00080188 CITY OF CUPERTINO -
BUILDING orvlswly - PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME _ _ APPLICATION SUB DATE
T01 GARY M R� At
ry
PITON@. SANITARY NO. CON'I'ROL NO.
�✓ O O ARCHIFECTENGiNEER: _ r - BUILDING PERM]F INFO
-"6 BLDG ELECT PLUMB SIECH
Z y b LICENSED CONTRACTOR'S DECLARATION Job Description
O¢_ I worry anion that 1 am licensed under provisions of Chapter 9(contacted, _ p
Fv, with Section 71110)ofD"Wen 3 orm Busincss.nd Prolesdnna Cale,end myliwnsc
in full force end effect.
�a
isan
Lich Contractor MOVE DEDICATED OUTLET IN KTCHN FROM CO
3 u m
Date SDECLA
C ARCHITECT'S DECLARATION MICROWAVE -
I nndersmnJ my plans shell ba used vw public recnrls
SN.y ,
tic.O O Llucnscd Pmfuwslonal
s k'�tai that I a escorDER DECLARATION
w y 1 hereby alflrm that I um exemptn the Contractor's Lisinc Law for the r _
following rcmm�.(Section 703I.5,Basin....and
m
Pfewi.iunsnns Cadet Avy city nr county
�❑ wInch a p it construct
al p d I,t p' y.t .tare
i 3 Prot r .: I q th lyd t f h p 't t did signed t rancor
Ina h r cop It ra p n Ira c tracttractim,License Los(Chpter9 S Ft. Floor Area Valuation
(commencingwallS.ct ,i7010)ofDivis t3oftheRus'nodsand're,ess,rasCode) 9' -
or.het he ix exempt therefrom and the basis far the alleged exmnption.Any virlelion '
of Section 7031.5 by any app.iannt for a pernlii suhit,,,the app.terra to a nail penalty _
orbut more[Iran five hundreddollar,($500, - APNNumber_ Occupancy-'Tile
El 1. of the property y ply 'd wages a.'her : I p saran .
will do the k d'he sall"Ime is lot alardtal or offered f (Sao.7064
Business aid Professions Code.I he Commumor. License Law does not apply to an Ired Inspections
owerfn',°`hy Who amid,in mp...d themtad whoa such work himself .3E2300E0."Imp
throughemployees provided that"I'll impmvomenls arc oat intended or
offered for sale:if,however,the building or improvement N scold within one year of -
ampletien,the owner builder will hove the burden ofproving that he did not build or
h
improve to, . .,aof-.ale.) 304 — ROUGH ELECTRICAL
❑L asowner ofaheproperty,nm axemxive.y aentrnear,with feature eantmam., 501 - FINAL ELECTRICAL ENERGY ,
onstruut the protect(Sec.70}16,Business and Punomarope
ofn Code)The Coadm
License Law does[let apply in an owner of progeny who hams or mapnwew thio on, 505 — FINAL ELECTRICAL
and who contracts for such projector with a conrtaclar(s)licensed pursuant to tire
Colt, I sLi wI Law.
0 am exec under �. Bg PC fm this mato
Owner Date bill 100
d O 8/
11 WORKLR S COMPLNSATION UL LAR TION
IInoch,d1firn,a dr,paralty ofPerjury mi fllow'n6 Aedvniionv:
❑ 1 has.and will ardioncia . Canifisam of Crunch, t .elf nand for Worker's O
Counferawfirs, as provided It.. by Station 37x1 of rise Labor.Code, for the '
Personal of the work for which this permit is Iwstmd.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37111 of the Labor Code,for the performance of the work for which this permit is -
sued,My Worker's Cmnpenwtion fusumnec rnnier'and Policy or the,are:
Cramer: Palmy No.: '
CERTIFICATION OF EXF-MPTION FROM WORKER.' ,
COMPENSATION INSURANCE
('this deaden need not ha completed if the permit is for on"hundred dollars - -
-($I00)or la".) - - ,
1 cartify that in the performance of the work for which lhis permit ior issued,1 -
,shelf not employ any person In any manner so as to become subject to the Workers' '
Compensntlon Laws of California Dale
NOTICE TO APPLICANT:If,efu r making this Cenificvte of Exemption,y,so should '
Q -
bmth
ecomesubpet e Worker'sComgensolion provsm,,ofthe Labor Cade,you must _
fonhwllh comply with such provisions onthis permit shall M1c deemed revnkeJ. _
F � CONSTRUCTION LENDING AGENCY -
1 hereby affirm that there Is a sartmnlon lending ngen.y for dw performance
of the work for which this permit Is assure!(Sea.3099,Civ.CJA.
A. Wnif Name
z Land Address
.
f..I I larry that l haormadthi application undiase boom, base jibreamerion is • .
t� H carer I ab t comply with all city and county ordinances and state laws within,
.hutldmg eoulareaion,and herehy amhmizene,,antativex"f this city coo enterupon -
'y [,a thenbove-mentioned progeny for inspection parposes
Fy 0. (We) bre it)save,indemnify andkeep harmless theCity fC primo agmum
tr V] lixhil 1 1 dg ms,cara, aid espbrac,which may in.any way recore against said
C.7 z Cityin n: oaf th g mifftit.
TUNWILL
rva NDS AND WIILCOMPLY WITH ALL NON POINT
SOURCE REGULATIONSIssued by: Date
.Sagnmure ur Appbeanl/Comm�cmr Date Re-roofs n
HAZARDOUS MATERIALS DISCLOSURE.
Will tile apprcaatorfuture building oaaapaat store orhandle members material Type of Roof .
as defined by the Cupmim,Mnnicipel Cale,Chapter 9.12,and the He d h mrd Safety -
Cole,Sedion 25532(x)'1 - -
❑Yex ON. All roofs shall be inspected prior to any'roofing material being installed.
Will the apprlaamorhand baildmgoreflood too ogdi ounaordeviceswhich If a roof is installed without first obtaininginspection, I agree to remove
emit hazardous mrc.nmminxrL as defined by The Buy Area Air Quahly Managerman an p g '
District?
C all new materials for.inspection. Applicant understands and will comply with .
❑Yes El No all non-point source regulations. PP p y
- I have mud the hemNom Sectimateon,
2 505. 5533 a under 4.1 rude
e.95 of the t
if
iling does
Safetyently Sections255115,t it
end25554.ImWnnotif that - r
if the building Jrles not currently hnvcvtenant.tlam it is my responsibiliD la notify the -
:'p ncy.I of t mgtirements which must be mea prion.an amd of a Coniflcute of
Occupa � -/ -
�dD" Signature'of Applicant Date
",act rat ath ed age.1 D-�-/Dille All roof coverings to be Class "B"or better
• - OFFICE