01030142 CITY OF CUPERTINO'• >�aor ;;•re". t3i•,"• '.
uun.m vc utvtaroN „ - PERMIT CONTRACTOR INFORMAT30N rag
BUILDING ADDRESS. rt, ' PERMIT NO,
'].0050 S DE ANZA' BLVD " SASCO/.VALI-EY ELECTR. C + 01.0301.42
OFI N1 R'S NAME: 'r vI' 'IF APPLICATION Sl1H DATE,'-
CUPERTINO- CITY,' CENTER AS OC 'D r1'600 MEMOREX•:DR : . • 03/26/,:2001
PHONE' - t. „4 SANITARY NO. 'CONTROL NO
4 (408)t970-8300
PQ'LO ARCH ECI/ENGINEER. EBUILDING PERMIT INFO
W x BLDG LECPLUMB -. A1hC11
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LICENSED CONTRACTORS DECLARATION.
Z y c I hereby fern dot 1 _ f ,'e d p : r enap, 9 a •mins Job Description -
N�H wah Section 7000)of Division 3 of the Bu and Proleon its Coev,endny lieeme `
mm 3is
in far force one enact. t
C %License Class -- Lic.n a -: .' •', •. '4,
1Y1e `arraOlaf _TEMPORARY POWER 'SERVICE
w 3 0.,Fist ARCHITECT S DECLARATION' (f
L`O I understandany plans shall be noel as public becoof,
CO L¢ sent f,- 1
OWNER BUIL DER DECLARATION .
m—'m I h by offin, h t I a,intrude frod,the Contract I favof.r the / IF r
< indecent,ircown.(S,rlhod 7031.5,B I P f Could Any air,or county ,
which lott I t,fund. annowd, 1 I'-I p y7tewrc _ - t
i3 pro onto I. q 'heppl al hp tI II g d.a'timed `-
IF
'hal he is licarroad purcutin to the provisions l the Contractors Licarce Law(Chaining t S9' Ft. Floor Area Yi atl(xl
len g IhS I "dd)of Division 3 fin B dl f : Cede) - r
nl t he is rowneat behafrouri and the basic to, h Jetted csrundian.A y"volatien
.fSc,li 7031,5 by y ppl If retail subjects thea od noacvilpe lt, +
ern t m riverandradinputs- ($son) „APN Number Occupancy'l�ge
1:11.as of foledp ,dy nYmpl y e tl g their� I p head
will d d k f ah .l , i. , t I d B bar r.,l (Sao.9194 -
d f Code Th 'c , L L does n , pply t
B 1 36901.037.WMuired Inspections
w
ref prepcny WI been ,-i,r,ro,e th ree,, add who it If wo it h self.
IF
'a throughb. haply :.p"Idtht such1 pf.cu l ail df f
cyte I I .the if h 0 hill g I fprov ln: II Ids .. of ,
' de,plontn b ld will have nm , rnL�,ghad neganLtl,t'mor � � 103 — UFER Y -.
hnpnwere-pnrro'cof,.le) - 304 - ROUGH ELECTRICAL '
°],as owner of the property,a e ly contracting v,hit Iicadeel contractors to constant6
project the i 'eat ISee.9044,Bus'nea. d Hsda,,ionv Code l The Contractors "
License Inst nop , nn on ner of property who hu d: i heeon,
n n contracts lot such p 1 en with a contvmnrt(s)licensed pursuant to the/
Contractors Licnece Luw I - ;
0 1 a.
-
, r
rxemputndcr Sa. ,N&P C far ill,s reason - •-p'`
• "Owner Date
WORKER'S COMPENSATION
LNSATION DECI AI2ATI(lN-
Ihand,aBriii under Penalty of,pari,ry one of ale following declarations: ,
❑ 1 have and will inialai a u Card fcold oy Corona to:Ifo re, for We ker's i
" - r ,
•Cnmpe ', . provided for by Second 9900 f (lieLibor Code for the .. -
perf c ,f the wok forwlich'h,peri' ted. - '
°Ihave 1 ill nadounin Worker',Coordi Insurance,asray re by5ddo
37001 of the Labor CodCodejor the perfarrivinwe ofilark lot which his perall is -
issued MyWorkers CompcnsmoaInsurance carrier and Policy nuoulner.are - ' -
.Carrier .]),,troy No.: ,.
CERTIFICATION OF EXEMPTION FROM WORKERS'-' r
' COMPENSATION INSURANCE. "' C
- ('this recluse need not be completed if the permit is hiring hundred dollars p
is 100)tor]a,,I
•, -
I calif,then In theferIrnm nm of the veto fort winch th-pe ,il is issued,1
shall t ploy anti+ n Y n t reached bl a s N-Worker.,
..
Creasers.plI ,L W<y�P ID t - i
NOTICE IO APPLTL�Nt If.chl,,taking thk C ,f Ic ofPx p, you should - - m ,a
tecoure subjectt the Worker s C :a peprovisions ar be Lbor Code,you nus, k'
0
Lutheran band,with achlov,dicau,or[lot,permit Fall be declined revoked
Z-0 - . , ,
CONSTRUCTION LANDING AGENCY n _
G^
I hereby affiror that there 7ncion lending agency for the perfonn"nw
W Leal ' kf leh ah p mars ieuuad(Sw i09'l Cv C) - - ,
Leader',None
z
V C Icandy l.ii l have ]this ii,diduiturtand Fund Ihat hg:d,wd inficrancion as .. . -
[r correct 1 agree,o ci nilly with all city and county onf n ucre' A N,ad laws relaing -
0 f..) ¢i huitding carr.duction,and hereby authorize faresenmtivev of this city In enter npnn-
W the above-mentioned pmpeny for irvvpedinn purposes• - - ' f
<~ ay (We)agora ;III,ind,unifyinedA l hvrrle.:the Cty ilfC p t gate„
r-t to lial Iii c. Judgment ' 1 as,enar,which ar y in ant Y cr abu ns,sued al - `
f..) 'City n 4 ff1h f i g of pe- t -
APPLICA J "RS'IAN/p�SAN ILI COMPLY WRH ALLN POIT
soulacF c sl.��L�/ . a�7 cbj Issued by: Date'
slgna uae of Appl can/Cant nam, Date .Re-roofs .
HAZARDOUS MA'1'ERIALS DISCLOSURI?' - - r -
,
Will the offli t' fa b Icing nil ,,, ,rah dl l a . nchilial TypeofRoof
n,def d by th C p n pal CnJ Ch pf 9.12,hno In H alth nd Satiny
Consf.Section 5532() '
u All roofs shall be m'speoted prior to any rooting material being installed;
Will dwaHI AS future houldau,nosulant Aa rade ea which a roof is "stalled without.firs[obtaining an inspection,^i agree toyemove '
smith ll ares nam,, ' as lel aed edbyth Bay.oFeiAi Quality Mnn agement _
District'
all new materials for inspection. Applicanf understands and will comply with
❑ . a.
Yen` "° all non-point source regulations.,
1 have Front the Insurdoni unawnalk ra,hicarri under Chapter fi 95 of the - -
�Calllnm'a Heahh&Safety Code Section,2550525533 and 255341 undersumd that •• - ,
if to, gd , n t1Yl India.lhlt y pn'hlgt notify
coup t 0th rq a a hCh mus,he apt torso fa Lu,il wt f '• -
Occupan - -
, z rSignature'ofApplicant Date r
w
,.r rano Dade 'Allroof coverings to be Class Bi+or.betterIF
-
OFFICE .'.,
- - - ' e
Sent By: BASCO ELECTRIC; 408 970 8178; Mar-26-01 3:54PM; Page 2/2
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DE ANZA BLVD .
3/23/01(