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05020074 CITY OF CUPERTINO wc +i , BUILDING DIVISION PERMIT �gCON`TRACTORANFORMATION ,i BUILDING ADDRESS: NATIONAL CONSTRUCTION RENT Pl�'ITND05020074 OWNTROL OWNER'S NAME: PERMIT ISSUE DATE ONE: SANITARY NO. CONO, (RI A 8 221- RCHITEC(ENGINEER: BUILDING PERMIT INFO 0 BLOC IF.(.T PLUMB MECH 1� 0 ° 1hereby.Ifiren ualElOi licensedCorrOboRprovisionsofClON hapter9(commencing Job Description work Smdoo 7")of Division Sof the Box.and Professions Code.and my license is mfdlmChers a rc 7${? License nce a Lie.N TEMP POWER POLE n=° Da¢ Conracer EEN ARCHITECT'S DECLARATION —� W i 1 uMersund my plans slWl he used u Pmhlie record /✓�] Q Licensed Professional OWNER.BUILDER DECLARATION X I henehy from Net 1 on exempt from the Commutes License taw for the �- i e° following reason.(Section 703 1.5,Business and Profession Cade:Any city or county which mot.d.a permit to mmonct,altar.Improve,demolish,or.pair any structure Zi prior to its issuarim.also¢quires Nc applicant for such permit m rite a signed==on, G thatboulicensedpursuantatheprovisionoftheContractorslJansclaw(Chapter9 Sq. Ft. Floor Area Valuation rs $ (commencing with Section 7(0))of Division 3 of the Busincu and Professions Code)or that he B exempt therefrom and the bus far the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not mare than rove hundred dollars(ssu(H. 3 7APJ331QL60cr0 0 Occupancy Type 0 1,as owner of the property,or my employees with wages in their sale compensation, will da the work,and the amueture u not imm�dcd oroRertd tarsale(See.]044,Becalm.• and Pro(etians Cade:The Commoner's License Law don not apply to an owner of Required Inspections property who s,pmvi cd tat chicon,and who dassmh work rinser ed for ugh his / Own employers,provided that such improvements art not arofintended oroRered the ow.r- (Oyy�J however.the building a improvement is hath within one year of cemove for the owner- Wilder will haw the burden of proving that bo did not build or improve for purpose of sale.). M1,as owner of Ne propertumuiny,am exclusively contracting with liceed commuters i.,.-4- � onsaet th projem(Sec.]044,Business and Pmfetions Cade:)The Contracer's U. arse Law dors not applya an owner of progeny wW Wilds or improves tharemn,and who,tiz, forsuch projccmwithscon=wr(s)lim mdpumanta the Contractor License law. ❑l am exempt undo Sm, /� B&PCf this myon Owners-��'�asL✓rW Dem2 r WORKER'S COMPENSATION DECLARATION I hereby aRrn under penally of perjury one of the fallowing dcclaradons: I have and will maintain a Cenifiateof Comm.,a self-mane for Woke,Compse. sation,u provided for by Section 3]00 of She Labor Code,for the performance of Nt work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Ime.m,u mquined by Salon 3700 of the Labe Code,for the perfomunee of the work for which Nis permit is issued. My Worker's Compensation Insurance prier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EXFMPI'ION FROM WORKERS COMPENSATION INSURANCE (Thu section reed not be completed if the permit Is(none hundred dollars Hi 100) m leu.) 1 cenifv that in Ne Performance of the work for which this permit or issued,l Nall not employ any person in any manner ha as in become subject to the Workers'Compemadon Laws of California Dae Applicant NOTICE TO APPLICANT.If,afmr making this Certificate of Exemption,you should baoate Subject to the Worker's Compensation provisions of the labor Code,you mut .,O foMwith Permit comply with such provisions or thus Peit shall W deemed m,olmd. 'Py CONSTRUCTION LENDING AGENCY F' I hereby affirm that them is a constroction lending agcocyfor the Performance of Ir'> the work fur which this permit is Issued(Sec.3097,Civ.C.) a0 Lender Name 0.z tender.Add. U Q 1 certify that 1 have mad this application and sue that thin above information is U,L" Mom.I agree m comply with all city and county ordinances and sure laws misting to QU Wilding coesmuction,and hereby authoim representatives of this city in enter upon chic r W above-mentioned poi for inspemion purposes. F py (We)agree to saw,indemnify and kap harmless the City of Cupenina against r/) Iiabilidee.judgments,costs and cxpcaxs which may in any way aura against said City U z in consequence of the granting of this '+ APPLICANT UNDERSTANDS ANDD WILL COMPLY WITH ALL NON-POINT Issued by: Da SOURCE REGULATIONS. s4to_� a Signature of AppbcaMConm 1.1 Dam Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will thea applicant or future Wilding occupant smm m fundic havardoes material u de0ned by the Cupertino Municipal Code.eloper 9.12,and the Health and Safety ,jMfiCWe.Section 25532(.)7 ❑Ya yNo All roofs shall be inspected prior to any roofing material being installed. Wel the applicant or future Wilding Medfield on,equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove hararems air contaminants u defined by the Bay Area Air Quality Management DistrictT all new materials for inspection. 11 r�,. 13 Yea ®No I have read the huaNcwnsts materials exp inemenu under Chapter 6.95 of the Califor. ria Health d:Safety Cade,Smdons 255f15,25533 and 25534.1 understand that ifthe building does not currently have a tenant,Nu it E my rupouibility,In nod ry the occupant of the require nuwhk:h metpriartudomumceor.Ccoifmaharat 11 Signa[ureofApplicant Date bS Gwne,m,.w!mcvedagal Dam All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEI�TINO Building Department 502007 JOB ADDRESS: PERMIT 060q, nog: CA-Tw OWNER'S NAME: PHONE # 4 p g_ a7A -'Z5 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork \\ Cement Finishing Electrical U A p EN`r (_ Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -4� ` f 012 Al 0161— Owner/Contractor Si re Date CITY OF CUPERTINO2 o � 7q TEMP POWER bS 7 `CUPERT►NO PERMIT APPLICATION FORM APN # 37,c- 3/f- Date: Dg-) ►I los Building Address: I �J �06m, MEN C-0I>ERTIIV©- C _q Owner's Name: Phone #: SUG &GAOATHAN A09- fW -2S4-5' ' Contractor: Phone: License#: Contact: Phone: Cupertino Business License #: Building Permit Info: Elect ❑ Job Description: Tern P • P©L-E Go N ecri ON Foo AN Ck.)THo(�SE Residential [ ' Commercial ❑ Cost of Project: J+SD Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE 'Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING -24 s--s 7 •