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00090085rp - OC I s oz -c M qq W 33u` P, �Z> z z0 a iazi Q •5z OU U } Gzi 'U Yom, CITYOFCUPERTINO. , •;`•.f CONTRACTOR INFORMATION: .' HUD,DOva.urvlstoN. PERMIT' BUILDING ADDRESS'. - PERMIT NO. ' oO85' - OWNER'S"��l11756.' ._ J APPLICATION SUB [)Ali" ',• ,. I Z GUIDO 1,. .. 17 SANITARY NO. CONTROL NO. ,SOL 11 '.x ARCHITECTIENGINLER:' - -BOILDING PERMIT INTO ' -BLDG • - - n ELECT' PLUMB' MrcD LICENSCDCONTRACrOR S DFCI ARATION Job Description ' '•'n - ' Ih hY II mlM1 tl 1�fne .. 'IthS 1 n'l000) rD 6 }o' �dt�� '�JfyP le p I . L d it nyI license /6/h Litersv c taamor -G 3 •UPGRADE PANEL ,100 RMP. 'TO 200- AMP, CIRCI _a ARCHITEG'r'S DECI.AR PION "- TIMER ON• OUTDOOR, I_IGHI'S. hIEW 5T. ,UPGRA I dmd,,dandmyplan ,hmI be,dsad.as pirhim mood. ., FOUNTAIN' CIRCUITI,IIEXTENSION.�-FOR FOUNTAI OWNER BUILDER DECLARATION I h by ff 1M1 t I an mardrin fmai the Contractor's License Law for the fol g' (Sect(Secti 17031,5,Built...d Peadfisian, Code: Anycity I,, only tll d I 'n,amebicwb h quP It :1 • .. s PriorIn t.t.requires1happlicantf suchpermitt flsigned:Itemenl .SgkFt. T"IOOr Area ValDahon. that he licensed ptt (he ronswams oftM1 C t' t License 1(Chapter9- (commencingwlb Section 7000)ofDivision 3 of the Business unit Profession, Code) or thinone is exempt IM1amfarm and he b .. to the alleged mpfnn Anyvlmmu n of Section 9031.5 by any applicant let a permit snued, the applienm In a civil penalty ' APN Number � � Occupancy Type of not room than rive hundred dollar., ($50") , property, r v employees s pcns7 -tilowner ohne rt n with wages a. -d i. le com tion: _ r i "Required Inspections' ) will i tl k d thestructure t intended r offered f r 11 '(S ]044 'Ra 1r . proper reds ccs rn c 1 : 1 1 : n I apply to an' own property '' p- II rumnnA h d .. t kti mall er ufo his own provided 1hm such t n eat is I e net ',b Jed of employees fered fon sole. the building en improvement , smold Primed ,be year of 0�boftr 356 ]. ZG4S. RJG w er rudder l the owner -binder will have the burden of proving shin he diJ nm'huilA nr •. s hiompletifar p f purpose fame)• ,, .' ❑I as raster of hip properly am exclusively contracting withlicensed coulactin s 1 304 --" ROUGH ELECTRICAL construct theproject (Sec 9044 Business d P od ss ons Code:) The Contractor's notapplyloanowner fn improves themonn 50;f: — FI'NRI_ ELECTRICAL ENERGY' Lieadi-a does p Iywhohald: r anti h I ill, f such projects with contractors) r d pursumtl to the - — FINAL, �"-505 e, t hm Lied dLw.f - .. _EI_ECTRICAL _° l In, exempt underSu. ;.B&PC in thixmi,en owner nam WORKER'S COMPENSATION DECLARATIONf Is - .. I herebyaffirin underpenally or pep > or [lie following d I t s I hard and 'll dancond . Certificate ofConsent t If' 'lfoa, W ker-s •.10 Compensation, as provided r by Sect 39011 of the Labor Code, for the Is- 'Nal"Invarive ofti work for hthis permit is issued, 'eYih Jwll me ma W kers Co p f nlnsuran y reJ by S' fan • , �j071 fth Lb rCJ I d pito. fin wnkf- h hlh p ,nl i, iss d MyW �-rc � In��w' anJ P,I ) mM1er.ru , �Jff�� 1 cvmcr', MY N . ^DU• L „• - - r _I'^i1V, WORKERS' CERTIFICACOMPENSION OF ATIO + t ` COMPENSATION INSURANCE ' - INSURION ANCE •- • 0 his weron need not be mmplemd TIM1e perm r is for one ht ndred doll rs e 4 - .a S ($100) or less.) 1 certify that n the perbx mance f II k f which thisp it i, nemed I _ - ,?tell ear employ any person in any seas tobecome subject to the Workers'' * darner Compensation Laws or California. Dam. , r , Applicant it •'a-. - - NOTICE TO APPLICANT. If, f1 A 61h: Critifisereal Exempriml you shot lit becamesuh,cut r.lhe Workers Compensation Poi sof the Labor Cede, ycunant !milm, It comply with such........ as or this pmeni(shallbe damned invoked., I CONSTRUCTIONL ENDING AC HNCY'- 1 hereby affirm that there is a contractie t lending agency the the performance , ofth Isf,rwhichthis permit is l...W(Ser 310] Civ C,) Lend r. Name _ _ 1 .. Leddcr'. Adeffe, - ♦ _ '}. 1 certify that I h d this ppb I nsimulate the, lM1 ab 1 a I, t t I ting curate,. 1 g t .IY tl II and moan an I since ly reminders tbuilding consmeti t and hereby doth epresenloli w orlhts,ty mcnhrtma, a the ab.,wendationed.rope ry f r InsipidEt n p rp ce - - - I:' ' . - •- (Y)eBeatcdmdmfy andkeep h : the Coy of Corsi .,ain't •r s liabilities,judgments, costs aad wm,me which may In any way mune agar laid n �� City in nsequece ofth gaining (if lh pcmil: - APPLICANT UNOERSTA�'D�A ILL COMPLY WITH ALL NON- INT [saDedb Date Y' SOURCP REGULATION7.L.-^ 9 p • �' Signature fApplearticVVVVnrJJJJt al Re roofs .F _ HAZARDOUS MAT IAI S DISCLOSURE' Willth apps' r f t b ld' g p to ,h dl hoed" . .lateral TYPe Of'ROOf -In - as Jefred by [he Criterion Municipal Code Chapter 9 l_, nd the Health and Safely - + Cede, Section 25532(a)', _ /• '' ' ' ' 1 ❑vea r „ ' • All roofs shall be inspected prior to any roofing material tieing installed. Will the dP.licart or from hirudins eaerient' irse equipment or devices which If a roof is installed' without first obtaining an inspection, I agree to remove . coil it cot nl, as da6ndby the By Am, Air Qumty Management -r' rote air"- � ' ; all new materials for inspecti•ollE nt Applicaunderstands and will comply with . ,. all non -point source regulations. 1 h d he harould.on'smarmal, y tau do Chapter fi y5 the a - Cvrf Health Safety tl Sections 25505,25533and 25534 I nit nd(ar -- - fifth trilling d s not e rl [bar it myresponsibilitys n 'lh p t Id qthichmidbeme,pror issuance r ,. Oc p y �m Signature of Applicant'Date' I o All roof coverings to be Class B or better: Owner tirautharizd nt I Date OFFICE ,.,_ _ _sr d