02070113 CITY OF CUPERTINO _
BUILDING DIVISIONPERMIT i'CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT
10300 CRESTON DR AN KY CONSTRUCTION CO N`02070113
OWNER'S NAME APPLICATI "
LYNNE A RON HANSON 2530 BAMBI LN 87}x /2002
HONE:
(408) 234-2673 SANITARY NO. CONTROL NO.
z z ARCHITECT,1ENGINEER:
O C BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
L I I
�¢c
m z, LICENSED CONTRACTOR'S DECLARATION
v.xa aU ain fulIl Chfrchy_f_cmR nthat ndewp isionsof
Chapmr9(commrnnn B
Job Descriptiontion
with Smie]p )ofDiv'sion3oftheBusinUPGRADE METER.Prfess
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DataConi my
LL o G ARCHITECT 0 Tc0
C \.)4undenrand my plans bb(( d e rdx
i g p O L«nsed Professional
c OW -BUT ERDECLARATION
11^° es
I hereby affirm shin 1 1m Business
from the Connector's o License Law for the
h? following noea permit
]031 S,Business end Professions Cade:Any city or county $1000
Y G whirhitsissuance.
requires permit re mmnum,giber,improve,demolish, fi repair ed swaurc
63m -vd hi:itsensialsnniquirtsdre kb%ismicars ofo Crnpermi's to file Lovismtemenf-
- Nahmncing with
pursuini vi the ofDimvof Ne Ce Business
Liccnu Wwlns Cor) _ apt , . .
(commencing loftheBvinexempti n,Any
tit ' 'i' ' `"'-2' I' Valuation
rommenein .. , 1` u.. . -...�.. r..t t l�i`.i; 4�!1. � ''
or Nm tie i5 in 31.3 bi Neiefr 1111cad Inc basis for she alleged exemption,m Any l violation
-of not more
than
v hundre dollaror, SSW),tsobjcru @e 4pplicanuopcivil pcnalry- 30APNlb&ebTdH ELECTR CAL.:•
mrnm more Nan R.d naaerea amina(ssao). �•" Occupancy Type
01,as owner of the property,or my employees with wages ax their axle compensation, 501 - FINAL ELECTRIC ENERGY
will do'die work:and the structure s t Intended ur"offered for sall'(Sea.']0",'
'Busid<ss and Professions Coda:The Contractor's License Law _w does not apply to an Boit$ it
owner of property who builds or improves thereon,esW who does such work bimulf
or through his own employees.Provided that such improvements am not intended or
oered for sale If,howccr the boldin t-
R t pry e t that
in o year or _ .... ..
imp'.
completion,the owner-builder will have Nc burden of Prov ng that he did not build or '1 ^- `•'
improve for purpose of sale J. F 8/1s 0 A L E
,am vrlunvd contracting - '- -----
I:as owner of the pmpcnY Y B inn licensed Ira forst
carse the does
project(Sec.To a,Stv,inowner
sty who
Code:)TC them JUL 2 4 20021"':'
and wit Ww docs nota 1 man owner of improves Na ? i
PP Y propcnY who bu Id
.and.wno commnsL su<h.mol«u wM.a cantmcmrts)Lcevd.pursuant�m the. .
e ' I .. n
Conuacmh License W _._..__.._.
❑leme exempt do Sec •BBCPCfo thisuaso 1"I.; •' t,
Owner D;(e hB`IYfLI�ING
- WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under air
hy of perjury one of the following declarations:
I hale and will
mnimGin''a CeniBcaie of GOnsam m ulr-inseu for Worker's
Compensation, es-providM for by Section 3700 of the Labor Code,for the
performance of the work for which this Permit is onood.
_ ❑1 h ve nod IIiII mairI Work: s Compcvat o 1 `rdntt.ex requiud by 5«tion
3700 of the Wbo Cod f me rformarc of N rnueu
tss,I l' Wo k res co
. y pc oone1sunne ohne dFaheytuber ue�
an
o which
c•.,
y _ CERTIFICA ION EXEMPIgON OM .5.1, .. .
.. COMPENSATION INSURANCE...... . ..._•.._._.._- __._
o''' NN soon need Ibe'complBeEdthe Permit is for one hundred dollen '`i t w ""'lv" •' f '
WN)or less.), -
P Y Ypns on r' .'
1 dmpl Nat ''Ne perfo f du h fo h ch N - - —•—•--_....._.,..._..
Compt I o y 'cr so t'become bleu NeW rkdcri
Compensauan Wwsof Cehfomm Deie
Applicant_.:
NOTICE. TO APPLICA - Y,usold
- - - _— - ---- -- -- -- ------
Z
becomesubjen to Nc WorkerCCompensation t
fonM1 N ply With provisions rill s ioso(Ne Lebo Cod you must
permit shall be deemsed revoked.
t �' '"CONSTRUCTION LENDINGAGENCY 't - '.i;:
""`I 1 Ae by elfrm that Ne a constivcs o I d g genry fo Ne pert 4manc
W '� of Nc wokfor htdh Nspe- 'ns su d(S 309] Q.C.) - ` t•
ZD: Lend Add •..a r __ _ _-__ `I_ ..-_.__
U 0
I cell fy Nat i h e ed N ppluat on a d t t Nat she abo adma is '
tL L.,: arrta 1 ag e m omp1Y nit it sty Doti co niY ordinance and sate laws rch m, '
�.f) mbuddmg constmboon.end heuby imhoriu icpresenutiJes of This city toenter upon
:it< t>a Ne abov nt o W pmperty for pectioa p ryaus /J
L•t pet fR4)egree so Dater ndemn fy and ke phartNesa the Ciry of
(,03 Cupcn against
liabil ues rydg ¢,eo t d pectus wit ch m y y w y cera g not said
U�Z' City 'c nseq cote of gram g fNis pc t
S UIIRCE
1kpRCE REE fR A.NOS ANDNILL COMPLY NTTH All`sON ."tai r
.' n NS:
- , Issued by: Dale
ignalure pphe onvacm q': '�".` Re-COOP$
as deCupertino
AZARDOUS MATERIALS DISCLOSURE' s' .'i
1 r% �IbNe C Kini a Powrt ho Id n8 aculsera stem haMle havrdous muenil Type of Roof, - .. -•--- _
y pen no Mumc pot Cod Chaps 912 e d Ne H ilN e d Saf ry "' - - - - - --
5 son255324) 4 r s. I P ry'LI v .r s _
Code DYes - �No, - e .'
r
"d-ding: All roofs shall be inspected prior to.any roofing materialbeing installed._--_.,_,.
. WiIlNeepplttnto « pem uSq pmento devitts tern If a roof Is install)d Without first obtaining an inspection' I agree to'reiriove
rryI h:actio s c u ams u/defi ped by the 111 y Arc Air Q nsy Me gement
u5tr"' p/ all new materials for inspection. Applicant understands and will comply with
itt " "; `all non-poinf source regulationsi` - "
: 1 ha lead the hezudous'mauritls gmrcmetiti'under Chapter h95 of the
Safny Cude Sections 3550$25533 end 25534.1 undcmand Nn
Ymsponsibf,Y in car
occ e t f Ne reme a Nch muu be n poo t otos ce of a Certsficau'of `
Ouo< o zc
m. e � Signature of Applicant _ - _ Date
_
fNe ultl d s
p
pant
" P ; i • All roof coverings to be Class "B ' or better
OFFICE.. . . .