03010102CITY OFCUPERTINO
BUILDING DIVISION PERM IT
BUILDING ALDB ZSANO / RODR I GUE S
- � ,
RAVI.Yz11 �IO
-co NTI'ORINk'FSR„oiIA',
GIA
PERMIT NO.
OWN T`PALMAS LANE LP
6300 MONTEREY
PeRM ueD
SANITARY NO. C 0.
(408)842-9655
BUILDING PERMIT INFO
ARCHITECf/ENOINEE0.:
O ELECT PLUMS O
LICENSED CONTRACIORB DECLARATION
Job Description
1 hereby Nal l em licensed under pmvlsloK of Chapter 9 (commencing
with Station of Divl on Sof du Bear dBrofKsioKCode,uldmyllcentU
CJ
p� p y� n p pal
F II WJ L 9.adl
'
In full force attract. _
Lima. Cl Lt. IS
G°°t°
STREET LIGHTS/BOLLARD
JUN 1 0 2003
Deas
ARCHDELLA 1 N
1. ..11.y phos/M1)1111 Ipyf6d as p c rttordi
L..ear dcoal
OWNER -BUILDER DECLARATION
BUILDING
g I hereby affirm that I am exempt from the Contractor's License Law far the
D following mems. (SaOon 11171., BKiness end protesaiu. Cale: Any city or county
-
which requires a permil to construct, alter, lmpm., dcmnlim. K repair toy awnure
lohebausnce,arm inquhms the applicant for such penult 0 file a Sigma statement
Sq. Ft. Floor Area Valuation
Prim
< that he Is liconxed PumnnuolM Pmvl-to- of the Crunowor'WCo.c I.. (Chapter 9
(commencing with Schon 7000)ofD"Im, 3 M the Business and Protein°. Cc#) -1
,
. thai he h exempt therefrom and the bash ran the alleged exemption. Any violation of
for a subjects the applicant e A dkl Penalty of
0 cal anC e
Number P Y PrP
Section 70313 by any appllcanl Permit
no, am man raw hundred dollars ($500).
369 3 2 0 0 3. 0 0
3 6
0 j. an owner of the pmpeoy. or my employees wit wage a 0ulrmle Compemtin".
will do the work.and the atN°Nm is not Intended or offered to W,(Sec. 7044. Business
egg�ired Inspections
and Pref naloK Code: The ConuacSees Liman, Law dans Out apply u an owner or
who daessuch work himself ser Woughhis
304 — ROUGH N' LE CTIZ I CAL
Property who builds or improves lhcretin.and
If,
dalsuch impmcemeu nare not Intended croRered fertile,—
501 FINAL ELECTRICAL ENERGY
..employees, provided
however, the building K impre"amell is told within one year of Completion. the."",.
held ser imprme for purpoac of
505 — FINAL ELECTRICAL
Wilder will live Ina burden of proving that Its did ool
axle.).
❑ I, as owner of the progeny, am exclusively contracting with licensed contractors to
7044. Business tad Freiman. Code:) The Con=es U-
wKtrvn BIC pmjm lgee.
ce.e law docs not apply m m owner of property aM10 builds or impress durton, and
licensed to the Communities
.
who contents for such pmejmin with a e°nnelor(e) pursuant
License Law' , B 8 P C for this won
[3 1 am exempt under See.
Data
WORKERS COMPENSATION DECLARATION
hereby aBiren under penalty of Pedury ane of the following dedi ntions:
and willmainW na CUMcemtif Consent se1M.urt fn WormesConi
provided for by Section 7100 of the labor Code, for NepeRormance of Ne
which this permll is issued.
103cm1y"Wh,
andwillmaintain Weanea Cpwxxm IKWa11R, at required by Section
Code, for Ne of the work for which this pernil is Issued.
the labor performance
ker's Co pma.lia9lneu�na earticr sndP
EXEMPTION FROM WORKERS'
ERTIFICATE/OF
COMPENSATION INSURANCE
(ITIS section need ame, completed If the Permit Is fntinohundreedellan (5100)
tar len.)
I =try that in the performance of the work for which this Permit is issued. I Mail not
in any manner an u m become subjecl,a the Worker' ComPe.adon
employ any peen
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If.afar making this Carlini of Exemption. you Should
become subject to the Worker's Compensation previsions of the labor Coke. you must
`Z, forthwith comply with such provisions or this permit shell be deemed invoked.
0 CONSPRUCDON LENDING AGENCY
1 berehy, ai mw that there Is • construction lending agency In the perfurmmm of
> the work fn which th4 permit is Issued (Sm. 7097• Civ. C.)
QLender's Name
_
z Lender's Address
Q 1 ,Wry that 1 have read this sppilntlon and sum that the sbuce Informnlun
wide all city and county owinames and start leas mining
h
to
corms. 1 a&= to comply the
building conswei ad hereby suNodd reprttsenailvet this city to enter
shove.mentioned pmpeny (n inspection purPoees.
menu against
a sgal.t
indemnify and keep m the City
1. ti
I par (Wb) egnx to eve,
may i =me
f/f liabilities, judgments, costs and caPensea which may In my array attmc agelnstseld City
I
r77 In coll¢qumm of the granting of this pereal. Date
APPLICANTREGUDNUNDERSTANDS A ILL COMPLY WITH A6{c910N-POINT Issued by:
SOU EREGU ONS. � �-JNL/7v
�_
Re -roofs
si lure of ppli on m
Type of Roof
HAZARDOUS MATERIALS tKowOSURE
un Sudai
Willy inns or (Muni building eccupmrnorc Omand
He Health and
as earned by tits Cupertino Municipal Code. Chapter 9.12. and tite Health end Safety
abe C
All roofs shall be inspected prior to any roofing material being installed.
ode. Section 23532(x)7
❑Yes �"°
If a roof is installed without first obtaining an inspection, I agree to remove
will Ire applicant or (alum buildin axupant .c input inenl or dclim which
"w
for inspection.
A, hanNoue oir contaminants as d cal by the Bey Ame Air Quality Management
all new materials
ricO
❑Yes o
I have rte the hmardnusmateriale requirements under Chapur0.95oHhc Celifor-
ntleNaidJhLLlfBcbuilding
not currentlyhaw nm4 that t h y sGory Ihilily to wary, uPan
entswmtn I I emelP r tt isoniR.�roempan
dmDale
Signature of Applicant
All roof coverings to be Class "B" or better
wncr ter east td eFe -v0au