00060115 CI'T'Y OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMI F N'O,
OWNER'S NAh1E: APPLICATION SUB DATE
0 /1F2 00
PHONE: SAKE[,%BY No. CONTROL NO.
ARCHITECT'/ENGINEEW BUILDING PERMIT INFO
❑IDG ELECT' PI.UMA MUCH
re
Gaa
�- LICIiNSIiDCON'TRACBtIR'S DI:CLARAfION Job Description
Z u"�' I hereby atbno,hat 1 a.licenced under provillon,of Chapter 9 konorwomg P
�_Fj with Scainn PgXll of Divisiunlofthe BY,IaeR apd lTder,ion,Code.nnJ any Intense
6 5 i,in full Po,ec and effect.
ice Liccnsc Clu, Lie,« ELECTRICAL SERVICE
Dale Contmaar
3'i G ARCHITECTS DECLARATION
h=H g I undcmand my plums shall he used u,public recoil, .
'fir
i 3:p p Licensed Pr..fe,ional
es OWNER BUILDER DECLARATION
y I hereby affirm chat I um veep,bon,,he Co..ratio's I.icen,a Law for the
H Z< firio.ving action.(Section 7031.5.Hair ne.s and Prolec,ion,Code'.Arm oily In Canny
x p which requires a pcm,i,,o comfort.alma improve.de nonan,or repair any saucmm
113°° pnormlu issuance,akare4uiren,Maii icunt fornuch III it)file a signed stamen,
tib l,,i, wen,edl.,aaa.w the'nvi. onha Co.mctors idttna•Law Claimer 9 Sq. Ft. Floor Area Valuation
Tce Ing with Section 9aXp al Division3 of the Busines,and Profession.Cede)
,,,that Le is vice.,,hemfm.aad the bis far he ancsed exemption.Any violation
of Seel ion 7031 by any applicant for a permit saniea,the split rad to a civil Finally
onto torte III live nund,ad dohwa(y500) APN Number Occupancy YPe
❑1,as owner of the proieny.or Try etnployee,with wages as their sole co.penlaim.. -40
,,If Ao,he cork,and no,,cueuure is , vended nr otic,ed for rade(Sec 1014. 32648036. L
Ravine,rand Profe„ioC
�.. de:'rha C,nmmmrs Deco,Law doer n,,,apply to an Required Inspections
owner of property Who builds or improvv,thereon,and who doe,such work himself
or rhnmgh his Awa employms.provided shat,urn improvements are not intended or 304 — ROUGH ELECTRICAL
otfemd for s:de,II;however,the ands ins or i.pmvonant is sold within one year of
imOn
npen , he own,laalda,will ham the burden of provins that he din o„l build or ' 501 — FINAL ELECTRICAL ENERGY
mprove for purpo r of salc.l.
lonhe.....oly,am exelaxively eonooedng win,neea.ed eool.alo�x m 505 — FINAL ELECTRICAL
rnn roti the projca(sco.1041,Bandar r and 1'ndos.lon,Code:)'I'In,Contracmr'r
Litt se Law doe,not apply m an urine,of property who build,or imprme,,hernm.
and who,malnetx for ouch pored,wile a ortw tis)licensed ponuunt,o the
Contractors Limo,I.cov
❑Tun, of Sec _ ,13 k P C for,his rea. /
lac �1I2Ir I
c, kKE CUMPENSAT )N I+�CLAItAIIIIN
I hereby affirm under penalty of I,crium one of the following declaratians: '
❑ 1 have and will aviation a CerrIECone of Consent ,o se11'-in,.for Wmker', O(�
Compcn,minn, as Provided for by Section 31a1 of ,he Ulna Code, for the
padinm,.0 of the work for which this Penni,i.wired.
❑1 have and will muinmin Walker's Cnmpensaion Insurance,a,required by Section
3101 of,he IaMa Code.for,he performance of the work for which,his permit is
stored,My Workers Gnnpen.aion Innurunce carrier and Policy another are:
Cameo Policy Nb:
CERTIFICATION OF EXEMPTION FROM WORKERS'
cumn:NSA'noN INSURANCE
(His section need Dat be completed if the permit is for one hundred dl
($1 Nu it le,x.)
1 tinily that in the scrionchave of the work for which,hl,permit is i.nuN.1
,hall not employ any pe,son in any manner.o as it,Essence.-bred In the Workers'
Compensation Law,of Culif..aia.Date
Apprenm
NC TICS TO APPLICANT:11.afit,making,his Certificate of EXe.ptian,y„v should
lecture subject to the Worker,C.penration provisions of the labor Code,you hurt
Q O lint hwith crnuply with ouch Pnokin I,,,,this permit Joll redeemed re—ord
F ^ CONSTRUCTION LENDING AGENCY
I 1 heren, uh t,that there is a llr,lending-Italy fm the perfor.ancIt
nl'@c work I'Owhich licit
permio i,oned(Sec.3091,Civ.C.)
L C Lender's None
= 7 1<ndcr'c Adams
V Q1 ernly,ha th lead this PPI' of broad late ltrnlc above trou-no,ofilari, `
R. E. our
1 agree to corropLy Is illb all city andcounty andinarrocit andor, I misting
Q a, „h h1 6 L t Jherebya ,b representatives�. fth: ,Y, ion
Fr•' �” (W 1 6ri t d 'f) s i h yina cry Icuen' b'nu
to hob I'TcJudg nobs.t „and csicnxs wit c oar nam way aamc against said
E) y City in can.npmnn:u( ,c Iran of mu
AI'I'hIC F ,TANDSANOW PLYWITHALLNON--�POOIINT Issued by. Date
RILGAA
sigaa np atm w,a Re-roofs
.ARDOl16 MATERIALS UI SCLOSUItE
Will cappficaboafatumbuimmgoev.pant cm I,,nandlenvallou.tnaenol Type of Roof
axdefined y the Cupenor Municipal C-,de,Chapter 942.and the Health and Safety
Calc,Sm,ion 25532001 _
oyer 11 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfuture building orropentuse equipment ordevices which If a roof is installed without first obtaining an inspection. I agree to remove
mil h o ?a dra,ofI contenimum ax dchood by the Bay Area Air Quality Manxavnoem 1 all new materials for inspection. Applicant understands and will comply with
oyer 0No all non-point Source regulations.
I have read the haza too,.acrous le(jnircmvnts under Chamcr ar)5 at,he
Calabar
labar a ]It 1, &Safety Cde.Section,2557 .'5533 and 25534.1 underamoul b., .
d.hc iniI insd , o,cancndyhavaa .martir:,,y respontimllty to notify the
iupant of tit- notorious which etm o
m '11111 u,ir.aanf a Certificate it
AEU— Signature of Applicant Date
All roof coverings to be Class "B" or better