00050190 CITY OF CUPERTINO
BUILIIING DIVISION PERMIT CONTRACTOR INFORMATION:
BOILDING ADDRESS: PERMITNO.
_ 10412 NOEL AV FALCONE AND SNYDER C11 INC
OWNER'S NAME: APPLICATION SU
ESOUIVEL ALFONSO F AND JILL D 650 LINCOLN AVE
HONE: SANITARY NO. 1 Et
Metz ARCHI"FECIIENGINHER: BUILDING PERMIT INFO
(4108)292-97105
BLDG ELECT' MR MECII
y<a1 —
a. I.ICIINSI?DCON'I32ACIOI2'SDIiC1.ARATION lob Description
z z o,— 1 hereby affirm that 1.am licensed under provisions of Chapter 9(,mmearcing P
rwith Section 70WOrf Division 3 of the Business add Probe.s Cade.0 'license
�mS Lin full fn.ea cB t.
p.etQ et icnx a C. 7:(;.ir..n Z �ri-fit u
1e 3 0. Dal[" /� Cnlllll+Clnr
YI LL ARCHITECT'S DECLARAl'ION
C�=O 1 under a al my fit an..hall be used as public accords
g o o Licensed profas,n nal RDD AIR CONDITIONER
OWNERdf UILDER DECLARATION
usf' I herehy of rut Lha 1 am exempt tram the Conlmemr's License law for the
CZ follow ingreason.(Section 7031.5,Business and Profe.vsiona Cuxle:Any rayor county
SFC wnh 1 p ' II losel,alI 1 fn.or rejaUr anyacmm
i3 pn, t t I. y st Ipl^ Ir 11 'llid ti d tic seal
mats 1 sedp : tt top ttn c t I r L Ica rvcr9 Sy. Ft. Floor Area Valuation
(commencing with Section 70(10)of Decision 3 of the Business and I rofe. on.CurreyIS 1
in that he is exempt therefmnt and the hasiv for the alleged extradition.Any violation
of Sort inn 7031.5 brainy applicant for a parnal subjects tire...lie u I a,a civil penally
,if out more than rvchundred dollars(sv)ul. APN Number Occupancy Type
❑l.asowncronheproperty.array employees with wages asmetsolecompenxalon 32647051. 00
will du lie,ore,cad the xlux are is nen imanned in offered In,sale(Ser.71144.
Basin.,had rmtesxionx Code:The Courtrai License ww does na apply ro an Required Inspections
owner of property Who builds ser impnnes thenen and who does ach work himself
or through his own employees,provided that such improvements an not intended or
offered Iia sale If.hnwcve,,the huildrig or Impmvcnnune is sold war.one year of
iomplednn,the ownerhuilder will have the burden of proving(hal he did ned build or
mprom bupamase ofsale�l. 303 — ROUGH MECHANICAL
0 L as owner of the proiPerty.ant exclusively connecting with licensed contractors 1. 304 — ROUGH ELECTRICAL_
mslmet the pr Ject(See.7044.Business Emit Pmms,ians Codi'I'he Contractor,
properly p 505 — FINAL ELECTRICAL
Licenses co doe,war my m tut cts ,a t m budce aE improves
ami who amtams for such Pmjalx with o camrunorta)licensed punuam m the
01;at,creme cad, See 518 — FINAL MECHANICAL
❑I:un exennpt under Sec. .B k P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I herchY u01nn nndcr I+cnally of pa jury one of the fall,,,Ing declarations:
I have unit will maintain a Certificate of Consent la oh-insure for Wader's y O
ComPenmtino av insured for by Section 37W of the Labor Cade, for the
perm of the wore lot which this pc'ratit is ixxaed.
[{J`J I h�mee so
will nnaintain worker's Compenalmn Insensate.as na aired by Sectian
7`7 00 n,the LtMa Cadc,for the prformonce of Mc work for which this Noun is
iaxuM,Myy+uvkor�Con m'wn Insurance career and Policy
--n//u�mher-00
Cwoer37LLer// W Policy No.:� 5 /�
CERTIFICATION OF EN EMITION FROM WORKERS'
COMPENSATION INSURANCE
fl'hi x sect ilo need not be complanrd if he permit F f r one hundred Anllnn
("-'or
SI W)or Ica,.)/
ce v t E ado n c n(I ark far which this permit is ixvucd,1
'hull not em any asp lax m Mromc nuhjcm hE IM1c WodcM
Compensm n - ithfomla�
Applicant a haul)
sion Ii'O A ('LICA 'E tet making thus mit eme of Emmption,You s
baunaxtl6je0 a+the Wurl%"' mr,d EEprovis on,nfthe huMa Cale,you maxi
0 O fmhwith comply wish such
pnwisted,or IM1is permit shall M Jaenmd revoked. ,
FiCONSTRUCTION LENDING AGENCY
a > I hereby attain that there is it construc0nn lending agency lin the perfommnce
of the wad for which Ihb pmmit is ixsacd(See 91197.Civ.Cd
L O 1<ndct'a Name
Z landdsAJdacss
V 0 I eemify(hut 1 hove rend'nil appliadlon antI'mm that the arroc iabo n atinn '
Gi F•, ao ith or.+comply wall city and county oudinancea and side law,refining
Q U tilding munch...andhemby amhonm representatives of this city it,enter upon
W he aMwc.m natwgp pmn on t u loses.
p
(We) •• sx'o d• mil a d kiaphwho, ray the Cityof...mina st na
N dial.. •rosea ves which ouy In any way accrue against suit
CJ Z City in en c eta a e y4 n `f this permit.
APPLIC UNIT D DWILLCOMPLYWITH�'�P01 Issued by: Date
SOUR C ❑ fION `
Signature of Applicant/Contractor side Re-roofs
HAZARI)OUS MATERIALS DISCLOSURE
Will the applicant or lunare building aca,.,store or hani h rearl material Type of Roof
refusedas Sam,he r ul4Ena Munlcipul�Code.Cmlacr 1),12 rad dm Health and Safety
Cad
0 Ye, All foo shall be ected prior to any roofingg material being installed.
Will me applicant or future building occupant ase cyaipntem or device.wh cn If a r of s install'inspou rst obtaining an inspection, 1 agree to remove
emit hnaardom ait rantumin:ons nv Jotl by Thr(lay Area Air Duality Munngenum
Di'trim all eV�terials ' p [fon. Applicant understand' and will comply with
O Yca al nor t • ions.
me ma I c Imran+ :(meal.retlaircmems and,Chapter 495 of the
'allfurnk ItralEh&Sufmy( S 25585.2.1533 and 25934.1 undesurr EM1a J
if the Mill"does y tenant.that it i,my asrym'ibility to rarefy the
accupanl a remav xc a mast be met rim, nsyaryry'' laic feat'of
oa,npa y 0isS nature of Applicant Date
aammned agent I Dane All roof coverings to be Class"B++or better
OFFICE