02070144 CITY OF CUPERTINO - ' .' +NTRAC
BUILDING DIVISION (.;COTOR`.INEORMATION:`"
PERMIT
�:b'• x .pt.f -rP.,, .
BUILDING ADDRESS:
19764 LA MAR DR PERMITN8'2 0 7 0 14 4 8.2070144
"MAI 7I S JOANNA APPUCAT6Sy1t"Cl2 0 02
?HONE: - SANITARY NO.
/. 't CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
u L_I L:7 u '
R i LICENSED CONTRACTOR'S DECLARATION
rro thereby.M.athat 1ono licensetlunderprovisiamofChapmr9(commencing UNGRADE ELECT gakDeseription
L t_� xi,hS,cti.n7000).f Dilisi..3.flh,B.,inessand Professions Cafe.mdmylicenss
m y_ is in full force and effect. -
z¢a License Class Cc.x
On u Data Comracmr
a.t a. G ARCHITECT'S DECLARATION
;1 1 understand my plans shall W used es public records
p O Licensed Professional
u,w•,m OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am ,amp,from the Contractor's License law for the $1000
a- following reason.(Section 7031.5.Business and Professions Code:Any city or county
f€o which requires a permit to construct.alter,improve,demolish.or repair any structure
w3� .pdwmits iuuerrce;also requirps,the aPPlicam fwmch permnto Ble asignM natemem - _ _ _ _ __...__..___._ __ -__
that hats Licensed pursuidto the ptovismas of that Canmctors License Law(Chapter t)
(commacing witp$ectiop Jp00)af Divisionlof the Business and Ppf¢sions Code) ��.F,\i•t1-364.W r' °s' F "r'rt r, Valuation
k,t. 10.1.L. .s Il �
or that he is taemp(iienefrom'and the basis for the alleged nemptiod.Any violetion a
-af Sectio°7031.5 by any applicant for a permit subjects the applicant to a civil penalty
7of tett more then five hundred dollen(9500). PN il, ; r..: Occupancy Type
❑l,as caner of the property,or my employees with wages us their sole compensation, 501 - FINAL ELECTRI AL ENERGY
will'do-the work:and amstructureis'out Intended-or*offered for sale(Sec:7fWa," _ _
�Busmms hoil Proiso,sm s Code:The Contractor's License Law does not apply to an
owner of property Who Wilds or impmvcs thereon,and who does such work himself
or through his own employees.provided that such improvements a«not intended or
offered for sole.1[however,the Wilding or improvement is sold within one year !- "_ ---- .._..__...... ..... ..._. . ___.. _._._ ._____. ........_._...
'dompletim,the owner W ilder will have the Wrden of proving that he did not Wild or .•S?F":e
improve
for purpose of tile.).
- ._wt Icer_ __..__ ._. . . _ _____ _
IIIc._._....___.___..-.__._..__.._._ ._. . ..._______- ___.. .____. .
ad
r: I:as wrier of Ne propmy,am thomeaaly corn Profession,
Co k:)The Common to �- —- -- -
nswct the project lScc.]Oda,Business and Professions Coded The Contncmi ti _
+ .`, .-tIfPLL �:ri i)rk„;`iIXC
License law dart not apply to on weer of Property who Wilds w improrcs tW«an,
_.arq bo eco wns.fw ryolecu widr. srutor(s)bcensd purtwm.to the
Co ors Licenu la ___._._ ___....______.
❑le pt nder5 - ``;B`&P)C for Nm reason X01' pt lot!
SEP 1 8 2002
t_, W S COMPENSANgA DECLARATION
Ai hereby affiw under petuhyof perjury c ofthe followingdeckmations:'- �����'��
❑ 1 hnde'md wilt'maintain'e'Certiflemc of Conunr to ulf-insum fon Worker-s
Comperwtion.-;u-previded-far by-Section 3700 of the Labor-Coda, for the
p ufommnce of the wort for which this Permit is Wood.
_ El haveaid'will'meinuiri.WoAirs Compenuiion innirmce,as regbised by Seaian
3700 of the Labor Code,for the pBRormance of Ne-work for which this pemut is
issued.My Workers Compensation Insurance tamer end Poli '
pen cy number are
Pohey N '( .:r c.. yl ` 1 �i. v 'r>r i'•.1. .. .t•:it.';i itf.,. . -. ._ '
Iles.:CERTIFICATION OF EXEMPTION
M FROM'.WORMU']r 1.. :� �..I.',i _ \P'1Y . til.#: •. .9.
COMPENSATION INSURANCE'_ ___
:.� -t ._.....__..__.__.._. �_
1 t (Th son needot M len ncompleted if the Permit is for one hundred dolt a. ^':I )I,C”I i 1 C L
ecti '-
(5100)a less 7.
_.0It.
.. .._.........•.�.. ........._._.._...,v._..
y!a �1 -Nat iii tit go
a of the wk(r hichihr perm t is I mad 1
shall of p1 no in nneru to=e 'm s blet9lod ri li..(i.IL' ^i J t.il�+'lyn�5ii
Compo a v C domr '•• ((
rment _.
t CBT PLICANT:If;after makl g. iCenlfmneaf EaemPtion.You shout 1; "o
Z a. I ct to the Workers Compensation provmans of theLWr Code.you must
z forth th ply with such pro tmus or this permit shell W doomed invoked.
_ .. ._
^(r t r. ">CONSTRUCTION LENDING AGENCY
°'I I hereby eRrm that there Is a construct o d ng agency for the performance e LC' I LC'' ,
flit work( hico tht permits sstied(Sec 3097 Cr C)
Q 'land rtiN me 't- a �. s 1... . ..._._.._.._ _ ._. _. .__
z LeiNers Addre
U
„ I comfy that I hely read t1us ity adapplicationnal store that s m above a mfow ais is
U roheq.l agree to rode,a he eb atu and county ordinances and stem lows relating
L1 the atheingmentioned°n;and fiertbyeuthariureposenlalivu of this city to enter upon
�,r.fres the above e) t acted property for inspection purposes _ ,
G ' (We)agreefdsae mdemnify speroudkeep whihamyinilitis any'vyafcyou Iat aid
t� Ihties 1 dgmenu.ro u and mpcnses hash they n any, ey cease age nn said v V
L,) Cit ronsequence of she ynnung' spa t i;
S0 7 AWTU�TSERSTANb yY 'ILI;'N LY WITH ALLNO�PO'kT Issuedb
q 7 Y Date
.Ec mea by the Capenlno Mon c pal Fade Ch�pmr 9 12,end the Health e Re-roofs
PP
Cod HAZARD A1'ERIan DISCLOSURE
Will the a Item t.(eras«i I n ecu t store or handle lf,sh our Safety r 1 ------
and].
-'• " --
Type of Roof
as s1. - _
e it 5321U2t Y It f I lis - C: f l .'v ♦ i.Y. 1 �s f t 1x1 L� �„ r
rr arta ria , 11 +I
_All roofs shall.be inspected,prior to,.any roofing material being installed.....................
Will the eppli put fume it ing wmpun use equipment or devices,which If a roof is iristalled'without first obtaining an-,inspection;'`I'agree to4eruove
emit It can,eraomamtnants asd1Fltied by the Bey Area Art Quality Management
Dsimm+ t ,. all new materials for inspection. Applicant understands and will comply with
-,a es- y t °',..; q «ments:uti' . .._. _ ... ._..._ -
114._ telti4kt e. t, I :1 a1non-point source regu]anonS,tri„
1
Have«idae herxd m mamriels der.Ch r 695 of Ne '
I.Hmil th&Sefit C.Sections 250325533 and 255341 understand that
Nab Iltlmg does nes aurtentlY have ire that
is my auto sbdiui gotif of
- -' '" """""'
apa of Ne rcgpirtmenu ht h,mosi m'p'or,to 4soenca ofd CeniRcn of I'
G .aZ Signature of Applicant..__ .,, ......._., Date
can r .thorizeAt gent All roof coverings to be Class B or better "
l
1 OFFICE.._ _..... ._.._.. _.