00080141 +- CITY OF CUPERTINO "•
BUILDING uIIVISI NpER1VIIT' CONTRACTOR INFORMATION:
BUILDING'ADDRESS: - .. PERMIT NO:
.. OWNER'S NAtil BYRNE , _ , APPLICATION SUB DATE. .
PHONE "„HOS CHRISTY _ y c , SANIPARY.N Oal'I101,NQT
as
O�p zO ARCHITECT/ENOINF.F.R', - - BUILDING PFRMG INTO,.
•, BLOC ELECT 'PLUMB MECH
y G
aN LICENSED CONTRACTOR'S DECLARATION
� lob Description.,
0,4 real`Bran I p Charlie, ( nncrg
x .c whi.Bill rnrcn9c 11arhad affect,0Ge . Class s.n3ofthe BLu g� sora PPD!Ins CnJa..and my license £
- '• ” '
Contractor
.5,b. Palo
-
ADD f£i BEC: 19 CIRCUITS
ARCHI I fic I'S DECLARATION
O< 1 d :,. J )pF 'h R be use I p hl cords
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0 0
Licensed Protein Doul x
OWNER BUIf DPR DECLARA9ION.
u'3I hereby ff a that 1,un exempt f h Contractor 1' L formal ,
C Z¢ folio ' ,,s (Section 7031.5,Brs nc.and P froi as Cinla Any vityor county - 'rt' • ' -
55�CIs hich requirespermit .r ,,alser, inapiteve,de I'.hrepair any s rucun
u�i3m P,.III to, al 1 '.thIpl tl ape lI rI signed I,emem
. mato l : In : rt m p ,- f tile Columnar- License L (Chapter 9 SqFt Floor Area,,, - Vahiationt-" '
(en r
teing w m Semon 7000)of Division3 of tire .e Buane:and Pat..an,Cade? , -
or that Ill exempt therefrom l the basis let l lleged alvial Any viol man
of Sedion Il3I5by.' Y applicantFrap ' it subjectstheapplicanttr civil Penalty
APN Numbr"(fnot corcthanivel 0 `
Z,Occupa e
El1.mn,ca'aflhe proper,,,or my employees with wages as their sole cnnperewion,
will do the k d the , t , , 11 offered fir sale(So,.9044 -
Business d Processions C d :Th Courtrai:aL L 1 t apply 1n n 35 ircd Inspections
owner Who b ld,or'nprove,Ounc n ardwho due'3tehwork honed(
or through h':own eimplayinds.provided that such annotersers arc not intended or' - _offered fsale If,however thbuilding or improvement is willwm' one year of 304 -- ROUGH ELECTRICAL, '
completion,the oener larlder will have the burGlen of prov ng that he did all build or ,
impowcforpurposenfaale.). :50V FINAL. ELECTRICAL ENERGY n
,ol r.ftheproperty,arm exclusively arroveringwithlicense,deoranna 'S05 FINAL ELECTRICAL—
construe, '
the project(Se 9044:Business d Profen.Dns
Code) Contractor',ter e _ -
Li,eroa Lawilwas mor apply t r of propety who hand,,),-improve,therm u - '
and 'h contacts farproject,vdith a oneraemr(s)lien:e l p ant Io,he e° `
Couttuda%s License Law. - -
❑I
aw,reter extempu,nder Sac O B RP C far this maker
Data.
WORKER'S COMPENSATION
�s
DFCI ARAE ION
I hereby rffrn mill pt ' y M'perl Y of the Indiana,dI t s - r t� O + ,
Cl I have and will n ante n a CStilwate of Coolant m son unaric for Workers `
Compensation, as provided for by Section 3700 ol the Labor C.de'for the -
perf - (the wok frwhch this Planar,is ,,.ad, I
pp
WIh d 'll Nman Worker's Compensation) rejoinedbyS t -
371 f the Labor Code for the perfinrrlaunvc of rho work Alt which this per nit is - 4
_uue L My Workers Compnn
ensv,iInstill cairlar and Policy number one
anti atn.iriiJC.vi Policy No.:�GUesa /2F
_._ 4.Lat�J'ICpTION Oil 13XEMPTION FROM WORKERS' '
��'/"�I PLCOMNSATION INSURANCE
t
,. r t '
(Thi section need not be completed f(lie peormi is for one hurdled dollar,
ISI GO).1 less) v ` -
I comfy rhaf in the performance a the }k for which III,no ant is lssu ed,I
shall not employ any person y matter_so as it)bceo ate subject to the Workers'; '
Cotpen5at on Laws of Calformar Date a '
Applicant
-
d NOTICFTOAPPLICANT ifft - k' bd C tft fL _II_ ) .hnulJ - - _
z becomembJeca.theW k C mirror provisionsof the Labor Cutlet you runs[
Q .forth th conatlyw[In suchtcmwisimra�orIhis permit sballbed J revoked. -
Z r
r^� 4 CONSTRUCTION LENDING AGF.NCY - - -
I herebyoff nth that 7 udog age y C th perp Dna to ,.
.(thework f r. hchth p itis'ssue<I(SS 3017 Ci, C) t :• '; '
6i Lender s Name - ,
Lcnde ,Address -
C.I I certifythe,Ihas,r,ad th 'appl t J lons'lorthe'lilawa ilmoommairmis
O Ea
correct l 6' t rplY th all city d county d - J state 1 daring '
V ,.buildingconstruction, Jh by carbonic,repr f Y : Ifl city to enter upon
(� the abovenrectinued property f 'pe J. p m . _
:> Z�)' liabilities,judgments,) b , costsmdeml expenses
penes which
k h p1htray
re yin ruhneY-wyY-fcC p-at gm ramg-:'aniaJ
City in crawflarle a ngI
APPLICANT UNDERSTANDS AND WILL .s
_
COMPLY WITH ALL NON POINT 'tJ
Issued by:
SOURCE REGULATIONS ' ` Date, �•�—'f �`-�`�
4
Signature of Apprcnwcemranar Date jRe-roofs,.. - - - `. .•
HAZARDOUS MATERIALS DISCLOSURE 3 -
Wuth.eppliedur or future building occupant store or handle hall matim Type of Roof'- ;
;is defined by,ma Collator.Munt'pal Cade Chapter 912 and the Health old Sale,,
Cod Section 25532(.)°
°v " " n o All roofs shallbe inspected prior to any'roofing material,betng^installed'. '
Will theapplicant Iran,bidding h pt u Pmfd h _ Ifa roof is installewitho'tit first ob[almng an inspection, 1 agree to remove
cillIreland.,,,al mm I dirncd by the Bay AmaA Q Ip Mawga t
District? V all new mat Il r egPIC lion Applicant unite.." . ds°and will comply wrth,�,
°v , a all non nt rcc regulations ' ,
I l a e^I the h I - at a q ate f,' d Ch pr r 595 d th >I
Califarman,Health d Social 5505 SSA d 25594understandt,that
the
If be slot dy hrtn tthrr' }Y Larybl'ryr Blyth . e .,^f - p e Ofl
,,.pan the cls which must tire(prior roissuance.Fa Cen'fwt .fes
. Dora a ure of Applicant-. ^ > e . . . - b rte• .. . _ .
weer, a, ;aed agent Dnt ^ All roof coverings to be Class `B or better