01050029 "f
CITY l FNDIVSIONlISIPERMIT CONTRACTOR INFORMATION:
BUILDINGADD1M539 FARALLONE DR PERMITNO. 01050029
2 nf5Qi9 �-!�
OWNER'S NAM APPLICATION SUB DATE
OOT KENNETH G AND JUDY I_ 05/03/2001
PHONE: s SANI'T'ARY NO, COMI'ROLNO:
O O O ARCHI'I'EC'1'717NGINIZ17R: BUILDING PERMIT INFO
m❑ BLDG ELE PLUMB MGCH
Z i Lrm thatGD CONroul under pressions
DECLARATION - Job Description
OZ_ 1tionhereby )fthan1.3 oftnmdunderprovisions.(Chapmr and(commencing
cense
F i withSection7lal0)effect. ion3 of the Business unJ lhofc,einns Cale,and my license ^KW PU SOLAR NET INTERTIE
l rs o full :m and effect.
cwa 1;ao eat.x Conti W/ BATTERY BACKUP'.
Dmc S DELLA
ARCHITIiCI"S DECLARATION
t a ; 1 unJemm�J my VIn.,shall he cord as public tecams
u O p Licensal fic"iaa.l
OWNER-Ii UILDER UF:CLARA'HON
N
u7 I hereby caffirin h t 1 a,.exempt from the Contractors Liven:,Livema,Law fur the
t Z a following ng ren(Section 7031 S Holmes,end Profession Cud A y cim mr county
5.,t Ow which req r, Labrobil lo,arolni Ia,inprove,denuffi,th,or m,i,i,.ny'unectm
EW q3 pher in t a.ist.ickom,prim,theatiplicul forsuch Isi file a,illeadmiclarfart
'but he is licensed punuanno the provisions of file Cmnrmasrs License Law(Chapmr9 - S Ft. Floor Area Valuation
(commencing with Stttied7W ,3 B)ofDi,isionof the Business and Professions Code) tl'
or that he is exempt therefrom and the basis for the alleged exemption.Any violminn
of Section 7031.5 by any applicant lis n p.nnif subjects the applicant to u civil penalty
of not more Nan five hundred doctors(S500). APN Number Occup&P.1,owner of the property,or my employees with wages as their sale condiment),
will do the work and the xmmmm is not intended or offered for sale(See.7044. 1L,�,
business d Prole.,: Code:3 no Contractor's w re
cf r s LicenLaw As not apply In an `- `s L"`s'�R8 " ired Inspections
1 property Who bunds or impm m
:thereon,,and who does such work himself
orvthrough his own employees.provided that such improvements am not intended or
offered for sale.If,however.the building or improvement is sold within one year of .304 — ROUGH ELECTRICAL
conipleion,the owner-hnllJcr will have the IF l.n of pmviag that he did nut build or
improve forpuriverofsale). 5�0 1I (TRICAL ENERGY
O L asownerof the Progeny.am exclusively cnntntcting with licensed amfraeuus to - 505 EIIVAL CTRICAL
conamd the project(Sec.7044.Business amt Professions Code:)']he Commemr:e _ NOV 1 4 L '1
Llccne Law does nal apply In an owner of properly who builds or Iniprovas thcrvon.
a000nd who comocts far such projects with a enmoctnrtsl licensed Vanuatu to the 1
Commamrs License Law
Clean
exmnpilnJer$�_�/ �r�m/B&PCfnrthicrcaeon BUILDING
Oscar RK RSCO PENS / `"
WORKER'S COMPFNSAI'10 DECLARATION
I hereby of ien unit,, a.],y of peajury one of the following dcduotimas -
❑ 1 have and will maintain a Cenilicam of Consent to self-inmm for Worker's
Compensation, as provided (or by Section 3700 of the Labor Code, for the
performance of the walk for which this permit is issue.
❑I have and will maintain Worker's Conalkhautlon Insurance,as required by Section -
3700 of the LaMsr Codc,(.r the Lbourmance of the and,for which this permit is
sued.My Workers Compenmuion Insurance carrier and Policy number am:
Ganite Policy No.:
CERTIFICAI[ON OF EXEM!"FION FROM WORKERS'
COMPENSATION INSURANCE
(This union mad not be cnmplemd Hthe permit ie In,one IF load code, '
($100)or la".)
1 certify that in the performance of the work for which this pemniu is issued,1
,had ant employ any pcuom in any Immner su as f.he..nm object to the WorkcM
Compemnation Law,of California.Date
Applicant
NOTICE TO APPLICANC IL after ranking this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you most
Q O forthwith comply with arch pmvisienx or th is permit shall he deemed revoked.
T N
F CONSem is a ION LENDING AGENCY
C Ihereby offers that there iss construction(S.. lending agency for the performance
Lz: .(the work for which this Vomit is issued(Seco 3097,Civ.CJ
L Q Lender's Nnmc
.7 z Lroubr's Audits,
U 1 certify that 1 have read this application and stem Lou the above information i..,
Fa a....let.1 agree to comply within any:old ammty aminancex and Uulo laws mhning '
U m building colmmcti.nnal hereby xuthorim repreuenlativee.(thi,city m enter upon
>„ W the above-mentioned property for inspection purposes.
0. IWel agree to save,indemnify and keep M1annless the City of Cupertino against
in liabilities,judgments,cots and expente,which ,toy in any way acme ngvinsl snit
U z Chy In c msecpmnee the coming ol'this permit
API'LI ANTUNfj�1: STAN SAND WILL COMPLY WITH ALL 'UN-HINT Issued by: _V ^ 3"•
S 'E RBGt�[e/1 NS /� / g y: Date
Signature of Applicata/Cnnmemr b 4)—e l Re-roofs
HAZARDOUS MATERIALS DISCLOSURE.
Will the...wannn furore building mLpm onesur handle remember,moterml Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.L2.and the Health and Safety
Code.Section 25532(a)^ '
El Yes No - All roofs shall be inspected prior to any roofing material being installed.
Wilt the applicant or future building occupant use equipment or device,which If a roof is installed without first obtainingan inspection, I agree to remove
mit hmardo.,air comenionn secs defined by fife Bay Area Air Quality Management P ifs
Di...iet, all new materials for inspection. Applicant understands and will comply with
oyes I�No all non-point source regulations.
I have mad the hvnamous materials regnire nems under Chapter 6.95 of the
Cadmum.Health&Safety Code,Stations 25305,25533 and 25534.1 undersmnJ❑mf
if the thele in,docs not carmally have a mnan6 track only rexpanaibility to naily th. -
c pate tf the re n which nwst be amt prior In ixsuance ofa Certificate of
or yy Signature of Applicant - Date
o ` m All roof coverings to be Class "B" or better
OFFICE
"f
CITY l FNDIVSIONlISIPERMIT CONTRACTOR INFORMATION:
BUILDINGADD1M539 FARALLONE DR PERMITNO. 01050029
2 nf5Qi9 �-!�
OWNER'S NAM APPLICATION SUB DATE
OOT KENNETH G AND JUDY I_ 05/03/2001
PHONE: s SANI'T'ARY NO, COMI'ROLNO:
O O O ARCHI'I'EC'1'717NGINIZ17R: BUILDING PERMIT INFO
m❑ BLDG ELE PLUMB MGCH
Z i Lrm thatGD CONroul under pressions
DECLARATION - Job Description
OZ_ 1tionhereby )fthan1.3 oftnmdunderprovisions.(Chapmr and(commencing
cense
F i withSection7lal0)effect. ion3 of the Business unJ lhofc,einns Cale,and my license ^KW PU SOLAR NET INTERTIE
l rs o full :m and effect.
cwa 1;ao eat.x Conti W/ BATTERY BACKUP'.
Dmc S DELLA
ARCHITIiCI"S DECLARATION
t a ; 1 unJemm�J my VIn.,shall he cord as public tecams
u O p Licensal fic"iaa.l
OWNER-Ii UILDER UF:CLARA'HON
N
u7 I hereby caffirin h t 1 a,.exempt from the Contractors Liven:,Livema,Law fur the
t Z a following ng ren(Section 7031 S Holmes,end Profession Cud A y cim mr county
5.,t Ow which req r, Labrobil lo,arolni Ia,inprove,denuffi,th,or m,i,i,.ny'unectm
EW q3 pher in t a.ist.ickom,prim,theatiplicul forsuch Isi file a,illeadmiclarfart
'but he is licensed punuanno the provisions of file Cmnrmasrs License Law(Chapmr9 - S Ft. Floor Area Valuation
(commencing with Stttied7W ,3 B)ofDi,isionof the Business and Professions Code) tl'
or that he is exempt therefrom and the basis for the alleged exemption.Any violminn
of Section 7031.5 by any applicant lis n p.nnif subjects the applicant to u civil penalty
of not more Nan five hundred doctors(S500). APN Number Occup&P.1,owner of the property,or my employees with wages as their sale condiment),
will do the work and the xmmmm is not intended or offered for sale(See.7044. 1L,�,
business d Prole.,: Code:3 no Contractor's w re
cf r s LicenLaw As not apply In an `- `s L"`s'�R8 " ired Inspections
1 property Who bunds or impm m
:thereon,,and who does such work himself
orvthrough his own employees.provided that such improvements am not intended or
offered for sale.If,however.the building or improvement is sold within one year of .304 — ROUGH ELECTRICAL
conipleion,the owner-hnllJcr will have the IF l.n of pmviag that he did nut build or
improve forpuriverofsale). 5�0 1I (TRICAL ENERGY
O L asownerof the Progeny.am exclusively cnntntcting with licensed amfraeuus to - 505 EIIVAL CTRICAL
conamd the project(Sec.7044.Business amt Professions Code:)']he Commemr:e _ NOV 1 4 L '1
Llccne Law does nal apply In an owner of properly who builds or Iniprovas thcrvon.
a000nd who comocts far such projects with a enmoctnrtsl licensed Vanuatu to the 1
Commamrs License Law
Clean
exmnpilnJer$�_�/ �r�m/B&PCfnrthicrcaeon BUILDING
Oscar RK RSCO PENS / `"
WORKER'S COMPFNSAI'10 DECLARATION
I hereby of ien unit,, a.],y of peajury one of the following dcduotimas -
❑ 1 have and will maintain a Cenilicam of Consent to self-inmm for Worker's
Compensation, as provided (or by Section 3700 of the Labor Code, for the
performance of the walk for which this permit is issue.
❑I have and will maintain Worker's Conalkhautlon Insurance,as required by Section -
3700 of the LaMsr Codc,(.r the Lbourmance of the and,for which this permit is
sued.My Workers Compenmuion Insurance carrier and Policy number am:
Ganite Policy No.:
CERTIFICAI[ON OF EXEM!"FION FROM WORKERS'
COMPENSATION INSURANCE
(This union mad not be cnmplemd Hthe permit ie In,one IF load code, '
($100)or la".)
1 certify that in the performance of the work for which this pemniu is issued,1
,had ant employ any pcuom in any Immner su as f.he..nm object to the WorkcM
Compemnation Law,or California.Date
Applicant
NOTICE TO APPLICANC IL after ranking this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you most
Q O forthwith comply with arch pmvisienx or th is permit shall he deemed revoked.
T N
F CONSem is a ION LENDING AGENCY
C Ihereby offers that there iss construction(S.. lending agency for the performance
Lz: .(the work for which this Vomit is issued(Seco 3097,Civ.CJ
L Q Lender's Nnmc
.7 z Lroubr's Audits,
U 1 certify that 1 have read this application and stem Lou the above information i..,
Fa a....let.1 agree to comply within any:old ammty aminancex and Uulo laws mhning '
U m building colmmcti.nnal hereby xuthorim repreuenlativee.(thi,city m enter upon
>„ W the above-mentioned property for inspection purposes.
0. IWel agree to save,indemnify and keep M1annless the City of Cupertino against
in liabilities,judgments,cots and expente,which ,toy in any way acme ngvinsl snit
U z Chy In c msecpmnee the coming ol'this permit
API'LI ANTUNfj�1: STAN SAND WILL COMPLY WITH ALL 'UN-HINT Issued by: _V ^ 3"•
S 'E RBGt�[e/1 NS /� / g y: Date
Signature of Applicata/Cnnmemr b 4)—e l Re-roofs
HAZARDOUS MATERIALS DISCLOSURE.
Will the...wannn furore building mLpm onesur handle remember,moterml Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.L2.and the Health and Safety
Code.Section 25532(a)^ '
El Yes No - All roofs shall be inspected prior to any roofing material being installed.
Wilt the applicant or future building occupant use equipment or device,which If a roof is installed without first obtainingan inspection, I agree to remove
mit hmardo.,air comenionn secs defined by fife Bay Area Air Quality Management P ifs
Di...iet, all new materials for inspection. Applicant understands and will comply with
oyes I�No all non-point source regulations.
I have mad the hvnamous materials regnire nems under Chapter 6.95 of the
Cadmum.Health&Safety Code,Stations 25305,25533 and 25534.1 undersmnJ❑mf
if the thele in,docs not carmally have a mnan6 track only rexpanaibility to naily th. -
c pate tf the re n which nwst be amt prior In ixsuance ofa Certificate of
or yy Signature of Applicant - Date
o ` m All roof coverings to be Class "B" or better
OFFICE