00050100 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bu1Ll>IRCA3 _.. DLM ELECTRIC INC PERMI'I'NO.
�
OW'NER'SNA - - 1794 THE ALAMEDA APPLICATION SUB DATF.
050 188
r'HONIi, - SANnARY NO. l 1-
ZlO ARC U[FCT/ GINEER: (408) 947-0233 BUILDING PERIAT INFO
' BLDG I''1 FCL' PLUMB MECH
�z
LICENSEDC1)MIRACf[)R'SDECLARATION Job DCSCri [ion
C z= I Mchy worm Ilul I am 10.vmed al a yravnionx of Chapter 9l romnencing P
F v_rr wish Senimm7000)afllivi are3ufde Buxincomal I'mi 5ians CoJe,wsdmylicenu
Y—
is in full frra and effort.
S er a. Data Glu. I.ic.a
3 or
a. Data ARCHITECT'S DI Cl-A
halleaDIiCLAHATION
IaIld,:nlmw.m.yPlnn,.nwllwu.awlmmrpanuemcardf ADD ELECT
a LieenuJ 1'mt,5iaw
c OWNER-BUILDER from
Is�S I lertby.swoon
Lha 1 em emir fmm 1Pr Connacsar's Any c Low for 1ho
I.,Z oblaiill g fevssm.(Semon J031 S,Busi�vrd Pn clemals h,or Any city«evmmy
is which rets kuaa rcrmi,to cams mc4 nllm,Impnnc,said,fc,,aii a in,a stir ulry nrucwn:
�3 unitmil.iarowdpauraor IuimsllnopPsrso f«r bat Conacmino Rk Low(avmmenl
IhwheixramwibSecllimmM,.fD.�o n3,lm Hurnisum!.Pol�w...CcxClai 9 Sq. Ft. Floor Area Valuation
(what b,is wins Sarianont a)of DKass% 30l a aBesides mp ionPo,.A.,vi Cat)
a mmo he is 31.5 b 1n[t[fmm and Be,basis fa the is bre piphro i a.Any sioWial E 1
a '��r�nu��aa,(asnn.ilwn N lianlm.einlrc,wlr A14. 00 Occupancy Type
�r
D1,asm To nf , l tic nnal,ne is oto suitkdagcsmlhel k—L,mpumalion,
will ne Ibe sutra,aw Ihu oda:Tb is not Contractor
or offemd oa sak)See. to am
Brume.s and property
Who,
Cat:Tn<fwesbenr X Liana Lowdoes
sun«apply m m Required Inspections
owner d pupeny employees,
loyees,p improve Is sumo and!who Jnes seen wank i or
of Borough mr his sun howeseecs.provided 1w Asch oep is
b within
rot imendW a
completion,
fon xvle.IL howcvcr,me building a ins an offr g is vAJ he did one)'cu M
mamplminn,fine nwmf-hailucnwiuha.�Inehwennrpm,inglnnlheJidnabrilea - 304 — ROUGH ELECTRICAL
y,mve mr pmryum ar.alo).
❑1,a,owrer of dsa lnmeny,am exclusively contracting with ucomod contractors to 501 — FINRL ELECTRICRL ENERGY
mmmmet me Iroject(see.71Ws.Busine.LIw Prol.lom Cuell The ContYmr, 505 — FINAL ELECTRICAL
License Law docs rat amply m an owns of ppmy wuild.
wnoho bne impoves Ihereco
ata who commas m th
for such pojcess wilh v cu mrcur(s)Ii ei seA punuenu e
Cammnur•u Lcen.0 Lew.
❑I anm cern...akr Sac. B&I'C fur mix reason
Owner Dmc
WORKERS COMPENSATION DECLARATION
I hereby of no uldm rc.Ity of perjury t.e of me fall—inti dent rasianx:
7 I nes LW will mninwin n Comfisue of Co! In mdf.ir.urt f«Worker's
m
frcmmlon, as p M,ad Lr by 9mlinn 371X) or the L,N+ Code, for the
Parammalea„[Ire w«k rnr»n'cn mi.pem6f it msned. '
❑1 have and will mdnla rr Worker'u Compensamon Ins...as nquiml by Senior
3700 of the Lr Ctda for Ile penfomonee ft be,x. for which this Permit is
issued.Aly Wsrkcrs Conyensmion3�wi� d P
c erolicy number art:
xu t'61-w FURL U.A Pnbcy No. _U 20A I'SIA
'cA
CF. TII'IC Vl lON OP EXI?MMION FROM WORK]?RS'
COMPENSATION INSURANCE
renis union neat mot he completed if the terrorist is for«e nundrtd dallux
IS Ifi orles)
1 Gari fy Ina1 in me p_d omwnee of the work for which Ihis Permit is is:uW.1 '
sM1all nm crafty any pewn in wry mania- n.it,hecone wood tom,-Wakan' .
Comrara ion Iawu of CdiRrnia Dam _
A,I.nl
NOTICE TO APPUCANr:It.after making this CenlEcast of Exemption,you shout
becomes Nct 10 me Workers Canpeosatian pnrym isiuN Bic I ou mus Care.y
O O firsi ilh cunply wins rach fnuJ•isians ar mix .it shall M1e lecmw revakN.
z
^F ^ CONSTRUCTION LEN DI NG AGENCY
i I naehy anion Ihnt mare is a con.,.,n IcrJing age Y lie Ire perrmwnce .
nlof the work fon which this permit Ir i ed(San.11197.Civ.C.) .
CL. Lenc shone
U z L ider's Adlint
U O I ad Ify mal 1 hmc read Ihis lifi aian and Rem fhauhc ahovc information in
LL [r Corral I Utica w atmPly wins all city and aaany aJimrcc and scut laws mlalng
O U to miding umuruction,anal hechy autronic mpimcnamve of his city memerupm -
} L4 me eMwe.nerhoom propany lu ina psJnn puDrna.
A. (Welagrte ll)sav walcoIIN[y and keep h.rmlcs,the Cily of Curcninoagaina
h lianililie,iudgmaxs,a.card espenes which may in^cry way ucrve against uw
U Z' City in emseyrae'e of the gmnling of mit pclrmil.
APPIRNT SOURCGREGUDER HANDS AND WILL COMPLY WITH ALL NTIssuedb Date S- —VO
Signamrt it PPh'imuCrmuixur Dasa Re-roofs
I IADkRDOUS MATERIALS DISCLOSURE ,
Will me applieam or future hiring oemappinl Sae car handle hamm,c rs maRriut Type of Roof
as defined is the Cupenim Municipal Cat.CRyum 9.13.and Ill Ifealm mho Safely
Code,Section 2553La)?
❑Yes 0N All roofs shallbe inspected prior to any roofing material being installed.
Will One appEeml«future wilding occupant ax mla,mamor Berke»high If a roof is installed without first obtaining an inspection, I agree to remove
amt Wardous air cantymiwntx as Jcf ted by the Buy Arca Air Quality Marageart
District? all new materials for inspection. Applicant understands and will comply with
°Ye 0 No all non-point source regulations. -
I have mW We hmandors mrl n is"mariners s uMur Capes 69 of Lha
Cwlvmar"lelilh&S:dcfy Cale,Sm tin a,5505.25533 and 25,5W,l uncersland dal , .
if th,bain%docs m cunenfly have a lewnl.that if is my rc ipinsihilhy to fplify lite
occVpul of 1ne rryuireal which muu 4 mel Prior m issuarcc of a Certifcafe of
`i Signature of Applicant Date
ran arlMNi:ed ace r' " o-S„— All roof coverings to be Class `B”or better
OFFICE