01120010 CITY OF CUPERTINO ` " -
BUILDING DIVISION PERMIT ,CONTRACTOR,INFORMATION: ,
ET8Tff'&jkLVERT DRIVE JOHNSON ELECTRICAL MEC PICAL 01120010
Al°�``M STONE PROPERTY 50 WASHINGTON ST. #30 Al2/03s/2001
PHONE: (408) 690-6401 SANITARY NO. CONTROL NO.
I�n00 ARCHITECT11NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ai I . I= U _J
LICENSED CONTRACTOR'S DECLARATION
z5„? lobEVI tion
DZ_ Ihon703 mvhmlamlicensedunderpmvisionzofChupter9(commencing REPLACE 100 AMP SEVICpE PANEL
mtu� with Section 703 Division 3ofthe Business and Portaions Cade,and my license
s ' in furce ll faand effect.
Z ne c a Licenm Class Lie.#
u 3 li N Dam Contra..,
ARCHITECT'S DECLARATION
sI understand my plane shall be used as public records
u O O Licensed Professional
re OWNER-BUILDER DECLARATION
n I hereby affirm that I am exempt fr..the Crntmnor's License Law for the
I—Z a following reason.(Section 7031.5,Business and Professions Code:Any city or enunry $1200
<x a Which required.pe it .construct,alter improve,demol sh,or repair any structure
t°j h o
poor to its-issuance,alsol :(he ppl a t for such parte t to file a signed statement-
(commencing
tat nt-
mmenc ns d p e ono the p o 10 f m Commctof L Isw(Cs pt 9” -
(emm mingwon SefonOma)ofD vi' 3of the theaBusds di .AnyviCode)ioni fi.l }3" � ( I; aI >f y _r')<l+.'L' Valuation
or thatheis exempt any applicant
p li and the basis for subjects
alleged errant to Any violation t
of Section]031 5 v any hundred
dollars
fora permit subjrers th<applicanno n evil penally' '
or nal msec man five handrea aonars easool 304APNh$009U ELECTRI AL Occupancy Type
❑I,as owner of the property,or my employees will,wages as mei,secs campensati. ,. '501 - FINAL ELECTRI A'L ENERGY
will do'the work,and mrstmcmreis not intended or offered far:ale(Sea.7oa4: 505 — FINAL EIIt �'il'�'r In tions"•
r Business and Professions Code:The Contractor's License Law does not apply to an
owner of pnopeny Who builds or improves marcor,and who it.such work himself
or through gh his own employees.provided mat such improvements am cut intended or
offered f 1 1r'hooseven-me IniMmig.,u-P em is old.. ifi n one year of
completion,- the owns builder will have the burden of proving that he did not build or
improve for purpose oLmlr.)
_PtIV J�a�ED ..
O I as owner of the prop. xcsin s a i i Professions lh I'rn Th Coot.. m ,
License the project(Sec '1044 owner d etywhbCode.)The Contractor,
License Law mer not apply man owner of property who builds se improves thereon,
n
=. _.andwh.ctors turas fin"wch Projects wim.a contmaor(s)Icensed purauanrm the DEC 1 p qo o�. .. _....._... __...._ _._...__ ....._.........
Contractors License L .. ..
❑lam exempt under See. � � �� ,B&PCfonhis mason
Gwnr DataBUILDING
WORKER'S COMPENSATION DECLARATION '
i
1 hereby affirm holder Penalty of pe 3 ry one of the following declarations
(t -: ❑ 1 have and will duration a Cenifie to of Consent to relpinartme for Worker's
Compensaf as promided I., by Section 37W of the Labor Code for the
_ performance of the work far Which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is
assn" k sC -p to 1 u ecmer and Policy
numbs ne:
A i` POI CY"a
. .. ..n
CERTIFlCATION OF EXEMPT -
'Ee e JI r a s s t{ -
IONFROMWORKERsf �4p` . . Afi. firs Y",a ,Iv L'i-If .,... lw.l �
COMPENSATION INSURANCE"
(Thrss alk n need nor be loopl,ad tf the permit is for one hundred aollers
IS 100)or less.)
M(, tIcn%,Ih Iinthe pm n nee fthe workfin hthpend,evismd1° yV s• a:-
shall not employ any Section in any manner so as m beocome subject to itis'Workers
Compensation Laws of
Q . Califnmi'.Data
em : ...
. .. . .. .
NOTICE
OTI TO APPLICANT.If,after making Cof Exemption you should
-bacome subject the Work rs Compensation
psnssf Labor Code you must
foma Wit It Drop IS With such provisions or this Permit shall do deemed revoked
.. . ._- .. _....... ._._.........__ _._.._.....'
._ .. _ .._..... ..... _..___ .._. _
......
~ 71 1iCONSTRUCTION LENDING AGENCY "
of 1 hereby which that m rated(See.
S . lending v.agency f the perfoemance
at :'�,u Lea o k for which th s permit sirssucd(S '3097.Civ:C) ,
-� 'Le refs Name --"�'-•
LS. Q
'on
z dae,Adda,,
V 1 cert fy tht I have need this application n d ates,that the above'nfor mar' n'
Div F cored I agree to ply with all city had o only d nances and state laws rel ting
0:C:> to building construction,and leardly deficaute ropectindrames offifik city to enter pod f
'„y-�4 thebo boned.pr penyf inspectionp ffa .. /1. z/ /'1z,1 04 (✓`-�.
tr 0. (Wejagreem e, demnfy and keep harm) the City fCaimmno against /, / (/ 4"
r rq liabilities,judgments,costs and expenses which may in any way accrue against said
Uj City in consequence of the granting of this parmii.'APPLICANT UNDERSTANDS AND WILL COMPLYWITH ALC NON-POINT Issuedb
SOURCE REGULATIONS.', y Date
si......q fAppbcant/c t t D tq„ Re roofs
HAZARDOUS MATERIALS DISCLOSURE "
Wr Ib-implm I ur ficardi building occuparat store or handle lariandicts material Type of Roof _
asaerned b theCupertino, M al Code,Chapter 912,and me Health d Safety,, , I , y 7' p a p s an roofing material bei
ode seal n 2 532 pa , ¢ _ I M1 ,.
C $ (7r r, a yE,. y , ♦ .
Dues ❑N All roofs shall be ms ectad nor_to y_ g ng installed _ ___-_-.
wu m ppl'cant future bu Idi g occupant equipment or three's If a roof is installed without first obtaining an inspection;'d agree to'remove
oiland,hazardous
Di t eta _ all_new materials for Inspection. Applicant understands and,will comply with
r, ❑No " .9�g
❑a s" d me hazardous mammals regmrememxLinda'
a dr Chap"'
hapte 6a a of Ne" `
maturational,a y y y n
all non-point source regulations,.I ,
I ha a tea
California Health'&Safety Code,Sections 25505,25533 and 25534:1 code I thea.
iftheboddindochadarren0 have a lenanl that d ism - _..__....... . .. . ... ._____. ._ ...__.. ..". . _._ ... .. .... .. _. .. __... ..__......
g y yssuance ofa m Camp
the
tie upznl of!he
h rcgdl c- ( arab mull b at
prior to issuance
of
Certificate of
i'
" G< y I:
Signature,of Apphc,ant_..... .. ..... .... . . . .. .. Date,.. -. .- .. _. ..... ..._. .- .
g ... . -
own nmhonzea t" All roof coverings to be Class "B" of better
. . J. .. . ....OFFICE.. .