04050066 CITY OF CUPERTINO z �,
emLomc orvlsloN PERMIT CONTRA TO INFORM
BUILDING ADDRESS: METROPOLITAN ELECTRICAL CO OITNO04.050066
121 MTTTT?.R All
OWNER'S NAME: PERMIT ISSUE DATE
CIN
NE: SANITARY NO. CONTROL NO.
(415) 642-3000
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
art Op LICENSED CONTRACTOR'S DECLARATION
s�¢� 1 hareby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description
'n< wiNSection7l)(Mol'Divieion Sof NCBusinmand Professions Code,andmyliscamis
M
iiecascea.nde@cf PAD/WALLS/TRASFER/ELECT. G
Liccnx Close Cunuh ^ /x
8 pp Dak Cun DELL V g+O
Yg
ARCHITECTS DECLARATION a
Yo 33 1 understand my plans all M uxJ as public rccnnts �+
is
3y, Licensed Prorami.nal
C OWNER-BUILDER DECLARATION
Connector's
E 0 0 I hmoso .('Sectfir.on t I70 1. exempt from Ne fession,C's :Any c Law for the
my
O o following moxa.Permit
1 ](131.5.Business and Pm(eesio li Code:Any city or county
$ which requires issuance.smolt ac ennmmeL eller,improve,demolish,nr e a sig any tMauro
thither inensedpursuant
mquimc,awkilimntfor such permiuoicense Law
(Chapter
¢�$ (e non i.a.g;wi pursu.A7g0U.f Divines nfthc eS.ain , Uccnxlaw(Chopnor9 Sq.Ft. Floor Area Valuation
Mot W Is exempt
Sminion and
basicon3 oftheegedc rept Professionslation or
ey.. that he la exmpl tMmfrom and the bssu for the alleged exempd.n.Any violation of $45000
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penalty of APN Number Occupancy e
not more Na.firs hundred dollars(SSW). P Y EYP
01,mownerof the prelacy.Or my.mploytm with wages as Nei,sole ennsisms ion,
will do thC work,and thallmi is not intended proffered f.rnale(Sec.7044,BusiwsRe uired Ins ections
and Professions Cc&:The Comtmcmf.Licenx Law does nm apply to an ewar of Q p
property who builds or im proven thereon,end who dao such work himsel f or through his
own employees.provided thatauch improwmens arc notimmaded orortered formic.If.
' however,the building or improvement is said within one year ofcompletion.One owner.
Wilder will have the burden.f proving that he did not Wild or improve for purpose of
Sala.).
owner of hW property,am exclusively contracting with licensed contractors to
wtnmt the project(Sec.704,1,Business and Professions Code:)The Contractor's Li.
cave law does not apply to an owner of property who Wilda or improves Manson.and. _
who contras for such projects with a contracmr(s)Iicemed pursuant o the Contractors
Liana law.
I.exmpl der Sec ,B&P C far Nis=on
rWg �e 5-11 A`E
/ WORKERS COMPENSATION DFCLsA ION
1io1 be elBrm underpenalty of perjury ow of Ne following deden0om:
haw,and will maintsin aCWdrwam.fCtnsent m self-insum forworkers Camper.
A,se provided fa by Section 37W of Ne labor Cadc,for Ne performance of ted -
work for which this permit is Wood.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W.f the labor Code,for the performance of Ne work for which this Permit is issued.
My Worker's Compensation Insurance molar and Policy number am:
Carrier. Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CMIssemia wed notbecompaenod If the p ion i is foronehundocd dollars(SIM)
or less.)
I emi Not in Ne performance of the work for which this permit is Wood.I shall not
employ any Person in any manner an as In become subject to the Workers'Compensadon
Lawn of California.Dem
Applicant
NOTICE TO APPLICANT:IL after making this Certificate or Exemption,you should ,
become subject to the Wonkela Compcmatitn provisions of the labor Code,you must
,JZ fonthwithcomply with such hrovivona w this permitmull be damned rawled.
Z O CONSTRUCTION LENDING AGENCY
[-i t hereby alRrm that More is a construction lending agency for the Performance of
lYi ti Nc Murk fa which Out permit Is Wood(Sec.Mn,Civ.C.)
G0 nName --//
Z ULendeer's r's Address
U Q 1 certify that I have mad Nis application and ask that the aWve information is
gL f~' correct.I agree to comply with all city and county ordinances and sus taws mating to
O V building construction,and hereby Authorize representatives of this city in enter upon the
fa7 aisove-mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
(n liabilities,judgments,Coss and expenses which may in any way accrue against said City ^S
t)Z in ec nsegance of Ne grammi,of this permit. U
^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
so,
REGU TIONS.
2��~✓Y-a-aa, Re-roofs
gnahure
'Ren nou"Oru0U5 MATERIALS DISCLOSURE Dom Type of Roof
Wi applicant s future building accupxt smrc or handle hamrd.us manorial
-'cloned by the Cupertino Municipal Cock,Chapter 9.12.and the Health and Safety
Code,Section 25532(a)a //////��� All roofs shall be inspected prior to any roofing material being installed.
Yes No
Will the applicant of
f lore building occupant use equipment s devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haxaN.us air c.numinams v Jcfined by the Bay Area Air Quality Management all new materials for inspection.
strict?
❑Yes la Nu
1 have mad Ne hamrdous materlas requihcmmix under Chapnor 6.95 of the Califor-
his Hcallh&SareiyCode,Sections 25505,25533 and 25534.1 understand the if the Wilding
dos not currently how a tenant Nal it 6 my responsibility to notify Ne nmutxt or the
mquirommu whit unbemel pri.nu issuance of a Ccrdficam of Occupancy. Signature Of Applicant Date
Wine,or ono tad ager hD I All roof coverings to be Class"B" or better