02060032 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
N:
PERMIT NO.
20075 DE PALMA LA R & Z DEVELOPMENT COMPAN INC 02060032
'OWNER'S NAME: APPLICATION SUB DATE
�DE PALMA LANE L. P. 1601 S DE ANZA BLV 06/05/2002
- SANITARY NO. CONTROL NO.
PHONE:
t (408) 252-1101
s Z `ARCHITECT/ENGINEER: BUILDING PERMIT INFO
{,:js Zi"'•:.;'r1ri�9.•. BLDG ELECT PLUMB MECH
<« I:_7 LJ L.J I__I
LICZ 1hereb fonEhsIDsONTRACfOR'p5DEunsARATION
ofCh 9feammenem Job Description
ensed under with Section Y a f c'I"s on 3 of the Busi m Chapter
I g
ix in
y 'Tena TEMPORARY POWER
al z 6 Llcenm l Lic.K
x n O Dam ontsanA
an 0 t: a LARAH N .
g .rand my plans shat e d s public rte Ns
ens c
e ER
o. e y affirm that I crop from d muanor's Lice w for the
?a fo Ing n.(Section 1031. ,B - ss and Prof ssions Code: ny city or county'
E D which met ims a Permit to constm ter,improve,demolish,or repair any structub,
$500
oossm issmncaalsortquitestheapplicant fiesuch pennino fleasigttedsmtcment _
that he Is lioenud pursues m the provisions of the Contractors License Law(Chapter9 „_ ..- So pt F OIp ea . Valuation
¢a < ipgwunSen ]Bon)efDivison3oftheBusmesan
sdPrprewnsdm
aCo
nr N t he is c{empt therefrom and the bass for the alleged co mpuoo Any violation
..afSeelim 7031.5 by any appfcenj fora permit subjects the applicant us a civil penalty
- ��.77 mDJh�e���
of not more than five handled dollar, S500). 304APIR8ft ELECTRICAL v"! Occupancy Type
❑I,as owner of the pompxmY Y pioyecs with wages as the r sole compere t on,
-will do the w rk and the someone is not intended or'ofered'for sale(Sec.1044; -' -- - Sol - - ---- ------.—___
tBus eat and Pfes: n Code:Th uacto
C nr's License law does not apply to an 505 - FINAL
INAL EFINAL 2L I`=1 9rUctionS'(: !, '
owner of property Who builds or improves thereon and who does such work himself
r through his n employees.provided that such improvements am not intended or
o Ie If,h _th-b Id ng 0 i Id h th year of '- ` ---
'cn improve
Neowner-builder Ilh echee bud fproving roat he did n Wild ld or
' rap for P ma f.1c.), -
r ❑I so fthep pent and ly of t g th l' seJ<ot t to
co w he dprojoes ct(S ] B n<s d Raf s Code)Th C t n s -
'Lic w does re l apply t o owner f son
pc ty h bu Id p th '
[a o c such P oittts.w t torts)hcetmed pursuant to.the. . .. .. _ ._. .. ._. ...__. ,.. __ //
< < .BA a)C')fmthsmamrs
net
v�
ION DEC A N
l hereby de pewhy perjury one of a following declarations:
{ ❑ I have and ill ma min�a&rtificam of'Conam to'self-insure for Woher's
Compensation: s p :ded-for by Section 3100 of the Labor Cade, for the
perform mce,of a work for which this permit is issued
❑I have ord'tvi rmaintain Wcrmr's Compeniatiotilnsuri as required by,Section
3100'of the Labor code,rot the pciforim nce of the work for which his Permit;s
y -Co m r'n Insurancecarrier and Poly bet re
e'S' tl PoI CY - .. _ f n <t t q '-C'1t.i!.�'!5
CERTIFI ATIONOFEXEM,�+'1�q��NFROM,WORKER.S, �. {_ k, I l I "t_ y,_
C COMPENSATIO IN NSURANCE -41-
'(phis
41'(This scciiun'nedd at be completed if the permit is for one hundred dollarsI'
(S IM)or less.) rA' ' 'C'.; ...1 f, iy• ;
.v -. _:.__: .. _._
1 mythat in ter pein an c ohh sin I' M1tbjest tis me d'1 1 I !
'shall not employ any person in any man .'as to bmome mb3ca to the Workers
COP tion Wws of Califdmia.Dare ., - ,.., .
shold \r
Z beets o
bj co the W ker Cimplorlillwas provisions of dre Laher Cal y u mun '
fo
Z O nhw ill comply with such prow i ons or ih s Permit dal . . on
ced revoked.
b"^CONSTRUCTION LENDfNG AGENCY
Q. 1 hereby form that be.isit on lend ng age cy for the perform nc<
f the work for*wh ch sh 'pe tis issued trail(S(Ses'309] Cis.C)
Lander',Add s. . ,
U Qcome rI, i lyitM1I Tc d p lin t and",are liml o information is
g ply its all C and county ordinances
ad state laws minting
rob Id gc tfid
dhamby Writebefissainnatives mthiscity mentor upon
bose nt oned p o ay form coom p ppse;.,.
tot rode hot and keep l rmlass the city of C penin against
N C t u r mad nse s h M1 m Y ,any aY g inq id V v
U C e - oafh & t ti
A P[ C NT. ♦pT \\ WILILCOMPLYWI J 1i'
. its cl RE 1 ) 1'd Issued by: Date
m of ic V or 'D t ' - /
ARDOU IATERIALSDISCLOSU E : Re-roofs
" th appy ant or forum Idng oe pant tom o handle harartb s mat w Type of Roof.
_ .
5s def by C pen noM pal CM1 pt 9I2 and the andSafety
v+........
CWe ti 31512,a)?,: 1 a`
❑ t t t❑No f t V I , I
All roofs sliall_be inspected poor to,any roofing material being installed. _
"A's IIs ppion f mebuddied pay Am. irQequipment tpev devices rom, If a roof is installed without first obtaining art inspection,) agree to remove ~
cm t hazed au connotations as defined 65 the Bay Area A Q Liy Manage ent
Di" c. . . all new materials for inspection. Applicant understands,and will comply with ._
all non-point source regulations_.
I h ve read the,h dos ma iiak regmmmenm under Chapter 695 of the '
�3H &Safe Code,See tins 25505.2553J3"a 111 .IUM Mand that
sft J snot tsentlY ha arc t h t tismy msp .'blty onalify the .__ .... ... . . . . ._ .. ..._ . .. _ _ _.. . _. .. ------- ---
a
_ _ _
ix c e9no rets whit ust M at P' uajssua f .e of '
Signature of Applicant _ Date
ate
All roof coverings to be Class"B" or better '
v
. . ... OFFICE.._ _.. _ . ._ .. .