00090163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: FERMI INO,
OW'NER'b NAME:10440 JOHNSON AVENUE TERRY BROWN, GEN C I Y91VdTOR000901.63
PHONE: SANITARY NO. CON'IRol.NO
SUSAN FROYD 1451Q BIG GASIIV WY 09/26/2000
areZ ARCHITIiCD6YGINEER: BUILDING PERMIT INFO
w- (.408) 868-1640 3LIX3 ELECT PLUMB MECH
<�G
a
y LICENSI?I JCON'nRd Lode,nsielle,DKI. al'CION
o =o t hereby antras i w 1 all Bemsea miner nnwi..iore rlcWlode9 a'ommeacive Job Description
mFw with fall
nelXoil al Divi.ion?ill the Nwinas and l'n,fcssinnsGde.and mylimnae -
M m^j
is In full have and cf4cl.
rc ¢ 1Jeenu Class Lic,a
1C a u Dmc or
IIIa,:
y 5 LL ARCTIhaS ARATION
�'=°5 1 dnee,.w;;nd my hl:ntx dl heaved
DECLDECLxee r.x pmnrr recants DEMO
ceo O LivervId I'moo,ional
c W o OWNIiR-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor'%License Law for the
C?< fallowing mason.(Section 7131.5.Businessland I'mfessims Axle:Any city or county
QAC wticM1 majoires a permit lhr,improve.dermlish,or repairy denature
�a 5near l t 1-..noinue,Ilia �'eo 11 r' tt,,fill, olined,clearcro
,hill he 1i'aaciedIs oundt ort .ittis c...onscor,L l ILn'Iter9 Sq. Ft. Floor Area Valuation
(commencing with Section 70k(d or Div sion?of the Business and Professions Code),
or that he is esempt thcmrmm and the basis tor the nneged exemption.Any violaian
of Section 7031.5 by any applicant for a permit subjean the applicant to a civil penalty.
of Bat maro than five hammed dollars Wild). APN Number Occupancy Type
❑I,r,owner af.he propcnr,,a my employac,will,wage,ax ffi lea Oaa cation, $10000
will Jo the work,and the,loa9me i,not immodest ar allemJ liar sale(Sec.7044.
Business and Profieso lis Cada:The Contractors License Law dor%not apply In an Re uired Inspections
owner of property Who builds or improves thctcon,and who docs such work nimxelf 37526047. IC10
or through his own employees.provided that.such improvements am not intended or
offered fill sale.If,however.the Wilding or impreverman is sold within one year of
completion.th,owner-0rjlder will have the Wrdcn of proving that he did not build or NO ASSIGNED INSPECTIONS
i'upma ry ymsm a .
r ser lie propenes am c,alcooely eliminating with licensed convector,to
assume project(Sec.7144,Business and Proms,ian.c Code:)The Contractor's
License Law docs not apply to an owner of pmpery who Wilds or improves frown.
and who amwets for such projects with a comrecmr(s)licensed pursuant to the
Cnnvacm to Irw.
111=ccslo';/Jlr�tun�e/c♦rtlS6cc/. .BRI/'CL�for tThis -
1C• N'ORKEMS COMP SAI'ION D[CLARATIfN �� �•r�
I hereby affirm under Penalty ofp jury line of the following declarations:
❑ 1 have and will maintain a Ccnifcam of Cnn cin m set6insure for W..ou's Y
Complueo loo, ns oo,idttd for by Station 3700 of the Labor Core, for the
parl'nnmmce of the work for which this permit Is issued.
01 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Cade,for the performance of the work for which this permit is
sued.My Worker's Compensation Insurance carrier and Policy masher am:
Carrier. Policy No
CERT'IPICAI ION OV HXEMII I ION FROM WORKERS'
COMPENSATION INSURANCE
(This mesion need not W complmcd if the permit is for ane hundred dollars
IS 100)or les.)
I amity thin in ilia Performance of the work for which this lwnnit is issued,I
,holt not employ any person in inry murmur so as to Icconte mbjen ,,'(he Wmka, .
Compenvalinn Lawn ol'Califon,it,Uwe
Applicant
NOTICE 9'O APPLICANT.IR after making this Ccnifcam of Excramon,you should
Wverm subject .,he Worker's Compensation provisions of he Labor Cmc,you must
Q O fnnbxilh comply with moll pro,kiunv or this permit.hall Wem
deed revoked.
Z r
ti CONSTRUCTION LENDING AGENCY
a > I family which(hal Owen is a nmsd I agency rte one rcrfnrm;n¢c
fill,work bar which this permit is issuedSSee,
cc.Vol.A.C Civ.C.)
L Q Lender's Name
= 7 Lender's AJJrns
V C 1 rattily that t have read this application and state that the above information is
R. rrect I alma m comply with all city and oomay ordinances;nal,sure law,rclaJng
V correct
.....and harchy I (Mario,remcnmtivicenf list,city ,I cmrupon '
'y W the aho(We)alseto pmpery Ianify and
on kepImuea.
L•' y IWe)aglecmxcost indemnify fyond which
smite City rf against
aid
fq liabilities,judgments,f,hc and capenas which may in any way revere against sail
f) Z City in nmseyuence of the gmming of this pennu. ^/� �yy
APPLICE UNDE TANDS AND WI LCOMPLY WITH ALL NO WT/ r (SSU I) DaIC� LCG IY�
SOURCAR v NS. Ys P 1 y'
sigmm�re IAP man'catttracwr - seam Re- Dots
HALARDOUS M1tATF.HIAI ti I ISCLCMRB
Will the applicant or future Wilding reverend stem or handle her udous material Type .
as de0nm by the Cupci ino Municipal Cade.Chapter 9.12,and the Health and Safety
Cma.Smaion 25532(u)7 -
0ye, 11No All root's shall be inspected prior to any roofing material being installed.
Wil ilia applicant orImum building a tnmmluseayjoulact ,,c'sieexwhich If a roof is installed without first obtaining an inspection, I agree to remove
it haaurdous or conmminants as Jemed by the Hay Arca Air Quality Mumlicmcnt
Di.,rill? all new inaterials for inspection. Applicant understands and will comply with
❑Ye, ON. all non-point source regulations.
1 hroc rand the hvardn.,nmmrid,nquircnsnts order Chapter 6.95 of the
California thrall,K Safely Cofc.Seat lnns 2550.5,255??and 255911 t dersmnJ thin kolhe,hlulda •does ten aalready name a tco:n,t.law It Is Illy mspomibdity u,raarr die
to: ercquire,nents which mast rte met prim to iaum,ec of aami=atcapaq Signature of Applicant Date
so
a aad,adeed ascot F` e All roof coverings to be Class "B•' or better
OFFICE