01090118 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10410 NORWICH AV 01090118
OWNER'S NAME: APPLICATION SUB DATE
BIELEFELD JOHN J AND PRISCIL 09/27/2001
PHONE: SANITARY NO. CONTROL NO.
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ARCHI'IECTXNGINEER: BUILDING PERMIT INFO
8 m BLDG ELECT PLUMB MECH
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LICENSED tim,I CONTRd under S DECLARATION Job Description
Z_L, 1 hereby vffim rhes 1 am limnscd under provisions of Chalon 9(commencing
:tw with Section7000)ofD"sion3oftheBusinessand fc,, n 1dmyllae UPGRADE PANEL TO 200 AMPS .
S y y is in full force and e8 t 2
re0 U Limns Class Lie,.X
Date Comnemr
a LLO h ARCHITECT'S DECLARA
I u dersmnd my plans shall be,used as public
T
i d o O Licensed PmPoxxiond
OWNER-BUILDER DECLARATION
u�=' 1 hereby.(Sunt shat 1 erre ei Lew for the
t?< which re reason.Permit
]omoru Bualtess aM Professions Code:repair
by m county $3000
E F 0 whim requires n e.a].to construct.alter.improve,demolish,l fi rtyir ant tuanni n
p�C3q ..pnor.ul ' 1 mtot teapplcmUor x«npamdtm Eleaamtwdxuemem
that hit.licensed p u t to thb o o s of the Contractors L cense law(Chapter 9 C' } t Valuation
or do nginipf,Section fina;XIad he blason iloof me rsailieil aimndiamfA.,vxCade)
of that io is 31-5 b any applicant
and she bash forms alleged eilmpoon Any vrolauon
of Section]0313 five
applicant far a permit subjects Ne eppliant to v civil pe,ulsy
err nm marc Tort here hundred eonnn(ame). 304p`PN ELECTRZ A'L Occupancy Type
Gl.as owner of the property.or my employees with wages m their sole compensation, -
will'do the work,and to structure is not intended or offered for sale(Sec.70d4, «
`Business and Professions Code:The Contractor's License Law does nm apply to an 505 - FINAL E EEVRRM§ Ections
ma of property Who Wilds or improver thereon,and who max such wantsnimulf '
or through his own employees.provided that such improvements are not intended or _
'offered for sale.If,however,the Wilding or Improvement is sold within one year of
completion,the ownerbuilder will have the When of proving that he did not build or
improve for purpose,of sale.). i O
[11.as owner of the property am exclusively contracting wit licensed common to
and who trnmect( such
Business and Professions Code)The Carsomwr's -,
LimaNGl t[
and wh m's bracts.ense law, o an owner with
property who Wilds or improves meteor,
du,
- _ - G 1 am oz's Li under Law.
pmlecss with a<onuanor(s)IicemM portiere to due.
pr c t(Sec.]
License Law,doves not eppl t \
u r •• I• ,BKPG(«tis uason ' .. .. �J
Owsur .,. Date'
' "WORKER'S COMPENSATION DECLARATION /_ ✓-LC(JC/l
' 1 hereby a(irm under penalty of perjury ane a(te following dmlmlims: ��-
C Inave and will provided
h byihccti of Conant to sdf-insure for Workers
Compensation, as provided-for by Section 37W of the labor Cade, for the
pe+fomun«of tk work f«which tis permit ix issuW.., ,
G 1 hada and will nodrdam Worker's Compen ation'lnsumcce,as reclaims!by Section
37M of the Labor Code,far the performance of the work for which tis permit is
issued.My Worker's'Cars, a ma Insurdnec carver and Policy limber ate:
Camera r ..j•,,'.n!� k'.'Policy No.: � "e r ( -,;_.�...T . .k t. . .. .r n
It CERTIFICATIONOFE%EIvIMONFROMWORKERSI
x - COMPENSATION INSURANCE _ . . ...... .._....._.
r (This secmon'med no be compleud if the permit is for one hundred dollen
(SIW)«less),
1 minify that int performance w rk for w this perm t s issued,I
Shall t employ any 1 o n y�nf e�x_n; t m mb3' t t the Worker' '
Compensa' n x of Cdlifomia,Dau
Applicant P': .. . . . . _ - .
NOTICE TO APPLICANT:IL after m2o,
cm cera of Ex Prion.You shouldbecome subjecna the Wokcls Compc pm ni a n"" r Code.you must
0forthwith comply with such provixinns permit sh I erred revoked.
zI I — 'CONSTRUCTIONDING A NCY " . ,.I ..
' I hereby aPnm tet d6eieB a conatmaion IeMing agency for the peaormmme
,�, sof to work forwhich this permit is issued(Sec.309],Cie CJ
Leader Name.,....r .._. ,. .,..v.. . .. .... .... .. .... r, . .. .s. .. _
;D Z lindcr's'Addrtss
V 0
1.adfy the,I have mad this application and sure thin me dove tfnmution is
Lc,'.E„ smirne,.I agr«m comply with all city and county ordinances and state laws relating
,to Wilding condeamioWand hereby authorize represeomtivex of tis city to enter upon
gy] the above-mentioned propemy for inspection purposes..,
,..G (We)agree to save,indemnify and keep hammiest the City of Cupertino against
tq liab bla,,%,judgmcnu,costs and expenu re way¢crate against Said
V.z ity in conu9ueatee of she gouron period
,APPLICANT UNDERSTANDS NO WILL PLYW HALL'NON.POINT Issued by: Date
SOURCE REGULATIONS. Y'
Srge urcofApplc nUC.-m .�- .: - Dau , Re-roofs
HAZkRDOUS M SCLOSUR
iY t m pplicant f tree W 1 a,ncmSam R or It a hazardous masedm Type of Roof
as d fd by.the Cupen no Municipal„ to Health and Safest s.y a. l t
CM.mum 251J2(o)+ ,In.O No '1 r't'f.1.1 ,
All.roofs shall be inspected prior.to.any roofing material being,installed.
.:will the apphcam or fu.lure Wilding«aupant equipment or devices which If a roof is insialled'without first obtaining an inspectioli;''Itagreexto remove
emit hazardous air com6minarts as defined by the Ray Area Air Quality Management
Dismmp '� all new materials for inspection. Applicant understands and will comply with .
'Q GYes „ GNo all non-point source regulations. „
1.
1 have reM the hasardous materials requirements maker Chaptcr 6.95�of Ne
Cvlifomia Health&Sately Ciidc,Sen 505.25537 and 25534.1 undersand that
if the building dues not curren v n that it is mymsponsibilitym nmifytbe
occdpant of the req in which vsi er prim to issuance of a Certificate of
cwtpaney.. a Signature of Applicant Date
owner«gator M agent: Date, All roof coverings to be Class"B"or better