01110047CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
22221 MC CLELLAN RD
GURU ELECTRIC
01110047
OWNER'S NAME:
APPLICATION SUB DATE
CUPERTINO CITY OF
1911 RESENELFE CIRCLE
11/07/2001
PHONE:
(408)254-4464
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I nereM1y awdm that lam R«nxea tinned provisions nrChapter 9(commencing
Job Description
with S«tion W00) of Division J of the Boniness end Profps tons Codc, and my li«nu
INSTALLING FOUR LIGHT FIXTURES BATHROOMS
,
cerullmice and rtrep it
CSI V
License I xs lac.,
Umc f� aT CnmrucA r �C
A CH DECLARATION
ll the. e
]understand my plans shall be used ss public t«orrt
Licensed Prnfessional
OWNER -BUILDER DECLARATION
1 hereby of Ito that I am exempt from the Contractor's Liccnu law fm she
following «axon. (Section 7031.5, Business and Professions Code: Any city or county
which requires a Permit to construct, alter, improve, demolish, or repair any strunum
J
_prix t l Is nee sthe applicant for such parrot toffee aimed statement_
Net he s licensed p rnu j 6 the pro s ons of the Contractor s License Law (Chapter 9
'ng See tie l?"tofDi, ision 3 the Boyins. and Professions Code)
rt+ { H p r�rt a
rk.F.l I,5
ValUBI100
(cora with of
or that he 1'x eacmpt therefrom end the basis for the alltged eiemytio6. Any violation
1 0��-5.;17'® gy _�f>:i Lj
of Section ]071:5 by may oppli<ant for a'permit subjects the appticam to a civil penalty-
�ofnut mom than five hundred dollars S503).
304APNk"8l9H ELECTRI
AL'`':"" Occupancy Type
O I, as owner of the property, or my employees with wages as their sole compensation.
will Jo the work,' and the "smiHure'is not intended -'or"offered 'for sale (Sec.'T04o,
Business and Profession, Code, The Contractor's License Law does not apply to an
505 - FINAL E E241l JR1M9p3YGlions
owner of property Who builds or improves thereon and who does such work himself
or through his own employ«s. provided Na such improvetren¢ nr< not intended or
. __ - _ ___ _ _ _ . _ .__. __
_.
offered for sthe. If, howevde the building or improvement n sold within one Wend of
_
- -f, •.. '- --- ,
the owner -builder will have the burden of proving that he did not build or
"
Icompletion, for
mprove and pamnne of sale).
co h as Owner jec pmpcny, em icctuW contmnors to
ntractimons
-- -- - - .:_. ...
Business and C
project (gee. ]Doan Business and Profc
construct thedoes Ces
,, .t
hob ills or impTheroves theroi.
License Law does nut mon owner property who builds or improves thereon.
' "
r such nt
-and who.amtrects for stmM1 proj«ts.with e.contractur(s).li<enseJ.pursuant. to.the..
—._.___.._.. .......... .___ .. __. _. ... _...._ _. .._._.._..___.. _ _......_._ _—.
Contractor's License Law.
❑ I am exempt under Sec. ;rp "nv' ,s ;B &PCfor this reason
It' Daic';. •:, - .a .::.'
WORKER'S COMPENSATION DECLARATION
' Ihereby affirm under, Penalty of perjury one of the following declarations:
[ /
❑ 1 have and'will maintain'a Cenifche of Consent to self -insure for Workers
J
Compensation, as pmvidW -for by-Sachmm 3200 of the labor Code, for the
performance of the work far which Nix permit is issued. .,
/
/
❑ 1 have and will mainumn Worker's Comperiatim Insurance, as required by Section
37W of the Labor Code, for the Performance of the woik for which this permif is
. tssuN ((M�y^Wo kef nm n t InsNnnce camereM PN cy numbe ere:"
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C:uner+la9TeU!ia..d
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vl`ll-:l.`-I'-•' tt•r9\.s-+A-'"•'',.
I "{CER'GFICATION OF,EXEMPTION PROM,WORKERSi:.-,J
"'
' " COMPENSATION INSURANCE',. �
__
"' (This union'Beed not be completed if the permit is for one hundred dollars
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ISIW)mlcss.), ,, ,,,,•,
. .y ,_ t .. ":
_:, tet; _
I Geralthaf in the rfommnceof ttie o k'f r which sh s tis issued, l'
...._,..__....._.._.._._..__....,,.,.....�..._...,.............. _.__.-.._._._.._._.,..,.__.. ....-,....._.,.,... .." .- ..._
j,,,.,. „ ..h '
shell not employ any person in any manner m as to become subject to the Workers
-
Compc sat Laws of C I f Dat
Applicant
in i
NO eETOAPPL1eANT If ifs penwat this C si fate of Exemption. you should
- .-...._._ ... ... ..... ... .. .. _. ... ..._ -
sTOAPPLICA IX 'C pe onnof the Labor Code. you
neco id,jact to the u must
foithwnN comply wnh such provtstons or Nu pcdmn shall be deemed revoked.
,y.P a"'•r CONSTRUCTION LENDING'AGF.NCV
' "" I hereby atBrm That Neie ii a mnatiuction Icriding agency for Ne peifomuutec
- • " '
of the whrk f
bender's Nan r which Nis permit is issued ISc2T309r, Civ. C.). • �, ; ..
Ver..: ...r.,v�_.: ,.
I<nder's Address' ..,.. : "
-
I terrify that I have read this application atm state that the above informal is
'codren..I.spot, to comply with all city and county ordinances and state laws relating
to building construction: had hereby, authanre repmnertntives of this city to enter upon
the above-mentioned property for inspection purposep. r,
(We) agree tin save, mdtini fy and keep historic. the City of Cupertino stairs,"'
-
liabilities, judgini costs atd expand. which may. in any way ecmoc against said
City n conscqucndc of the grantngof flus'perms "'.-
UNDERSTANDSANO WILL COMKY WITH ALINOrzi-POINT'-
Date
_APPLICANT
SOURCE REGULATIONS
ISSUedb v:
signamie ofApplicanUC "tractor -:,' '' 1' Date t ;'t.:
Re -roofs
+; t -HAJ RDQUS MATFRIALS DISCLOSURE'
worm pplia'nt Tmurcbudd'-Baeapant tnrebrmadl n etrmu
^�7
Type Roof..
haderiaf
of
as defltW by the Cupenm9 Municipal Code Chap 9 12 a d theHealth and Safcry
Cod
l�.a '.Y'st
❑nim255320)
ye
tit a.. ., ..
, __All roofs.shall.b" mspected.prior_to any roofing.material being installed.._. . ___.
.. , „•.
wnNewprattca,:rymaWilding aapanuv aquipmentordevieaawhich
If a roof is installed without first obtaining an inspection9'agree to remove
<lnmeaardo contaminants u dcfned by the Bey Area Air Quality Mahegemem
,
all new materials for inspection. Applicant understands and will comply with
❑v Otho'; t.
"all non -point source regulations; :.
In rdud the havrdoui rtu¢riili te9 artmcnts ands Chep( 'fi.95'0 thu
California Health & Safety Code, Sections 25505; 25533 and 25530. 1 understand that
- -
m6hbuildingdoes notcurrentlyhaveitennm; that it
tmy oresponsibilitymnotifydR
occv t of Ne requirements which - t to ass e c of a Cenificate,or
q p �r_
..
°ctpency•
Signature_ of Applicant _ .. -.- _ _Date
All roof coverings to be Class,"B" or better
Owner a-ttmtrdpadq again-. }, " Date..
:.r_:.......;. ..... _ :.... _ .. OFFICE