01020059 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRFSS: PIiRMIT NO.
010220059
OWNER'S NAME;: APPLICATION SUIT D/O 1;
1, 02/14/2001
191ONE: — SANITARY NO. CON'BOL NO.
O % ARCIIITF,I:f/I;NGINI[I;N'. - 1BUILDINGPERMIT INFO
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BLDG I71.I4C1' PLUMB MECH
aF�6y
pv� LICP,NSED COM RACIY)H'S DECLARATIONJob Description
%O>=0 1 herchy aldrin Ilett 1 am licensed under provi.vion,of Chapter 9(commencing
p m with Section 7pXBo Division Jof the thionm.and l'mfessi , de.undo license
11 at
rnrc,an r,mi2� 3 NEW FURNACE
Yy<J u
O�O Duren. las._—as Contractor
3 a � —�Ak HCI"S OhCI.ANA9l .
H u I underamnd my Pl;n+s,,hall Ile u.ad;m pnhhe Ie"nds
la
w d a� O Liccn.wrl Prnressional
OWNER-RUII,DER DECLARATION
o.6 o, 1 herchy mrmx that 1 am a troN f..m the Conttamnr's License law for the
co z< following lesson.(Scctiun 71131.5.Imine..and Professions Code:Any city or county
E F O which responses a Ipernint to construct, Iter,improve.demolish, p ny structure
a.3oy prior to itsalso requires the applichalf pe ill fl "signed star
arrom
that he n. dp ..ando,the prookiloos ooh Conmicter n License Law(Chapter9 Sq. Ft. Floor Area Valuation
(enm:..mein,web Seunun 70000f Division l orthe Bm:naw and i'mlc"ions Cade)
,hu be Is exelnpt Ihcntnnn and me hook boor Ilia.Ilcgwi excllg,dml,Any violin a $0
of Ruction 7031.5 by any applicant for a Penni).subjects the applicant to a civil renulty
m not more than Eve numbed dollars 1351X). APN Number . Occupancy Type
❑1.as ow he,ili he prtxperi,ser my employees with wag,on,their ttae compenwtl m. ?
will do Its,work,and the domain,is not intended or offered far vile see.704,1.
Business and professions Code:rne Contractor.License Law docs not apply to an Required Inspections
orvtir of progeny Who huild..or improve%mercon,and who dues such work himwlf
vmight his ow it a:nploy,espooided mot%udr mpre ctact ,are roar intended or 204 — UNDERFLOOR FRAME
olU-1 for rale.II',huwmer,Ib,miming in impmvamunt is.old w,Ibn one ycar ooh
..ptelll,the nwner.baimer,will If'o,me minden of Pro ins mat he dm len bold nn 301 — ROUGH PLUMBING
union,for pntpmm m'arced.
303 — ROUGH MECHANICAL
❑1.trownet of the miserly,am exclusively contracting with licensed Conicmnm
construct the project(See. to
Business anderty whits.Cort The eex themr. 304 — ROUGH ELECT P.I CAI_
andwho
Law don not appy to an ow net of property w'ho bands or d purse s thereon,
and rano I Jcns R+o won rnnieel.with.a mnmmdaa.)licensed paosxailxt m me 505 — FINAL ELECTRICAL
Contractor,1 aegn nnlm sews. .It&PC nnthls reason 507 — FINAL PI_LJIYIIIING
Owner Dale 508 — FINAL MECHANICAL
WORKERS COMPENSAIION DHCLARA'I'ION 51.4 — FINAL PUBLIC WORKS
I harcby aaina umler pwtalty of perluly one of the fallowing dcd.onmes:
❑ 1 basic and will malntan a Certincam of Corwin to self-insure lin W'orker's
Compcmution.as provided far by Scctiun 3700 of the Luton Coda, lire she
perfonnuno of the will for which role pmnuit I.loud. -
❑1 have and will eminlain Worker's Coulpenxunna Insurance,its required by S,dion
371X1 of the latxn Code,lis he performance of he work to which this permit is
isle d �J\y W�oo�/4(' Campenn,tiww
on Inmw carrier and polino
policy nher me::
Coer✓ 1 so,�t' L—,t —Policy No.:��JLgp�
m
CERTIFICATIONOp EFI MITO F 41 WOItKLI(S'
COMPENSATION INSURANCE;
(This cdin i need nil be compl,(td if Ilia permit is Goo one homrcd dollars
IS I00)an IcelJ
I cohnny that In the ivronciance of ilia voork for which this parent is issued,1 •�
shall not employ any erwor in any manner so asto become subb,cl to tire W rkcn /
Com,anscon.Lays.of California.Data
Appl t
NOTICE BO APIIICANf If aflat A gm:Caralcme ofl no Yrom should
suction,subject it)the Worker s Compensation prnr i on.t f the Lather Clude,y,run /
Z O fonhwltM1 comply wh....n prackina,or 1111,penail shall be deunmd revoked.
FCONS'rRUCI'ION LI.NDIN'G AGENCY O/
a ' 1 heathy shiner daa mete Is a automation landing aganc'y for the foramone
cattle work fen which leis penin to i...ad(Set.3097.Civ.C.)
L Q Lander's Nano
5 z Lender's Address
V C [cenify]hat l have read this application and mum that the above information is
4. Ea torted.1 agree u+unnply s.i(h all chy ani coun,unhmmom and one laws lelming
U to huiminga+mwotion.and notary uohorio representatives of this dry lovoter upon
w me abnvo-mm..tiancd prupu ly]or Inypxalon It c"
(We)ngrce ox,;oa,indemnity not keep liar ]a,,the City ul'Ci,,Iino ugma,l
'r V) liabilities.judgmares,cost,,and expenses which Indy in any way accrue.agaim(said
C.7 z City in mmequcnceol the gomin,rf leis Penn i]. \ 7// O
APPLICANT UNDERSTANDS AND WILLC010PLY WITH ALL NON-POINT Issued by: Date - l
SO' 'E REGI�sT
.g ranrnnpRc.xnvcnn(mano Dat, Re-roofs
Will IIALARuture MAlogicALs DISCLOSUHG
es]by IxpCap.Ilea.)manorpal oda.up:)room<mh:Innliath"mna.ndSAial Type of Roof
lie de,7ncd byb, 32(a)?no Muniulpul)soda.Cllupmr9.12,and Ilia Itrullb ad Safety ,
Cde. OYc.x^_55320x)7 0N .
All roofs shall be inspected prior to any roofing material being installed.
Will the apNimamorfuture had ldingtpeuipantuse equipment ordc%ica:wren If a roof is installed without first obtaining an inspection, I agree to remove
emit h t mous air comamimm1,as defined by the Bay Arca Air Quality Management
District' all new materials for inspection. Applicant understands and will comply with
o Ye. 0N all non-point source regulations.
I hall rw:al me hanmtrnu numd;lls rdpo'clac ll ender Chapmr 6.95 of Lha
Calilorma I bahb de Safety Com,Sections 25505,25533 and 25534.1 understand that
it me building doe,not currently color,a tenant.(ilia 11 a my re.ponsihi lily u,roily'be
occur.,u]mw rc,dreacno which mon br,n¢]or to i......col a Ccni6cam of
`ccur / Signature of Applicant Date
t)kT or uwhurir dogerx( Data All roof coverings to be Class "B" or better
OFFICE