02050101 TY
CI
BUILDING DIVISIONNOPERMdT CONTRACTOR INFORMATION:
Byil,plcf�,DD]_iPss;- MEADOW CT DON WADE ELECTRIC CO PERMIT No. 02050101
°Wath DE LEON 16320 HARWOOD RD AP,y,C(}T 1',sIBgATE2 —
PHONE: (408) 377-2323 SANITARY NO. LUU CONTROL NO.
Cal ARCHITECIIENGINEER: BUILDING PERMIT INFO
E w- BLDG ELECT PLUMB MF,CH
h= LICENSED CONTRACTOR'S DECLARATION ,[�h
i e I hereby¢roan mat 1 it,licensed ander providnns of Chapter p(cnmmeneing NEW MAIN PANEL/ADBes�W$ANEL
:tut with Section 7")of Division 3 ofthe Business and Professions Col and my license
is in full f ce ane efforf
i a w a Lleeru;ppl Lie,Is
i 3 u.a Dae Contractor
ARCHITECT'S DECLARATION
I understand my plans shall M used as public reeaNs
's of
i p o l.icsmed Professional
z OWNER-BUILDER DECLARATION
w1 hereby alarm or,1 an,exempt fntm the Commnnr's License Law for the
t?a following mason(Section 7031.5.Business end Professions Cade:Any city or county $4000
P S o which requires a permit m construct.alte,improve,demolish,or repair any slrucmrc
i 3� .,dot t oho 1 m pplicam for such permniofleasigned smiemrnt - - — - - ---- - - -
thathesl sFd Wrsre nothe pro ns of the Conirumrs Creno Luw(CM1epmr9 _
36 2�,ff�r:Alfla .,, Valuation
(con i gg tl Scci ]000) the vitt for
shit aged cls and Profusions Cnde) t )`.i , k -,l� C.!i a' .•
of that o is 2xcmpt tnelvfrom and he basis fm the alleged exemption.Any violation � '
-of Section IDban by any hundred
o ll for o permit subjenv the applicant m e civil penahy-
nrantmnremanBvenpndreeennnrs(ssao). 3044RN I'➢3Qi)1•GI'I ELECTRI AL,t••'-,r, Occupancy Type
°I,asowner ofinepruparty.or my employees with wages as their sole compensation, 501 - FINAL ELECTRI AL ENERGY
'will do the work,and me'awcture isnot intended or offered for sale(See:701 505 _
FINAL
Business and Professions Code.The Contractor's License Low does not apply to an tints"'- sl-iJ
own
r of romarly Who builds or improves mason,and who does such work himself
or Through M1' n ply provided' th t such improvements of intended or
uffc d f I' If,however.the holding p i Id th a year o! _- _ _ ...`. ..
compl i thebu ld will have theburden of flowing thathe did t build or -
pm f p rya f ).
..
0 1,as owner ofthe
propery exclusively cIrl8 selldo ite ,
i (
construct thep j a(Sec.70U.B-iness anti Professions il I Co t atom's
pr L does not apply to an owner of proPerry who builds or theme,
.nd»h tracts.for surch.prejects with a c t n(s)licensed pursuant.to the _
-----
Ca so .
. ..�
_ .. _._.
t r L der Sec.e/,�-Y_� B&PCT this mason
O er Daw"` tc A KS
WORKERR COMI Et\V/tiW'fQN DECLAftAT10N ////
0�
I hereby alEmi under penalty of perjury,one nf,the following dcclamticno
. ° 1 have and will maintein'a Cerifli of Consent to self-insure for Workers
Compensation, as provided lot by Section 3700 of the Labor Cade, for the
Performance of me work for which his permit is issued.
D I have and will mainsail Worker's Compensation Insurance,as required by Section
c
37M of he Labor Cade,for he performance of he nark for which his fix it'll
T. issued.My Workers Compensation Insomn<e carrier and Policy number are _
Cart n4.';.f d' Policy N'.
iCERTUICATION OF,FXEMPTION FROM WORKERS"
.�... ,.._. .. ,-{'....., COMPENSATION INSURANCE ,. s', ;,: , ,. _,_._._._.�___.-.._.__..____..._______.
miisscnionneedall tie'camplaeB if the permit is for one hundred dollars '• '.I ;,h it ,_ :tl A."
($IN)or Mess) .n•..
-- Irt fy to t the pe rf rtn c f the o k f f huh this pe t tied tl m
shell t mpl y pe so t Y o �n�u th W k
C
C 4 o t o ,awe of I D rJCI S (/
1 t:.5._
N Ct an to
he If, ft making hrCiif of tat he pt you Shoulds, ^t
Z omitsr'leny theworkersCompensatan permsansll theemedCode:you must
Q O comply p pcnni kc0,
frnthwith ram I with such provisions or this t shall items memo
,Z^r ,0 T"' t+CONSTRUCTION LENDING AGENCY "" -" '"•t.," "•
t I hereby Affirm that there,vii construction lending agency for the peilormance 't
of tfie work for which this permit is i...ed(Sec.3W7,Civ.C.)-
aQ -{ends N _.. ...._ .. _. _ _. __. ...___
Lender Add . _
V 1 certify that 1 have mad this ppl f d state that[he bo einformation is
W [.a am<t I agree to comply with all city and d a
county ces d tat 1 mining
Q !) R,Wilding constructionand hereby authorize repreenmtie-ofma city to enter upon
r;� the above-amationed property for inspection purposes. ,
F,t 4 I We)agree to save, ndcmndy and kap harmless the City of Cupertino against
rq
liabilities.judgments.costs and expenses which may in any way acerae against said 1
U,tZ City m co se sur re of the giant ng of his permit /
�S, LC RF�GINyDE'fRpST�ANy5 AND WILL COMPLY WIT 4LLNON POINT Issued by: r- Date
sylphnlfurt of AVphemNCoinmctor : :. .' .. . oar.. ,. Re roofs
. „ HAZARDOUS MATERIALS DISCLOSUREWill I t
. e
ll., future b ldingexecution t r ha dl h treo maerial -. .Type of Roof
as eef cd bymesuperin Municipal Coe Chapter 9.12,and!m Health d Safety
code sena as
- .-.
_ t I -I f' All roofs shall be,inspected prior to roofing.material being-installed, -__ -,
Will to Fplic !-'or build' g �apa�t a.e eqn v ,dei e«whcn If a roof is installed without first obtaining an inspection, I agree16 remove
ant t h ardour a r conmmmants as defined by the Bay Area An Quality Management
Diort - all new materials for inspection. Applicant understands and will comply with
( °r- Asia all non-point source regulations..,_ -
mft1T I nave l ah S.narurddusS.Iterials5rcyu dents and i Chapters!95bLme
Califohad Health a Safety Code,'Sectiam 2550;t it
am sponsi cloy demand mat _
if!b,Wilding Lass nm 2uiiemly hoveerenant.that it i_s my responsibillry mnmify the - -
cc p a of to rcquircm m h ch moa h t p t i, f'Cdnificere of n
°c " y Signature of Applicant Dale
.. . . __ .. - - -
mamM1onaea.gat, Date. All roof coverings to be Class "B" or better'