00120033 CITY OF CUPF.RTINO
noaDl.Nc DIVISION PERMIT CONTBACTOR'I'NFOBMATION ='� '
BUII-DINGAD'.t{' `74 CUPERTINO _ RD • r PF:NMITNO.
0�(l.c'04y1..5,:d
Ni 11'S NAM''��--FF I ;Y APPLICATION SUB DATE
CNSON• HUGH F RR,`lMRUSTF, 1.2/06/2000
PHONE: , d.- . - - - - - SANITARY NO, CONTROLNO
G o o ARCHITECTF.NOINEER BUILDING PERMIT INFO '
PP BLDG' ELECT PLUMB MECH
y Z LICENSED CONTRACTOR S DECLARATION• 7; Job Descil t1On w
O Z✓,j O I hardly if , thatI blamed d p f Ch'is 9( nmr c ng '+ , P . ,
F; with b I 7i)(KInfl ion 11 dP fete' C d d fYl neo �»
"kg Br effect. UPGRADE' PANEL '
C�Q IJe rsc Class. L N ' 1 '
Us
ARCHII FCT'S UBCIARATION
OWNER-BUILDER DECLARATION
I thereby affirm that 1 am oalain from th C I License Law,rai-Ihe _
0 N following reason.(Section 71315 Business d I'mms,lon,Code Any ity car court, ' - • y,
which y ' P II t I h p demolish, p yamlurc +
prior to Is issuance,elso requires the applicant fh pernat totile a'signed.temnmm '^ '
the'he is licii.wfill t to the pierionam,ofithe C l" I f L U (Cha,,urr9 .SCII'Ff. Floor Area '•YalUatlOn
(ca nrnc:uy win,Sectio,900fol Dirt a3 of the Bassin. dP'otestnt,Code) ,.
.1 list hout fluarefroll and(hen'', fiar the alleged exeanner.Any u'ni't on
.ar S I 9031.5 by laryariffli,sal f a sounit abject,Ihe ppl t r I p costly, .
or t n i hundred.s dollars($5nn)- - APN Number 'L d Occu ane e
❑i work,
re p i).mnye nplyeeawlhwngua ih ret lac ftn.
..,t'E,Sl30F�;�. 00 P Y.�YP
will I tilek n , t r m del. offered I (See
7]a no
Bu d'P ..Required Inspections r"
'f Code Th C' nlr I 1' � pply n
Done] fp t Who bald:orraturseves therater,laid who does such workhimself 304 = ROUGH ,F_LECTRICAL_ '
tor th ghll. own hmpl(VPusidedfl t such ihfoovmhcianotintended r '
y .
' sats JI ntoIn buildingimprovement' la within eyear(if EOi -„ FINAL -ELECTRICAL> ENERGY .
'
ipiotheooevnes alder,w Invn nalrntipmdng that nn'anot naIenr ;mprov,nrlonToenneme.). .505 —_ FINAL ELECTRICAi
mstms n r of rho Properly,am eccla,ivcly contacting with licensed contractors to
m rhe pr jecl(Secs Bit, 1,1 and Pmfesximm Chile:)l'he Contra..,', - - n +
License Law does misapply to an owner ofpmpeny who builds or improves thereon. '
and who contracts far such P'olects with a contractoro)licensed pursuant the y'
Cot t -r i' I - -
°I her assault aider Sec. - B&P CIrthis mason
w 1� r bat. 66 JS�j�:oL 2DoD .
WOR ( IirANSKI'ION DECLARATION
I herchy affirn ander penah of .rum o e of the fnllowin•deel'ohinu y - • '
Y P Y.” . 6r
° I hie and w ll'mat nal a Cenifcale of Consent to self-insure far Worker x• „,. -
Cmnrnmere I as work Fill
for by Salina 3700 of the Lobos Axle, Ins Inn - -
perfonnana of Om work far which Ihi.pcnnil is issnad. -
°I have andwill alai I'i t Worker's Comparsocialin Insurance; required by Section + _
3910 of'Ihe.l.nhm'Code for the fommnce of the,work for which this - •I "
Pur permit is
rued.My Worker's Compnnamlon Insuronec currier and Pulley ndnnher nm.- e • ,
-Grr'cr PafyNO: F -
,- IFICATION OP EXEMPTION FROM WORKERS' `
COMPENSATION INSURANCE t
j his iotoh need oat he completed i f the permit Is fart re hundred d dlua
151000or l 1x.7
1 caud,that in the Pe f ora ran illi Ihe work for which his pe mn w I....a I
shill l ply _y p y- r so v in baa n subject m Ihe Workers'
Coli alien Laws of Caffria Data
'nc +�
Applicant.. _
NOTICE TO APPLICANT.It,after making ill is Com fieam of Exemption,")a should
Muernrk
tesubjctolheWoer',Compensation prnvi sof the Labor Code,you must _
D z
Forthwith comply with such,Provisions ions or(hi parent shall bedeennl revoked.
V� � CONSTRUCTION is a ION I-ENDINn AGENCY - _ - - - '
Hholds, �
1 hem
nftum that there iss sold malet
I nlendin acne hrft rmnnco ..
Y g agencyt .
Fs7 .w Lethe work for uhuh than panne is Lvuid(See 3092 Clv.C 1 _
zLamers Nome a,
z Lender's Address a '• - ,
U 0 1 clfylh'i Ila read his rinsfis,ant' I stem than the b f f ' • " !
�T•t [r
correct,1 g I ply all II city d o 1, J c f arm 1 I i g ' - - -
•� O mh li' 8 .t -1 ndhembyoulnn ' rep I 'tfths city tacateripm s
� rW4
. Ihe b i Pe
dP tyf a sI , p p .
` V) (W. , h
F fn liab I t j dg t nt: I expenseswhich
U 4 City lacier of de granting dthi perm y lily way sagainstd
APPLICANT UNDERSTAND, AND WILL COMPLY WITH ALL NON-POINT
soukce .cuLA' .Issued by:- -'Date
sgnam I -at ern .err Dam i Re-roofs ,
t, HAT )ODS MAItkIALS DISCLOSURE _
Will the replicate name,building a P m storearo- dl n d t'e'al Type of Roof
as armed by lM Carolina m Mun cipul Gele Chuptw 9.l x.ono the Heullh ami S irety -
Code,Section 2,5532(x)'! x . . r-. .
❑vee _ Ll No All roofs shall 6e inspected"prioi.to any roofing material being installed.,
WElthanpplicintorfatarebwminsnaui,,alaseequipmer�ordevice,which If a Toofisinsfalled-without first obtaining anins ection;"Iagree toremove
l emHhcourri asabcmnimninansasdemedbytheBayAreaAironefityMan"re n g P
-+ Diaper^ all new.materials for inspection. Applicant'understands'and will comply with' f
°P' °N all non-point source regulations:
time, dine h J nm ' I. I lents ut Icr Ch ant 0.95 nl the -
Cold ` H Health&Safely Code,-S tans 25505 25533 dna 5534.I understand that _
iffi building d res not ntly hacutenunthat t is un rmsptns hiity romtdyfhe
occupant of m5c requirements which must be mel prior to issuance of a Certificate ofam
'
Occope am
Signature of Applicant ' . ` "' Date,
0...ror. aderu cal - - Date All roofcoverings to be,Class."B"ror better
a
OFFICE