06040093 CITY OF CUPERTINO _ -oma',
BUILDING DIVISIONPERMIT 3fC-0 MA-TQR€INFORMATIONS
BUILDING ADDRESS: ELECTRIC USA PERMIT NO.06010093
18741 NEWSOM AVE
O ER'S NAME: PERMIT ISSUBDATB
JOSEPH DENHAM 480 ALDO AVE _____01_L2512006
FPIME: SANITARY NO. CONTROL NO.
(408) 370-3682
ARCHRECT(ENGINEER: BUILDING PERMIT INFO
BLDGo l� l!ELECT PWMB MECH
o
3Op LICENSED CONTRACTOR'S DECLARATION 7bDescri tion
I Mmop
by affirm that 1 am licensed under previsions of Chapter 9(commencing
ith Section 7000)of Division 3 of the Business and professions Cade,and my license is
1.full force a Ad effect RELOCATE WASHER/DRYER, INCLUDING
2qz LiaenseClass Lic.8
UNDERGR. UTILITYT WATER & SEWER, WATER HEATER
Com
Damr
eS�
A.shall use DECLARATION CONTRACTOR: ELECTRIC USA (#0100003851)
e I understand my plana shall E used u public DECLARATION
J
s Licensed Pmfatlnnel gg�yypp nonnnn
g
OWNER-BUILDER DECLARATIONcto r7 p /pl
2<I I wreby.(lure that I em exempt furor Ne icusimnar',License taw for de 111rfuJ'fff I'NT l rryyp)l 77711!(((
tact following moon.(Saito 70315,Business and Pre.cic u l Cad,:My city or aunty
which requires issuance.pmmti re c.res twi alter,improve,h Permit t ter repair any nmnure
S^ Odor m its easedPalso req.the the applia.I for such mumu to file a signed statement
< NmheincingwdOmction7 )ofDiviormNofOnButhe anessancenmlaw(xCode)r9 Sq. Ft. Floor Area r Valuation
�a
(commencing with Sadan]000)a(Divialon 3nf NC Business and Prefesdnns Code)of Fro
$4000
.. Nat he is exempt Ncmfwm and the basis for the alleged exemption.My violnlan of
Secdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ApN Number r� - Occupancy T
set more than five hundred dollars(5500). 4I.. d p p y y
❑
1,An owner of the property,or my employees with wagon ss theirwle compensation, 9 goo y�how Y
will do the work,and the mwmurt isnot Intended oroRered outside(Sec.7041,Business R ITC -In5 s��LwxnS
and Profession,Code:The Coomme,License law does net apply m in owner of P q.
property who bulldsorimprases thereon,and whodoes.uch work himself ,orthrough his
own employes,provided Nn such improvements art notlntaMed aro@red forssle.IL
however.the building or improvement H sold within one year of eampledon.The owwr-
wilder will have Or burden of proving Out W did not Wild or Improve for purpose of
sale.).
m owner of Oe pmpeny,am exclusively contracting with licensed contncmn to
odnroct Oe pro)at(Sec.7041,Business and Prefessitm Code:)The Conexctnea Lt.
awe law does not apply to an owner of property who Wilda or improv Nemon,and
who contracts for much projects with ecomunar(s)licensed potential to Oe Contractor's
Lice.law.
D Ism exempt under ,B a P C for this won
ereD
WOR OMPEN M, ECLAR DIOate '
I hemby&Turn n r perml y of perjury one of the fallowing declarations:
❑Ihxve and Wllm' u' aC.nA m.fC..tWul6ln.umf.W.,kce*C..Mn-
cation,ss provided fo Sedan)]00 of the IaWr Code.for the pcdormame of Ne
work for which Nis permit I.issued.
D 1 have and will maintain Worker's Compensation Insurance,an required by Section
3700 of the labor Code.her the performance of the work for which this permit is issued.
My Workers Campemadon Insenwe carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This mcdon wed not W compleed if de Permit Is Prone hundred dollars($100)
or Mss)
I artify Out in the performance of the work for which this Permit is issued.I shall net
employ any person in soy manncrwum owb' UuOe Workeet Compewdon
LAWS
tf CjAW6:
� 4
Applicant
NOTICE TIf.after this certificate of Exemption,you should
I wNe We,
Compensation provision.of the Labor Code,you mum
.,O I'oMwith with such Provisions or this Permit shall W deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[-dam IWreby slRrm that Nem I.Ac.rauninn londingagency Re the perfmmence of
!Yi
the work for which this permit Is issued(ser.3097,Civ.C.)
W�Q Lender's Name
7 z Lender's Addseas
U Q 1 ceNfy Nu 1 have mad Nisapplicatim AM rude Nn Ne above information la
igi f correct.1 agree to comply with W city and aunty ordllWm,and atlb laws missing to
C V Wilding construction,tiro hereby authorize representatives of Nis city he enter upon to
D7 move-mmumccl property for impection purposes.
LL (We)agree to cave,indemnify and keep humorless the City of Cupertino against
n+rA IIabIIWea,judgmenu,costs and expense,which may in any way acme against said City
(„)7 In conwquewe of the granting of this permll.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
1 Re-roofs
Signature ofAtyicausuContractor 11 D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store arbandle hvardous maerial
as dented by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
WYes
ill theoruwre c applicant Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emu hmerdous air contaminants As defined by Ne Bay AMA Air Quality Management - all new materials for inspection.
District? I
DYes P No
1 have mad the Wardrus materials requirements under Chapter 6.95 of the Califon
nia Health&SafnyCa0e,Swum 25505.25533 aro 25534.1 understand this lithe Wilding
does not currently have a tenant.Net it is my mspansibilay to nedfy the occupant of the
requirememswhic a Wmet poor toisman.a .cevIntmeor cpatya Signature of Applicant Date
Owner A, depcnt I (w ,te All roof coverings to be Class"B"or better