00090015CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
EUILDING ADDRESS:
PERMIT NO,
OW'NER'S NAME:
1933 PHIL LANE
APPLICA'ION SUIT DAIF
00090015
HONE:
SANI1'AIty NO. ('ON'IROI, NO.
HEENV
09/06/2000
ARCIIITELT/ENGINEER:
BUILDING PIiRMI'T INFO
EI.DG ELI PLUMB AIECH
LICENSED coni-RACTOR'S DECLARATION
Job Description
1 herchy affirm mal l ma Iwin.,vm name, pnoia nu of Chapter 9 (c ... rationing
with Section 9(XXB of Mvisinn 3 of me business and Ikoltweinn. Corfu, and my license
"'full Tome a 11'ect ,I
On cm. ,seat,
A '111'I'IiCI"S D!Cull, 'ION
ELECT UPGRADE
1 m,Mn,rp1 over snnblcrec..,d..
'NEN- exempt ifr DECLARATION
I hereby affirm Inas 1 am. from he C for he
l.lAny
-
Huaioa, and profession, c tyor
followat,
ire uires a. (Section B.,in Ca lc: Any city orrruture
comm.
improve. demolish. any awnure
which reywre.a a penny re commit atter. im Vmvu.
h embil t fie a signed
prier I IMv forthe wchpefor's lllcasignedsmtemcnt
priermits
� Sq. Ft. Floor Area
Valuation
cenedputasrc Ili the cions of Law teham=,a
malaeirJug pScOw mate nmaDivinxanne
he B,inc,, ancnae
wit ](Xxp of ie .n J„fthe Business and Peel Gide)
ins with
in t Inter A try vi
ha is Cxcmpt Intel alp nl and 'lie bvsi. hr, the alleged cscnpti..n. Any viowuly
of
Semi nn 911115 br any Ii,r t.Iilmil suhjucn tau• appllewn to t. CIV ll latently
!w,
APN Number
Occupancy Type
dnut
handled
nr van „arc Iran Ewa ha„died douse (Sslxu.
ul
$0
❑Lu ruflhcprolxRnPo nryc.nployec wimw'agcs amennnlerampem:nion.
Required Inspections
will Jo tae work, and the slucmrc is not intended or offmcd for sale (Sec. O(W.
does
Iwaincsa and Proressiana Code: The Contmemr's License Law not apply to an
ware of p,.,.y Who build% nr improves thereon. and who docs such work himself
375050 26. 00
a, through his own employees provided that Such impmvementa arc not intended or
offered fn, axle. If, however, the building or improvement is sold within ane year of
the owner-builder will have the burden of proving that he did not build or
inmpletion,
mprove Gtr parq.wofsale).
304 — ROUGH ELECTRICAL
CI..”'oo,,film noped'.ane..Inavely.nntrnningvidt ..wdeommcmr,m
501 — FINAL ELECTRICAL ENERGY
i�manic. the pnja', (See. 9(U4, loam,,, and Proles,....... Cu&O llm Cv ancon ,
ieCnwLawdnesamapply wan naweer..rpl'npcit, hoh,Nd+mbnptovcathcrena.
505 — FINAL ELECTRICAL
who umtructs 4,r such projects wilt u contract Iwerved pmsuna m the
,
Eit
nmrmm,'s License Law'.
❑ I am exempt under Sec. . B & P C Sur this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION
,
I hereby aW. undo, penalty of perjury one of IM1c sol lowing dcclam iom:
C 1 have and will at it) Insure Worker.he
u Certificate Secli of Coro3700
Salon
tae Llmor Cfor for Is
rusidnn 3900 o e L Code
Counrcu-tial, as provided Ia by
'
perfonnuwe of Inc work lorwhiea,aif permh ix ina,W.
❑ 1 have and will . mm Worker's Cn.nimnmlian Insurance, us .eynlrnl by $carne
39(X1 of be Lah, C n ', fur me perPo ranee of the work for waica tare pennil is
issueJ. n / C penwtion Insurance Cartier and feller „anal, are,
Janie - Policy No.:
iRTIPICAI'1ON 01; EXEMPTION FROM WORKERS'
CONIPI?NSAI '[ON INSURANCE
M\
(This waren need not be, completed it the pennil ix for one hundred dollars
SI do
I c,,il.I
mnity mut in the pc cent IM1c work fn, wales this pall. is issued. 1
it Oy
santl n..l anglee any pa' , , .uq Sun ran .,s m M1annte subject In mt Workers
C..mpcnsatinn Inws of Calll..nia, U.ecnln
NoflCli TO 11; nim, nuking this me al Exemption, you shouldl
NO[ ICE.
u, is be Wor: wilve must
tunsh Int nl SurLaboreemed
Cnion, pscrad.
h,
or this m, ked.
fonhwim comply wish >u<h pnniniom or this pm,it shall l deemed rcroACJ.
comply with anchpe
CONS'TRUCT'ION LEN DING AGENCY -
1 hereby affirm that there is a comtmction lending agency for the performance
of the work for which this permll i. swed (Sec. 3199. Civ. C.)
'
Lendc,'s Nmnc
IsnJcr', Address
I certify Out i have n'c I Suis eppllaal and stair fee meal c inlunnation is
s
corral. l agme l,, c'umply with ull it, mal county ordinances and aloe laws relating
In building constmelion..md thereby; horire mp ..nuallvex or hi, city hr enar upon
tae above .,ncall oned prup'ny for InapeOion prom a.
(we) agree to savc. indcmnily nnJ kceP l Icss the City of Coast against
b
,
liabilities. judgmcros, rods and a proses satin ,yin airy wry uccme again.. said
City in consoque ce.[the grant g of hispen .a
_ OO
AYPLI ERS AND AN LLC MPLY WITH ASL NON POINT
Issued by: Date
SOmI S. Ce//
Re-roofs
ature of AppG=aritcon a for nate
HA9ARDOUS MATERIALS DISCLOSURE
y will lie impliemn (It Enum budding ocCapnnt store o, hunt le bneunlooa mammal
Type of Roof
as fell I by the Cupeninu Municipal Code. Cbap cr 9.12, and the Icahn and Surety
Cade. Sermon 25532(a)11
C Yca 0N
All roofs shall be inspected prior to any roofing material being installed.
Will he applicant „t mimela,imine,,rcapwn live =wi,ranl,rt dc.i==. ishich
If a roof is installed without first obtaining an inspection, 1 agree to remove
coil h.zodnu.a air romamiamis as de ined by the Bay Area Air Quality Malmgcment
Dundee -
all new materials for inspection. Applicant understands and will comply with
DYca ElNo
all non-point source regulations.
1 have read the haloadous materials requirements under Chapter &95 of the
Culifomia Health & Safety Coca Sections25505.25533 and 25534. 1 mucournlmat
It the building dues nnlcurnm have nonan.Ihmitix in m,,onsihilily to notify the
pa a Amcntx hid eats. nc n prior m is nese of u Cenifcam of
Signature of Applicant Date
Dale
All rt of coverings to be Class "B" or better