND WILL COMPLY WITH ALL NON -POINT
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URC ULAT S -
Issued by: R r J w
,I�a(e
•Sigmmur pplicarUCi hamar - Dam
'Re -roofs
,-I HALAI2DOl15 MdinjorAL5 DISCLOSUREhandl
WiIl thebythe plica, or Eamon,clCoeConntymmnr huddle
mSafetr
Type Of ROOF ` ...
as deOSed by the Oupenino Municipal Cnde, Chupmr 9.12, and the Hrallh and Safety
Braila
Cnde, Section 25592(a)'f'
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❑Ye: , '. o No
,All roofs shall be'inspected prior to any roofing material being installed..
Will theca,or limac buildho, netipante. egnlpmaalm devices which
Jepnal by
If a roof is installed without first obtainingan ins ection, Ill agree to remove
p g
edmitdr,ardnus air coationerms as the Bay Arca Air Quality Management
of:trip
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all new materials for inspection, Applicant understands and will comply with -
❑Yes .0 No
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all non -point source regulations.'
1 have rend wnc hararilous malCrwLv rupnircnmms under Chap¢r 6.95 of the
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CmilhoulIhealth & Safety Code , Section, 25505,25533 and 25534. I understand that
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is f,o myi'espnnsibiBly n, no(ify (he
ifaathebuildingdncpnotcuraswhich
musthe- mmmol
prior I. i"hanrc it a Cenificma of
Signature of Applicant' Date;.` ..
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- All roof coverings to be Class"B" or, better' ,
)w.a, bred agent .Dale
OFFICE