08060052 CITY OF CUPERTINOxwa
BUILDING DIVISION PE '.CONTRACTORtINFORMATI
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PEAMR NO.
."RY'9%_T".9SbE ANZA BLVD CUPERTINO ELECTRIC INC 08060052
NEWS NAME: PERMIT ISSUE DATE
PHILIP & BARGARA TRUSTEE 1132 N 7TH ST 06/06/2008
PHONE: SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
INSTALL LIGHT POLE AT BLDG ELECT PLUMB MECH
O O O D
900 LICENSED CONTRACTORS DECLARATION . ,Jpb„)]pgCp hOn
�u Ihucby affirm Nat l am licenced under provisions of Chapter 9(crmmencing - ^— ••^•• ^^--^-^ - ^^ p
with Section 7")of Division 3 of the Business and ProfessioQn,Code.and my Ileerue is
now in fail r..eawden- 6J
j z LI<enc ass tt U Lic.Y _
�Fp Dow C-3a -20Oo�+ Contractor
7W ARCHITECTS DECLARATION
s
U 1 understand my plans
Nall he used or public retard
a G H Licensed Pmfessianal
CO3 Oat I am BUILDER unDECLARATION
O hereby Maso .(Tiers on 11. Bumps from the Comas Co License Any c law for the
COO O following meson(Sutton 7031.5,Busher. and Parne,Ot ndi Cad:Any city or aunty
$ which mgvira n permit ro ionsw0.altrs.imProw,dmaRN,11 mpnfr say suumum
panic,he isl icomed c.alsontin to PovisiosofOn,far such pemrr's Lacma Law(mal stalement
< ohmhoiscingwitpursuantmtheOfDiaioi.3the nBuactor'a13.nselaw(Chapter9 Sq.Ft.Floor Area Valuation
e�$
that he
S.Iian70W)of boxisfrsh aleged..ond Professiovi Cod)or
^ Nat ha u aempl thmcfrom and the buts for the alleged essmp0on Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of APN Number Occupancy Type
not mom man fin hundred dollars ISM p y YP
I,u owam of the property.or my emplhyces with wages 0 their sale compensation,
will an the WmIL and the rotation,u Out inmutaim aRcrad roraal.(Sec.7014,Business
and Prof comm s Cade:The CantrxlMs Liceve Law does Out apply In an owner of Required Inspections
property who hold ar i mprow,Nacho,and who saes such wort himself err through his
Own emFlayces.provided mar such improvements are not inteMed oronemd forsale.IL
however,the Wilding or improvement usuld within ore fear orcompktioq the comer.
Wilder will have the Weaken of proving that he did not Wild or improve for purposa of
sale.).
1,u owner of the properly,am exclusively contracting with liamed contractors to
construct the project(Sec.7044,Business and Professions Code)The Contractor's Li.
cense law loos not apply to an owner of property who Wilds or improves thereon,and
who contracts for such pmjeces with a conuacuu(s)licensed pursuant to the Contractor's
l.ieensa Taw.
0 l ser exempt mule,gee .B&PC for the wan
w Dow
WORKER'S COMPENSATION DECLARATION
f heaby affirm under penally of perjury ou of the following dechrod ore:
l haw and will maintain aCe tifiam of Cmuenuo self.insurt for WmkchCampen-
salian,u provided fm by Seedier TIDO of the Labor Cod.fm the Performance of the
wart far which this Permit is issued.
1 have and will maintain WorkeYs Compensation Insurance,as required by Section
3700 of me labor Code,for the pcsfosmance of tie work forwhich Our permit is issued.
My Workers Campevtalion Wuraaca am.and Policy number are:
Carrier. Z0C.41 Qa s, vjnIicyNo.: G o C
CERTTFIGIE OF EMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Ih6 occoun head not 1w completed lithe permit is forane hundred dollen(SIM)
or less)
1 earl that in the perfoanana of the work fa which this permit u issued.)Nall tit
employ any person in any manurm ss be become subject to the Wodu:ss'CompemaJu
Laws of Caliromia Dam
Applicant
NOTICE TO APPLICANT:If.aMr making W.Certlrcam of Exemption,you should
became subject to the Wart ax Compensation previsions of Jur LoWr Code,you moa
.J z forthwith comply with such Provisions or the permit shall W dictated rewked.
Lzm O CONSTRUCTION LENDING AGENCY
[-r I hereby affirm mat them lace cone d.o lending agency for the perform....(
!Y i the work for which this permit to issued(Sox.3097,Civ.C.)
aA Lendces Name
z lender's Aad.
J 0 I cMify mat 1 haw read this appliesum.and ser¢Nu Oe show iafotmatiun is
D. unat.1 agree to cmnplY with all city and county onlinances and stain laws relating to
.0 Wilding continuation,and hereby authodm reprerenutiwa(tribes city to enter upon mo
14 ahovrm j.diind Pmpcny for inspection Purposes
G (We)agree to saw,indemnify and loop harmless the City of Cupertino against
sn in
equence of
growto ing
ex tenses which may in any way attne againslsaidCity
U z APPLICANT
of UNDERSTANDS
of the D mit. Issued b
APPLICANT ULATIONANDs AND WILL COMPLY WITH ALL NON-POINT y; : Date
SOURCE REGULATIONS.
Re-roofs'
Signa IlcamXOaumcb r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store tar Wandle hasardaur mamriai
as darned by ee Cupertino Municipal Cade.Chapter 9.12,and the Heald and Safety.
.Section 25532(.)?
CI Yea �u All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future Wilding Occupant If a roof is installed without first obtainingan inspection,I agree to remove
PP d p c.Air u or M... which p g
emit hmallons aircumniwm u darned by the Bay Arta Air Quality Mamgemcm all new materials for inspection.
�ismct7 p
C3 Y. fO rvu
I have mad me hvaakws materials requirements under Chapterti.95ofine Cilifor.
nice Hcalth&Safcly Cade,Sections 25505.25533 and 25534.1 undcrnand thatif Oc building
does not currently haw a term.Out It is my tapomihility to notify the ceupsum of tie
rtquimmenuwhichas t;e ptiartoinsuarue.r.ceruficatohrOcapuey. Signature of Applicant Date
-ZP
owner r h ae.g rat D a' All roof coverings to be Class'A"or better