03040051 CITY OF CUPERTINO T� CoN� �s.^' �" "= �,�,� •""�] �"
BUILDING DIVISION PERMITCeS ' ,rtACTQIt
BUILDING ADDRESS: - PERMIT NO.
LOZANO/RODRIGUES GIACALONE ELECTRICAL SERVICES- 03040051
OWNE ' ME: FERMITISSUEDATE
PALMAS LANE LP 6300 MONTEREY RD. 04/08/2003
(408) 842-9655 SANITARY NO, CONTROL NO,
ARCHITEC'VENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby salon Nat 1 am licensed under provisions of Chapin 9(commencing P
.Ain
with Sectlon]IXp)of Division Sof dee BesincaarW ProfcWom Code.end mYlicemeb
n=% In full force end effett.
�pz ucemaaw uc.. REVISION--ADD BOLLARDS
e6 Duca: ARCHFF-CISI DECLARATION IN HOUSE USE ONLY, NO NEW PERMIT ISSUED
�5y+ I understand my plans stall be,used u public names ORIG. #03010102
�p Licensed Professional
,a OWNER-BUILDER DECLARATION
E I hereby affirm that I am exempt fro.the Contractures License Law for the
following reason.(Section 7031.5,Business;and professions Code:Any city or county
5$lei which requires a permit to construct,Jur.Improve,demolish,m minor any structure
y
pricy n its issuance.also requires the applicant for such Permit o Ole a signed statement
-�<
that he is licensed pursuant to the provislons of the Contractor',Uomso Law(chapter 9 Sq.Ft.Floor Area Valuation
?E(SCo (commencing with Section 7000)of Division 3 of the Business and Profosdnm Cai or
Z 3$ that he is exempt therefrom and Ile bub for the alleged exemption.Any violation of
Section 70313 by any applicant for a permh subjects the applicant in•ch ll Nosily of APN NumberT e
not more than It.hundred dolHn(g500k 'f�Y6�'c� yP
❑1.as owner of Ne property.or my employees with wag.as Neo sole compensation,
will do We work,and the structure is not intended or offered for We(S..IDu,Business
and Professions code:The Conmcdoe,Large,Law don not apply m an owner of 3 6 93 2 0 0 3 . 0 0 Required Inspections
property who buildsabpro as thereon,and who dmzswh work himselfor Ihmugh his
own employees.provided that such Improvements an,notindended motiered finale.IL
however,the building.,improvement is sold within one year ofmmpledon.the owner- 304 - ROUGH ELECTRICAL
Wieder will haw the burden of proving that Wdid not mud m Improve for purpose of -j. 501 - FINAL ELECTRICAL ENERGY
I,.ownerof Nepro eaclesivlycon Ing with licensed eondncunm 505 - FINAL ELECTRICAL ,
n the n nal ( .in g. m n.f ata"y wi Code:)The Cuntraseh U. �-Y\
doesnou bods o nee of naw milasor improve m and,
who torso projec thea trKlm(s)l' rased purtumuo Can tors
L \\
1 Ie I Sec ,B
w / Da V V
' OR P A N 6CLARAT
1 ereby ons der ata y of perjury one of the toll g dal tl.m:
andwill tains nlfieate of Consent agif-nsum for Workers Compen- -
Latlon u provided for by Sec an 3700 of the labor Code,for the performance of the
work orwhichthit pe his ad.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3700 of dm labor Code,for the performance of the work for which this permit is issues.
My Worker's Compensation Insurance carrier and Policy number tae:
Cartier: Policy No,:--
CERTIFICATE
o,: "
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not mcomplat !Iflbe permil b foronc hundreddollars(SIM)
or ma.),
1 certify that in the performance of the work for which this Permit is land.I shall not o
employ any petaon in any manmr a u m become subject m the WorkeW Compcnatlon
Lrwa of Califomla,Dem
Applicant
NOTICE To APPLICANT.If.after making this Certificate of Exemption,you should _
become subject to the Worker's Compensation previsions of the Labor Code,you must -
.,`/.. forthwith comply with such provisions m this permit shallbe doomed mwked. - -
0 CONSTRUCTION LENDING AGENCY -
:-rr Ihereby still.that them I..construction lending agency for the performarraof
Yv r+M+ the work for which this permit b Issued(Sec.3097,CN,C)
iia Q Lender's Name
3.z Lenders address
D
;)Q l.nify dhel 1 taw road thispli.tum and Stam NH the above informadiun b
LL P corm.I agree 10 comply with all and county uNim ed,and sum laws totaling u
O U building construction.en hereby Noria.proanutlwsofdeiacilyloenmrupnndee
�a .msec-mentional prep. y fee ins edam purposes. ..
(We)agree lm ,tndc ITy sed keep hatmtm Om Cidy of Cupeniw against
r R !1Wb !Lt., emu, stsanae pons.which mayin anyway same gains Id Cily
V z In n ce Idea rani o it mail.
AN ND ILL COMPLY WIT N Issued by: Date
U EG
Re-roofs
I'll
f "AZARD ,(MATERIALS DISCLOSUR Type of Roofl Nea Iisent or tutu.mlltling oceupat atrcmtandlc harudou mamHatby upertmoM icipal Code,Chapter9.11.and the Health and Safely
on 531(x)7All roofs shall be inspected prior to any roofing material being installed.
es
Wdl dhc applicant or lure building occupant ua equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
haraNnm air mnumi
Is u defined by the Bay Am Air Quality Management all new materials for inspection.
tricl?
Yes No
Its- hese scattering immc"uunder Chapter6.95ofdheclif"r-
nia y otic, 0.25505, 33 and 25534,l understood if Wilding '
Y awe. l Y n illlyce oufy ace Write
on d" i 0esm Signature of Applicant Date
0 m . 0 e a Dam All roof coverings to be Class"B"or better