01090030 CITY OF CUPERTINO
BDILDING DIVISION PERMITr CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
MICHAEL & *LKA NAGEL FRAN LEE CONSTRUCTION IN201090030
OWNER'S NAMEAPPLICATION SUB DATE
�o �BU �Wlino 1 13�Tti (��r 20917 FARGO DR 09/07/2001
PHONE:i SANITARY NO. CONTROL NO.(408) 996-2527
O m Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
id w BLDG ELECT PLUMB MECH
¢GUa = CJ 1_1 IJ
fir
y i LICENSED CONTRACTOR'S DECLARATION li_ i hereby affirm that 1 am licensed under provisions of Chapter 9m
,marrencing Job Description
wFuca wimSection]Wo7ofDiemen3oftheBnnleexsandprofession,Code,addmylicense TEMP POWER.
Y'ae
I,in full force and effect.
zad aV Lw are me Clasx Lir.p
O DContramor _
d.u.1-, ARCHITECTS DECLARATION
r=O aj I understand my plans shall be used no public mems,
�r
i?p OLimnsed Professiorml
m OWNER-BUILDER DECLARATION
•w R v 1 hereby affirm that i am exempt from the Cento cor's License Law for the
!=Z< following reason.(Section 7031.5.Business and Professions Code:Any city or county t $200
MFC which requires a permit to ennstrvct, q improve, ir a
ve,demolish,or repany structureai
i 3 =ids i. smidec also mo 'r U ppi tf hpernitto fl asgoed settlement, -
ttia htl I nx'ed pun (Idth pm m f th C tactor L La (Chaps 9 _ -
ea I , i Valuation
fcomme cmgwith Sat noBoo)ef Divi' 3 fm Basine -od.Rar s sidith2Y_,l>re J.t;(1'.+,.
or that A i ciempi th f' 'nd the basis for the alltged 4e pooh.A y viol tion '
-of Senior� Bin canyholicmtfora permit subjects the applicam toacivil pcnahy oraotmmemmfr m,mreadodera(swB> 1031PN1t� lr._a'.s OeeupaneyType
p L.az owner of the propeny,ser my employees widr wages az ...le compensation, '104 ROTJQ9
will d.the work,and the structure isnot imeni oroffered for'shle'(Sea:7044;'
'Bmibesi and'Professions Code:The Commnor's License Law does out apply m an Required Inspections'X
weer of propeny Who builds or improvesthereon,and who docs such work himself
0
or through h' ployees pmv den that h' p te encs anot,mended or
offered'f 1' h If. waver the building or unt3mommiatrssold within one Year of ....._....._.._.,. ._._... :.. .......... .. .. - le ...._ _..,..___ ., _ .......... ._..
completion,the owner budder will have the When of proving that he did nm build or
improve for propose of sale.). y
✓' Y71 as.. a Lth p p ny Ii-tei ly.. t t gwithic sed conscroodhor t ... .-....... .. ... _- t .
/tvextruct the project(Sce.7044 Business d Professions Code)nor Contractor's
,
License,Law does no, ppl do ner propicry,who builds p theorem, -yam
and he amuram, r- act h amrimarehm fiecrimid.ohoodure to the __ .....____....
OContractors Lm e L 77
I an &PCT thereason
OwDo �� s
ER FEN SATf N U DUN Y f
I erebyaffirmunde relit'of pequry,o eof the following dalamtions /
�+g ❑ -'wtll maintain a Cenific f Co ani-to self msum s
for Worker
Compensation, i
provided for by Section 3700 of the Labor Code, for the
partarmnwe orthe work for which this pernut Is Issued. ,
111 h nd will childish Worker's Conrpensatimi 1 m ranee as req lred by Section -
3'M of the Labor Code Far the performance of the work permit for which this peit is
issued.My Wodees Cmpenssabi msum c ammo a 11 icy man be,am:
erh k t>1"'�J;4U �!P01cy S 7 S f'
i CERTIFICATION OF EXEMPTION FROM.WORRERs' ;"': r-�tt) rte 1 ,t - �.. al 4f.,F Aft'
COMPENSATION INSURANCE t
(This section need not be compleied if the permit is for one hundred dollars
($100) 1 )
l . . - -.., - ...,...,.,. ... ...a..... ,.. ........ ................. ... ...n. ,.
1 m ft'thatin the performance o(IM work Ti",rvM1i h th leper
jshall t employ any pe n any manner so es Ice become subject to the Workers• "1"'
i,
Q O _Cmit Laws of Calf Dam
'AI
NOTICETO APPLICANT:If, k'
; t- f Emseripticur,am
should
become suirshnto the
WekCompensation provisions Cody a u
fonh th ply th ch prosmoor thispermit hall be r,ciao resk.d.
l ....._....�.. _.... i
._. ... . .
k
x "CONSMUCTIONLENDING'AGENCY "
I be by ITim thanh o xt t lend g g ncy far Ne peH rmunce .. I„ '
ftha wnakforaeldirlimislairro,i. sed lSey3097Ci.C) --_.._ __ _.- _ ..... .. . ._.._. _ .
6s:Q dithers Name r.. .. . . «., n= .. _. .. .... .... ......... .____...... .-
o:Z Lentl 5Addr llo%
I emfy thin f h d all
city
uapplicationd state thin theabs a m6muuon is..
'0 En t ortect.l agree to comply with all coop and c nty, odiati ccs and state lows refuting'
>a W toed ldngcntn ed andhreby author pd"S',vas--[h city 1. nmr upon)
,!W .the b t road pe f ' speer 'nod"S', an .
(W gEe s r ft' which
may ihcCty se ruio5gamd,
F� W' citi 1 t dg a c !ng, h h may r any , ec 1191. ainn said t
UZ Cit use Deo i g rh prma p
A L ND S SA WILL COMPLY Wit r NO�OINT r' Issued by: Date 7f ; /n
G � 1 7 �/i J
:. I$1gn t of,pp iDanUCo order, _ ".i 1� U Date Re-roofs
HA DOUS MATERIALS DIS CLOSURE yk
'i, i the applicam r f tuts b Id'ng occepantime,mrhandle hauNcoustradderial Type Of Roof .•.
as dein d by the Capenin.Mumapal Code Chepttt 9 12 d the Health and Sefery
CodeS�Y 255320 , N s ' ris, r'ca7 t S Y Qi I r r4.Y1 4Ai 4 .YG.
I' .r r ..All roofs shall.be it spectesLpnor_to.
any roofing.matenal being installed.
1.
Y1, W'113h appl c i f t«b lde,occ pain r eqo proem r de as when If a roof is installed Without first obtainingap;ilis ectioiiv I'fa ree`to'remove
emthazb 'a oro lsa.defindbyth BdyAm.A QalryMabg et, P g
. Ir
District , „l,, - , " all new materials for inspection. Applicant understands and will comply with
ore 1 o „ all'non'-porn£sourceregulations..,I,I'i „I
I hav rwd t Its a « 6
.9 re memsiunder Chapter 6.95'oTiha,
Cel fo didd, fat ,S' dons2 .25533and25534Aundemandthit!
u f, not se a to that t';mY rtspons b Tit to notify tfie
o up t f t i h mus m[
prim see'u a ce aro id a of
` n` _ .Signature of Applicant . Date
,Owner orsatlbmi#,ag ,,: 1 ,; i, ate„-, All roof coverings to be Class B oi'betteir
:1 ,, ._..... OFFICE ._.. ... .. .._ _ _......._.. .. ..... . .. . .._ .. ..