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CITY OF CUPERTINO
'C1it14IATIONa-.=;:
BUILDING DIVISION PERMIT
=CONTRAC�TOR�IN
BuaDINGADDRESS:
METROPOLITAN ELECTRICAL CO
�+ITNO.
10121 MILLER AV
ER'S NAME:
2400 THIRD ST
APPLICATION SUB DATE
EBER MICHAEL C AND SUZANNE 11
12/18/2002
TONE:
(415)642-3000
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
p
with Section 7000) of Division 3 of the Rusine %�d Professions Code, and my license is
ct. C �p
LLicense
TEMP POWER --MOBILE CELL SITE
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License Cl'^s c.p
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ARCIIITECT'S DECLA A QN 1 f'ir ^�
1 understand my plans shall be used as public records
Licensed Pmfesstonal
OWNER -BUILDER DECLARATION
1 herchy afrom that 1 am exempt from the Contractor's License Law for The
Following reason. (Second 7031.5. Business and Professions Code: Any city or county
which requires a permit m construct, alter, improve, demolish. or repair any structure
Prior to its issuance, also requires the applicant ler such permit to file a signed statement
that he is licensed the Contractor's License law (Chapter 9
Sq. Ft. Floor Area
$2 Y010ation
pursuanuo the provisions of
(commencing with Section 70010 of Division 3 of the Business and Professions Code) or
that he is exempt thomfrom and the basis for the alleged exemption. Any vi Amimi of
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of
not more than five hundred dollars (5500).
❑ I, as owner of the properly, or my employees with wages as their sole compensation.-
n
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—on'
RO GH R]_t
willdoBeework. and the structure is not intended or offered for sale (Sm. 7044, Business
and Professions Code: The Crimmins License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himselforibrough his
V iO — 1 i�. 1 'LI
own employees, such improvements Berod for
ne
Owner.
year fcompled
teees,ping or improvement thinoneyem of completion, the own r.
builder the gor old within
enofprovig Brad Of
builder will have the burden of proving that he did not build or improve for purpose of
awth
aeloJ.
)
I
❑ 1, as Owner of the property, am exclusively contracting with licensed comnnors to
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construct the project (Sec. 7044, Business and Professions Code:) The Conametor'a Li-
/
cense Law dnes not apply to an owner of property who Wilds or improves thereon. and
who consumer for such projects with a contractichd licensed pursuant to the Convenor's
License Law.
El I am exempt under Sec. B & P C for this mama
nor Dam
WORKER'S COMPENSATION DECLARATION
1 hereby al under penalty of perjury one of the following declarations:
I have and will maintain a Condition of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this pmmit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
370) of me Labor Code, for the performance of the work for which this permit is issued.
M W kFr's Cootetpenptionlrommewcatr rand Polic some
Catficr`.�(///_(� _ PolicySO
CERTIFICATE OF EX PTION FROM ORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)
or less.)
1 certify that in the performance of the work for which this permit is issued, l shall not
employ any pecten in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenificam of Exemption, you should
become subject to the Worker's Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency lou the performance of
the work for which this permit is issued (See. 3097, Civ. C.)
Undoes Namc
Lender's Address
I comfy that I have read this application and stem that the above information is
correct. l agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby aulhorizc representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
amara t
Issued by: Date
S ULA -"
Re -roofs
Type of Roof
Signawrc of Applica"AZARD Or am
HAZARDOUS MATE DISCLOSURE
Will the applicant orfuture boo oecupant store or hinllimosidousmaterial
as defined by the Cupertino Mundt Cndc, Chapter 9.12, and the Ilealth and Safety
Code, Cha
ode. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant nr future builoccupanl use equipment or devices which
emit hazardous air contaminanm as d ed by the Bay Arca Air Quality Management
all new materials for inspection.
District?
❑ Inc.,
Ihavernndthehara nusmamrialsrcquircmenmunder Chapmr6.95of Ne Califmr
nia Health&Safety Code 'lions]5505,35533and25534.lundcmwdthatifthe building
Ones not currently have a tenant, that it is my responsibility in notify the Iccupant of the
boRimmenm which must W mm of., to I....'If a cent re mf Gccupan .
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ownamhodl cd agent to