01030114 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PHRMI'P NO.
1075 KENTWOOD AVE YOUNG' S CON T UCTI N 01030114
gooIWNER'S NAME. ' APPLICATION SUI. )XII?
CONWAY BUDDY ERHARDT 14839
I'IIONE: SANITARY NO. CONTROL.NO.
T
OKZ ARCH["FECII/FaIGINEER; NUILUING PERMIT INFO
w�O O BLUE Ia,EL I' pfumil MI?CII
lUJ L-_1/ IJ 1=1
I,ICFNSFII COIsmtAC1OR'S DECLARATION Job Description
O 1 hereby i ffrn.than I am Beamed under pmvisrnn.of Chapter 9 be it encing
F y'� with Section 7(gp)el On,taint 3ofthe Bas111assand Profe,wionx Code,endmy license
¢ is in full farce and elect.
X0ic
62 Len.ecico acts TEMPORARY POWER
U:nc G11 LAA _
ARC1
III 111 IIiiCLA A LUN
t a so g I understand my plans shall he used as public rccomb;
w 6 i:Y
ec O hicemctl 1'rulcuinnnlec
Oar I.Iu❑lenno1 rt UECe ConrION
w'—+ 1 hereby affirm that 1 1. esmnpt amn the CnnianC;C( License Law for the
F 7 a following mmoa(Sntrit t 7oconstruct.aftess u o ec.flannel
l nn li Cade:Any ciny or stcounty
O which it,lire.a peon:.re i..IInpier,itnprove,demolish,(it repair sig any structure
c Prima+hscensedcoutedlo.ithe pro,pidmama.l be Cmd.mi. Liccos "w slapter9
�3� th.9.heinfameJ[Wefirm7m0fol'Daamn3oftheBusinessand.ehwonsCer9 Sq. F(. Floor Area alualion
(commencing with exempt beref 90Uopd Ui ha%i% J of the Business and ion.ProdAny v Inion
or Thal M iv31,5 htherefrom and the bows its the ct%thtl exemption.Any violation
III Semon,turn iv any applicunl fur a permit subjects the applicam m u civil penalty
of nal mare d,an fee natdred etuata(ss«u. APN Number Occupancy Type
01,as owner of the property,or my employees with I,al as their sole compensation.
will do the work and the structure is not intended or offered lot sale(See.7W4, -
nu,mc2s and Pfofesshms Cle:'Ihe Contractors Lieen.e Law me,tm.apply ,,an Required Inspections
orIII of property who builds or improves Ihemon,and who J«x such work himself
through hes own employ=s.pro,ided that such improvements are not intended or 304 — ROUGH ELECTRICAL
olfemd IDI.ale.If.hnwcvcr,the bidding on impmvcnma rs sold wilhin ane year of
inplellon.theowne,"bider will the hmden at pct+ Ing hal he did tot bulli or 501 — FINAL ELECTRICAL_ ENERGY
tnnrove lor purpoa m alcl.
❑1,no owner tithe prtl+eny.am exclusively contracting with licensed contractor.,to 505 — FINAL ELECTRICAL
I.avant the project(SN'.9044.nus mI profession,Col,:) Hot Ca:nractor',
Ieense I.aw doer tet apply a col'property.M10 h lis ar huproes fi e"mi.
.ad who CounnotwC, for such pct jack with a ,m mco T)licevesl pureu9nl to the
Contraanr's License Low.
0 I at a rept under Sec. ,If It P C•for this reason
Owncr Data
WORKER'S COMPENSATION DIiCLA RATION
Ihnehy Whit..ander Iennityn1'f a jory nna or Ihn following declaakets
0 1 have ani will national. a Cenifica,of Consent to eelf-inmm for Worker's
Compensation, as provided for by Section 37f f of the Labor Cade, for the
,,,'I IT c of.be work Lor which This Penni.Is Cacti.
❑1 have and will maintain Worker'%Compensation Insurance,as required by Section
'70r)or permit the Labor Code,for the performance of the work for which this peris _
mal.My Worker'.v Comq,cm
ntion Insurance earner and Policy number are:
Comer. Policy No,
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPIiNSATION INSURANCE
('I Lis section need not be......latest 11 lie III is for one hundred dollars
(Slip)or less.)
I c,dily IC In the pefoununce of the work to.which.his permit is issued.I
shall no,employ any person in any mmronm ,,as er lucre,xuhjaa To the Workets.
Compensation Lows of Celifomin,hale
Applicant
NCTICE'f0 APPLICANT':It,a0er making this Cenrlieae of Eaemptinn,you should '
became abjerrto the WnAds Cninpansation parr,krona or the Lahor cotta,you,nus. .
Q Q h,rthwl.h cnn+ply with such pnwision,m this pem,il shall he deenmJ nestled.
Fti
CONSTRUCT ION I.FN DING AGENCY
a > I hereby nllino thm Ihe'e is a conamel ran Iend,g agency or,he bictfomancc
oI the work for which this peril is Issued(See.3097,Civ.C.)
17. Q Ixndm's Name
;D Z Lender's Address
U 1«rt ify.hat I have Cecil Illi,applieminn un I Ham that the Chose In It nnntion i,
a+rect,I agree to comply with all city and county ordinances and state lows relating
U rebuilding castuction.and hereby aulhnrve representatives ofthis city to enter upon
the vb rtrn ad pr pony I' ,vo
F 4n (We) g t sa J 'fy dk I bar"I sstheC'ty l Ca,odiaoaglno
rn liabilities,judgment J ,Csv,which Ina,in any way inceraine.gainer sad t
f„) Z City I nc ..c Cut th gmmain,ofthis permit /-�
SAPPCA OURCE, ? 'fI)SRSTANDSAND I�MPLYWITHAN,NO4PORN Issued by: b/ Dille 1
711
Sigmou, of 'p"' at roman Dale RC-roofs
HA S MATIiRlll I D[SCLOSURI:
Will the oppfnmt or Endre building a9upeat store on hamue haanions mmerial Type of Roof _
as defnml by the Coia rano III pit Cole,Chapter 9:12,and the Ilcuhh and Safety
Cole.Section 25.132fa1^ '
❑Ye, ON- All roofs shall be inspected prior to any roofing material being installed.
Will thenpprematt,rtlmre hank ,ea Ise 9,,,iptnetI t.dnviee.which If a roof is installed without first obtaining an inspection, I agree to remove
do Init hvalloos air conlamin all as defined by.he nay Area Air Quality Management
Di,ni"! all new materials for inspection. Applicant understands and will comply with
13 Yen ON. all non-point source regulations.
I have read the miordnus mmerialy requirements under Chapter 495 of the '
California Health R safety Code.Seaioas 25505.25533 and 25.134.1 mobiramnd that
if the building does not currently have a tenant,that it r,my responsibility to notify.he
�,ys�pan I In.ralurraneals wh' nw be mel prior to"lo ante of a Certificate of
�7'�1/� //'' Signature of Applicant Date
(f norm d agent All roof coverings to be Class `B"or better
OFFICE