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01010049 CITY OF CUPERTINO 1, BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS JAMES CHRISTIE ELECTRIC 111q(TO"1010049 7634 KIRWIN LA OWNER'S NAAIE: MILLER DOUGLAS R AND KATHRYN A 1455 E FOXWORTHY AVE "P �"� 1N`� 1 . PHONE: (408) 369-8566 SANITARY NO. CONTROL NO. MOO ARCIB'1liCDENGINEER: .. BUILDING I'IiRSR I'INP) If I.ro ELECT' PLUMB PRICE Qi� I=1 Cl 1=1 I_I Z Oy Z I.ICBNSHDCONTRAGIOIR S DECI.ARA'HON Job Description °„i O herthy aflirin Ibat I am licensed under pmvieion.cof Chafer v Icm„on main, ce with Seclinn 7egb of Dims' on 3 of the Basinaad Prox,hn.code.and lily licen NEW PANEL sm c is in IiJI forted '^7 i z ca a Lirenv la„` © I.ic.a\\\ / L °1° Bale_� Cmtlr. 0 S u.v ANCnr F.CT'S UEC AT 10 s-=O'4 nnJermnJ Icy plain.hall M used a,1 bi sense 1, E�y— ce p,O Liecnwal I'ndcvsional - c i OWNER-BUILDER DRCLARN'ION 2, 1 hereby affirm that 1 am exempt from the Contractor',Liccn.a Law for the F=S follnwin,rcssom(Seen..7831.5.Business and PndeSaom Code:Any city ur county x e which requires a permit to commoner,aher,improve,demolish,or repair any structure a 3- it... I. 4 theapplicant r. h pa I file i'sed statement U he is racir,rdr l to the prov mv.utn C t . is License La,(Chwer9 Sq. Ft. Floor Area Vaaiillnion lar tb wit.Saaeot 70t0q of Dv' m Sol the Btnnav,and lnfcs ms Code) ... a that he Is exempt In yappli and or basin r"r the ullcycJ en.It,:I o Any vlolati"n _ at oil I....7031.5 iIt,v n....applicant lar a permit w.n'1ca'tx Aca'dpplie.n.set n null ptnmlty "rase more lemur finahamdrtd mru.tra 6vkp, APN Number Occupancy Type 01,.'o,,,,or the Properly,ar Iny employees,,It wase'a,Ihcir vote compen,aaolr. 35922014. 00 will it,,Ise work.and the ntmanure if nnI intended a otlured ha sale see.71 Business and RaleWals code Due Cnnlrunm'x License Law due'not appl5;1u anRC p 11ons mner Who Milds or improve, thereon,and who Jas such work himself 304 — ROUGH EL`�Lu QZhv or through his own employee.,provided that such improvements arc not intended or olrerval for de.If.Inc mer,be building or improvement is sold within one year of 501 — FINAL ELF_CTRICAL ENERGY innipletion,the oas net builder will have the burden ill proving that he did not build or improve n 505 — FINRL ELECTRICAL purpose 01.as owner of me property.am exclusively contracting with AcenseJ contractor.T" msumer the project(Sec.7B .Business and Prnfc,sion,Cori The,Contractor License lawo w doss not apply to an oner f property who bnildv or improves thereon, and who contracts lot such projects with a commcmrp)licensed pursuant to the Cnutrmla:,,Licenw Law. 01i I exempt under Sec. .B&11 C for This reason Owner Due WORKER'S COMPENSA IION DCCLARNIION 1 Immhy ul`in. ander penalty at rijary one of the following declarations I/ ❑ I J II amain Cntfnt tConsent l ll Wrker'% / Compo :I pinvidical lot by S floa 37gl ill the Lah Code, r the perlorroaraccul thav,ork for which this permit kissmal. 01 have and will nuinmin Worker's Com,porsalion Invurrounc.as rey d by lection 3700 of It,Labor Cale,far the performance of The work for which his permit is issued SI mkeee,Czviwer In.....cc rani N Itl umber are caner: V roue Nn.: j//_1 YL/ CEKI[F]CATION OF EXEMPTION R 1WORKER3' COMPEN NTiON INSURANCE [this section need not Na completed if the perant Is fur one hundred dollar, ($100)"1le,s.1 I oenify that In the perfnrn.ancn or the wink fur whlcb.his pennil Is unwed,I shall nut".....lily any I>cr any nr as at been.."nabject m Ilie Worker' Conynmsmion Laws ol'Cullfunne.Lanem m Applieanl Sol CH l 0 APPUCAN'L If.at nnkmg this Cant wide ill Exeunta ..l,you mould 7 hcea. c.umje,I ser l he Wader's Cnmpenwtion pro mnI the Lubar Code.you t Q O fanhwitb c....Is,wise such par vnuan ser this pemnt shall be deentnl revoked. L F' .1071.. CONSTRUCTION LENUI NG AGENCY L ak for which this mem is a construction(See. lending agency litr the performance of the work far which this pennil is issuecl lSe<.389E Co.C.1 a Q lender's Nuns � z LcnJer:Address V O 1 amity that I have read this application and slate that the above information is fL t”' c"nen.I..,rte to e...nply with all city and cm.my ordmana,aad state laws retain, Q V to building eonvtraction,and hereby authorize representatives of this city to enter upon Lheath nen omed PbrcnY uta impecoa m purposes. (Wc)agmc to save.indentnifyand keep Installs,the Ciyat Calurroo against VI liabilities,judgment,costs and e'penes which ni.y in tiny way:merue against said 7 City in.... "c..cc of ie griming of do,p:unit. _ —D APPLICANTUNDERS'T'ANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date/✓ SOLI rGU1.AT i,l"rmm �:atncanttr�'—'-^ Due Re-roofs II11,11lOU1 MATIiI ALS DISCL(ISURIi Will lhealrcantormum bulldingaavpanl Blore orhandle haeradoas.sacral Type of Roof as defined by the Cupen do Municipal Code,Chapter 9,12,and the Ifcdth and Safety Code,Nation 25532(.,)! 0Yes ONo All roofs Shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or all icr%w hich If a roof is installed without first obtaining an inspection, I agree to remove unit hazwrdom an ennmmtnants as defined by the Ray Ama Air pual ltyMam,emenl • Li,Trhr: all new materials for inspection. Applicant understands and will comply with 0)'e` ON. all non-point source regulations. I have mad the hazardous mawrials myuiremenis trader Chafer 6,95 ser the Calirorma Health&Safety Code.Seclinn'25505,25533 and 255311 understand that it The building docs not currently have 11 cram,That it is lily rc.ytunsihility to rally the xupuv A the A sire lwnts which triad he,=prior c j.'r nec of a Ccrtifcam of )A.,"'Y „.� Signature of Applicant Date "won vmmt".1,daeent L,m All roof coverings to be Class "B" or better OFFICE