00090018 CITY.,OF CUPERTINO '
Itnn.DINC n1VISION PERMITS CONTRACTOR INFORMATION:
:.e
ISUILUING AUDRRSS�.' - � -' PERMITNO .
OWNIR'S NAME: APPLICA'T'ION SDP DATE
NC 00090016 .
PHONE: - - - SANI'T'ARY NO. COMI 1101.NO.
i•J 5c;TEVFN4,; CRFEV IBI V. -09/66/2000
9
BUILDING PFRh11'1'INFO C ARCf11TECT/IiNCINEIiN: BLDG ELECT PLU=1MH n MECH
i7-8899
ZNj LICENSED CONTRACTOR'S DECLARATION Job Description -
O z O I han,biffirrou IM1 t i licensed 1 provisionsof Chapter 9 nnunenang
e F+ wins f 70(h).1 t Ihei i I'Ia 1 ndnyleense
Coe ] -'nf llf ttCn ire r
rc License CI s I tIf
Data Q{ C I torr_
3 -
ANCIII r'S DECLARATION • r
I u.aenmmi my pma,shin he used a,public records
a
<5 n ELECT SERVICE CHANGE
uyt S po p� hieenneJ Prale4.ionul' i OWNER-BUILDER DECI.the CoATION '
r' 1 hereby affirm thai 1 am exempt from the Cn,ion,Cosi License y(1 for the _
C.,>jQ followingme,nn.15ectinn emiNn,R,cher. and Rnl'exaionx Calc:Any city someare -
S F O which requires o pemtio to constmet,alter,impmve,demolish,of«Pair any mmcwre' - - -
i3$ pdonni liclea ,doodurntopo.a 1provi—ass fnr Connermiuory icense gned.aa¢mem
- thndide ingwitfbSc.ani,nlhepmvi,tnnannheennvudtne,,andseLawear,Cor9 'Sq. FL Floor Area ' .. Valuation
or that he is container with thenen om and the i sisfor l the Rusincs,and l rr Any viol tion -
or that he is therefrom and the bars for the l,,th J exemption.Any violation ,
,if.Sre,ion a than veal idnediconlrmupennil.mhjttkltte opplicnnun.civil pewlty
nr mot more that,fire bemired mdmra r851up. - APN Number ." Occupancy Type
❑La, rorlhc mr,rty,ntiny, ea loyee,with..'a,osthelr,ole compensation.
will it,,the work.'nldc.l :not law IJ ,It drr. 1 (So,.7N4, -
Ru c.:and lref.stt cd theC nr bm"Ullor,Lawdna:a.,apply as all Required Inspections
f property Who bmt ld: improves thereon and whodoes such work himself _
siowner thntngh his nun employeesprovided that such impmccmetns are nut intendedor n t {
offered for stile.If,I n,,lr,the building of imlirnvemonr is sold within one year nl ''3 t:.Fi4 Ld6Cr' QJt� -
completion.the owner,budder will have the burden of proving that he did not build or f
improve far pugro,e of s,daf, t
oL as nwnerof the property.ame.clusively. contracting is lh hde.,ed ennRaclnn In ' 304 ROUGH ELECTRICAL
e..,tme the project(see 7(u4.Business and pmre,.,inn,Cl The Comate.,', 501 - — F I NRI_ ELECTRICAL ENERGY -
Lieen,e Law does not apply In an owner nr propray who huild,o,impmve,macmt.
and It.comntets for Inch atirdt,.int.atmmeotl5) dnin,ad pu adval to in 505 — FINAL ELECT R I CAL'
ContractLicere law. '
C1I.m exempt under Sea
Owner - "- •Date
WORKER'S COMPENSATION DECLARATION _ -
Iherehyaffrntnderperilly ofperjury ate oftle fillioningdeal.neous.
❑ I h and Il maintain n C f t f Consent, for Worker', `
Cc Ip ,wi p d f by S t a111f1 f J L,'L b Cdle, dirt the -
purfortuarecofthe work for wr ch this permit is issued. - y
❑1 Novena]will maintain WorMr',Compenmlinn Insumme,n,required by Selina
.31W of the labor Coda,for the perfommnce of the work for which this permit I.issued.Sly lers Compensation Insurance eanijad{n�1eJ(s.�� - -
Carricn_/fiRT 'IG 10 �Polif,o, FROMwORK -
C CO MPENSATIONINSURANCH
(This section need not he completed!it the N mil is For ane hundred dollars - -
(41g1)orlessJ � - .t - -
Icertify that sir are in any man the work for wrier this permit it Issued.1
shall not employ any person in any manner m a,to become subject to the N'arken.' -
Compensation Laws of OJifmmia.Data . .
Applicant ., •. - - .
NOlhre,ndDllmdre/\Nrkers,C.. making Nis Cenifcam of Gentpti.n,yo...... _
,Q Obec�me subject y Ne Worker s Coma,,or ton pntvi l shop l e d L.bnr CWe,you mu.a
funhwith comply with such pnwinions.obis permit shall be deemed revoked, r
F :n CONSTRUCTION LENDING AGENCY ,
aj I hereby aRrm thud(here i,a can,lrvnion lending vycney for the performonec
r� Fr of doe w fin r which(if..permit is hatted(Sec.3097,Co.C.) „
L Q Lender's Name -
Ca.7 z Led :Address
I coar,that I have'read Ibis application and state thou the 1se infer urban ie
k. E. ..0.1 agtec In comply with all city and county ordinances and,late law,mlming
Q f,J to laidding con,tmetinn,;rod hardly tonsure representative,of Ni,any to enter upon „
gT] the abovenordinned property for impectie i pmlht,e,. t -
F y fWef ejece m save,indemnify anti keep harmless the City of Clipenimf again,,
W liabilities,juJgntena,cost. and eepenm<.hich may in any way ac<r a against said -
U City in cnmeyneWWnce ofll gen ting of this tremble n" pr
URCE I ND'AND WILL COMPLY WITHL O' INT Issued by: Date
Si lanum of A,phetm/Counceunt Date Re-roofs '
HAZARDOUS MATE<1AL5 DISCLOSURE
Will the applicant or future Fuildmig occupant store or handle hazvdou,national Type
os dadnal by doe Catwlino Nfrowipad Ciao.Clapet 9,12,ttnd the Ilwllh,toil Surety .
.Code,Seen..25532(.)? - -
• °Yes ElNo All roofs shall be inspected.prior to any roofing material being'ins,tailed.,
Will the applicant or future building occupant use equipments devices which If a roof is installed'without first obtaining an inspection, 1 agree to remove
mit humNom air com.mi...is as defined by the Illy Area Air Quality Management
,islnep < •all new materials for,inspection..-Applicant bnderstandsand will comply with
nye, ❑'rvq _ ' all hon-point source regulations. _
It...rend Ne harankmv n cane,requirements under Chapter 6.95 of the •e
Cubman'ot Health&Safoy Cuda,So,liom 25505,15533 and 25534,1 Inst .,it Thal • -
ifth.mildingdnesnot .nannyhave.,a...forma is my rtspmeib'ttya aifylhe '
s acupant or the req it 11 u„he mat,pC nifica r off o
°"pa°`y' f/II 6 0" Signature'of Applicant, • Date;
Oto ra,amhsbcd.,an, ,f Date . All roof coverings to be Class "B"Or better
CITY.,OF CUPERTINO '
Itnn.DINC n1VISION PERMITS CONTRACTOR INFORMATION:
:.e
ISUILUING AUDRRSS�.' - � -' PERMITNO .
OWNIR'S NAME: APPLICA'T'ION SDP DATE
NC 00090016 .
PHONE: - - - SANI'T'ARY NO. COMI 1101.NO.
i•J 5c;TEVFN4,; CRFEV IBI V. -09/66/2000
9
BUILDING PFRh11'1'INFO C ARCf11TECT/IiNCINEIiN: BLDG ELECT PLU=1MH n MECH
i7-8899
ZNj LICENSED CONTRACTOR'S DECLARATION Job Description -
O z O I han,biffirrou IM1 t i licensed 1 provisionsof Chapter 9 nnunenang
e F+ wins f 70(h).1 t Ihei i I'Ia 1 ndnyleense
Coe ] -'nf llf ttCn ire r
rc License CI s I tIf
Data Q{ C I torr_
3 -
ANCIII r'S DECLARATION • r
I u.aenmmi my pma,shin he used a,public records
a
<5 n ELECT SERVICE CHANGE
uyt S po p� hieenneJ Prale4.ionul' i OWNER-BUILDER DECI.the CoATION '
r' 1 hereby affirm thai 1 am exempt from the Cn,ion,Cosi License y(1 for the _
C.,>jQ followingme,nn.15ectinn emiNn,R,cher. and Rnl'exaionx Calc:Any city someare -
S F O which requires o pemtio to constmet,alter,impmve,demolish,of«Pair any mmcwre' - - -
i3$ pdonni liclea ,doodurntopo.a 1provi—ass fnr Connermiuory icense gned.aa¢mem
- thndide ingwitfbSc.ani,nlhepmvi,tnnannheennvudtne,,andseLawear,Cor9 'Sq. FL Floor Area ' .. Valuation
or that he is container with thenen om and the i sisfor l the Rusincs,and l rr Any viol tion -
or that he is therefrom and the bars for the l,,th J exemption.Any violation ,
,if.Sre,ion a than veal idnediconlrmupennil.mhjttkltte opplicnnun.civil pewlty
nr mot more that,fire bemired mdmra r851up. - APN Number ." Occupancy Type
❑La, rorlhc mr,rty,ntiny, ea loyee,with..'a,osthelr,ole compensation.
will it,,the work.'nldc.l :not law IJ ,It drr. 1 (So,.7N4, -
Ru c.:and lref.stt cd theC nr bm"Ullor,Lawdna:a.,apply as all Required Inspections
f property Who bmt ld: improves thereon and whodoes such work himself _
siowner thntngh his nun employeesprovided that such impmccmetns are nut intendedor n t {
offered for stile.If,I n,,lr,the building of imlirnvemonr is sold within one year nl ''3 t:.Fi4 Ld6Cr' QJt� -
completion.the owner,budder will have the burden of proving that he did not build or f
improve far pugro,e of s,daf, t
oL as nwnerof the property.ame.clusively. contracting is lh hde.,ed ennRaclnn In ' 304 ROUGH ELECTRICAL
e..,tme the project(see 7(u4.Business and pmre,.,inn,Cl The Comate.,', 501 - — F I NRI_ ELECTRICAL ENERGY -
Lieen,e Law does not apply In an owner nr propray who huild,o,impmve,macmt.
and It.comntets for Inch atirdt,.int.atmmeotl5) dnin,ad pu adval to in 505 — FINAL ELECT R I CAL'
ContractLicere law. '
C1I.m exempt under Sea
Owner - "- •Date
WORKER'S COMPENSATION DECLARATION _ -
Iherehyaffrntnderperilly ofperjury ate oftle fillioningdeal.neous.
❑ I h and Il maintain n C f t f Consent, for Worker', `
Cc Ip ,wi p d f by S t a111f1 f J L,'L b Cdle, dirt the -
purfortuarecofthe work for wr ch this permit is issued. - y
❑1 Novena]will maintain WorMr',Compenmlinn Insumme,n,required by Selina
.31W of the labor Coda,for the perfommnce of the work for which this permit I.issued.Sly lers Compensation Insurance eanijad{n�1eJ(s.�� - -
Carricn_/fiRT 'IG 10 �Polif,o, FROMwORK -
C CO MPENSATIONINSURANCH
(This section need not he completed!it the N mil is For ane hundred dollars - -
(41g1)orlessJ � - .t - -
Icertify that sir are in any man the work for wrier this permit it Issued.1
shall not employ any person in any manner m a,to become subject to the N'arken.' -
Compensation Laws of OJifmmia.Data . .
Applicant ., •. - - .
NOlhre,ndDllmdre/\Nrkers,C.. making Nis Cenifcam of Gentpti.n,yo...... _
,Q Obec�me subject y Ne Worker s Coma,,or ton pntvi l shop l e d L.bnr CWe,you mu.a
funhwith comply with such pnwinions.obis permit shall be deemed revoked, r
F :n CONSTRUCTION LENDING AGENCY ,
aj I hereby aRrm thud(here i,a can,lrvnion lending vycney for the performonec
r� Fr of doe w fin r which(if..permit is hatted(Sec.3097,Co.C.) „
L Q Lender's Name -
Ca.7 z Led :Address
I coar,that I have'read Ibis application and state thou the 1se infer urban ie
k. E. ..0.1 agtec In comply with all city and county ordinances and,late law,mlming
Q f,J to laidding con,tmetinn,;rod hardly tonsure representative,of Ni,any to enter upon „
gT] the abovenordinned property for impectie i pmlht,e,. t -
F y fWef ejece m save,indemnify anti keep harmless the City of Clipenimf again,,
W liabilities,juJgntena,cost. and eepenm<.hich may in any way ac<r a against said -
U City in cnmeyneWWnce ofll gen ting of this tremble n" pr
URCE I ND'AND WILL COMPLY WITHL O' INT Issued by: Date
Si lanum of A,phetm/Counceunt Date Re-roofs '
HAZARDOUS MATE<1AL5 DISCLOSURE
Will the applicant or future Fuildmig occupant store or handle hazvdou,national Type
os dadnal by doe Catwlino Nfrowipad Ciao.Clapet 9,12,ttnd the Ilwllh,toil Surety .
.Code,Seen..25532(.)? - -
• °Yes ElNo All roofs shall be inspected.prior to any roofing material being'ins,tailed.,
Will the applicant or future building occupant use equipments devices which If a roof is installed'without first obtaining an inspection, 1 agree to remove
mit humNom air com.mi...is as defined by the Illy Area Air Quality Management
,islnep < •all new materials for,inspection..-Applicant bnderstandsand will comply with
nye, ❑'rvq _ ' all hon-point source regulations. _
It...rend Ne harankmv n cane,requirements under Chapter 6.95 of the •e
Cubman'ot Health&Safoy Cuda,So,liom 25505,15533 and 25534,1 Inst .,it Thal • -
ifth.mildingdnesnot .nannyhave.,a...forma is my rtspmeib'ttya aifylhe '
s acupant or the req it 11 u„he mat,pC nifica r off o
°"pa°`y' f/II 6 0" Signature'of Applicant, • Date;
Oto ra,amhsbcd.,an, ,f Date . All roof coverings to be Class "B"Or better