08090033 CITY OF CUPERTINOx
BUILDING DIVISION PERMIT C�ONTR/1CTCTRIN' 'OItMA�ION�
BUILDING ADDRESS: PERMIT N0.
1505 S DE ANZA BLVD GENERAL LIGHTING SERVICE 08090033
W NER'S NAME: PERMIT ISSUE DATE
GRANIT ROCK 975 CHESTNUT ST 09/25/2008
HONE: SANITARY NO. CONTROL NO.
(408) 298-6670
ARCHITECTIENGINEER: BUILDING PERMITINPO
BLDG ELECT PLUMB MECH
�Oo LICENSED CONTRACTOR'S DECLARATION O O O O
I hmebY affirm Nat L am licensed made,provisinm ail[lamer 9(conso cin, Job Description
SERVICE with 5mdon]IX0)orDivivonSofNC Business and Professions co/de.m mylicenseu SERVICE UPGRADE 400AMP TO 800AMP
in roll farce and effort. y6GB6 Yp
;12� License 4` o Le.Y—
F Dam Contractor
^Q� JdkCHITECTS DECLARATION
WU I undtand ersmy plans shoal W used as Public records
Ld
40 t; Licensed Professional
OWNER-BUILDER DECLARATION
jM 1 hemby a1Rrm that 1 am attempt fmm the Conuaaars License Law for ted
y o O following maven.(Section 7M I.S,Business and Indications Come:Any city or county
which requires a permit to ennsu act.altar.improve,den o hen.or repair any suuctum
prior to its issuance.also mquirat the applicam for such permit to file a signed statement
YsNa.WulicensedpurmarttothepmviWansofthiConnector'sLicxn¢Isw(Chipmf9 Sq.Ft.Floor Area Valuation
y F (commencing with Section 7000)of Division 3 of dee Business and Professions Code)or $65000
C0$� Nat he u caempt therefrom and the lines for this alleged in empooa.My Wolauon of �p�t�t
Sadao]0'315 by airy applicant(ora permit subjects the applicut to a civil penalty of 3 6 610121 .-tT2' Number Occu ane Type
out mom Nan firs hundred dollen sspe. P Y YP
t]I.uowmrof Nepmputy,armywplaycuwith muNetr.mlocompenadon,
wise Pr deewmes and die he Commoners
ou not smmnded w ave do(orale(Sly us an Bud r of
Nd ertywhobu builCapitds
The rmsthe on,and
Lew duel or apply il rif owner of Required Inspections
ow.crowho Wiltlsorimproveshunpuandwho.no,intended
work himselfoidfors his
awn,mplayeWiProvided that such impmsemenuartnotlear mo@tied for sae If.
builder.the Meldingrimprowmrin4hat withinane year ar Winnow
fordeowmr-
builder HII have the Wilda of proving that W did not build ail improve for puryose of
sale.).
Ej 1,u own,of the progeny,am eaclmewly contracting with licensed moco m us Is
conswct Ne project(Sec.7)44,Basin.add P stioun m Code:)The ConbacmYs U.
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such pmjema wide a comommers)limnsed pursuant to the Contractors
Lice.U.,
❑l me exempt under Sac ,B&I C for Nis revon
m Dam
WORKER'S COMPENSATION DECLARATION
[ON
hereby afrure under panslty of perjury ons ardor fallowing dedantione,
❑1 haw and will maintain a Certificate o(Consent to self-insure for WodeaesCompm-
weoa,repro fPe by Suction 5]00 of Ili Inbar Cade.(ail Ne peRonna a a(Ne
wort for which
this;permit is iaued.
Q 1 have and will maintain Workers Compensation Insurance,u required by Section
3700 of die labor Code.for the periormam a of Na were for which Utes Permit is issued.
My WoM1ers CompenWion how.caarrooror add PWiry number am:
Carried Bjz✓e?E ( •d16Na.: 33jd gz 7.r/t7G
CE •CA OF E)EM PROM WORKERS
COMPENSADOI INSURANCE
(Tlas secdm toed not W completed If IW one,Permit is far ohundred dollars($IM)
or lila)
I comfy dim in to performance of Ne work for which this Permit I,issued,1 shall mat
emPloY any person in any hoenerso u to become subject to Ne Workers'Compensation
Laws ail California Dam
Applicant
NOTICE TO APPLICANT.If,aper making N0 Certificate of Exempdon,You should
become subject to the Workul Compensdon Provisions of the Labor Code,you must
., 0 forthwith comply with such povisimo w Nu permitshall W detected msxked.
'Z y CONSTRUCTION LENDING AGENCY
F I bombs Alms din Nem u a comtructimi lending agency for to pMormane,of
ill the work for which this permit U issued(Sec.3(19'1,Civ.C.)
Lenders Name
7 Z Lenders Animal
U Q 1 mnify Nat 1 haw mad this application and tom that the eWw odd nadun is
D. F correct.1 agree be comply with all city and county ondimMr and state laws totaling to
Ov Wildingcdnstrucdon,atWhembYaudiorimmPresmtadvxlofdeiseitywcn=upnndm
ove
[Ll sh -mentioned property for inspection purymes
0. (we)agree to sun,indemnify and limp harmless the City of Cupertino against
nFw h in C.-Notendgmmhecow and expenseswo. may in any way acmme,gainst said City
V z A APPLICANT
of the granting of this pelmet. K¢
SOULICAR ULA�NS.NDS AND WILL COMPLY WITH ALL NON-POINT Issued b'y: Date �' Z
S' AZ
Re-roofs
HAZARDOUS MATERIALS DISCI
someo handle
Dam Type Of Roof
Will y t e Cllmn it future building e,Chapter
some orrandthe Headdous mammal
u de.Sed io the Cupertino Municipal Code,Chepser 9.12,end the HmIN and Safety
ode,Seddon 255320)?
❑Yes Xrm All roofs shall be inspected prior to any roofing material being installed.
Win die applicant or future building occmpanL vac equipment or dnlces which If a roof is installed without first obtaining an inspection,I agree to remove
emit haWom"air cmtaminsnu as defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
O YesNu
Thaw mad Nehan mmerials quimmcrosunder CMpuo6.95ofNeCWi(or-
-OHmlde&Sef IYCode,ScNom25505.25533 ud25534.1 undcrsmnd Natif the Wilding
docs not curtemly host a enaI4 Nu it u my mtponsibility to notify the aupm ror dm
require nowhlchen he 'a m mtmaafacrrmamar�o Signature of Applicant Date
loth ,te gen Dam� All roof coverings to be Class in"or better