02100196 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:.
BDII ORPRIMROSE WY CITYWIDE ELECTRIC PERMIIN02100196
'RL+AR+RARIO ANGELO C 4686 MERCURY ST. #A APPLICATp(S�gMrj.2002
In HONE: (800) 797-8677 SANI'T'ARY NO. CONTROL NO.
ARCHU'ECI7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
WOOLICENSED CONTRACTOR'S DECLARATION
c u P I hereby notion that 1 am licensed under provisions of Chapter 91c,mmencing125 AMP UPGRAD�2 b Description
t,« withSttrion]IXXpnfUivisinnlnfthcBusinessanJPrnfcsxionsCndc.anJmylittnscix
f in full loroc and 5dct 0
ZO�Z License tI—mss l•: Lic.pJ
OZ—O Date_L/ / aICumorclor
gH�j ARClUTECTS DECI.AR 'ION
� �� Iunden,and my pitimiloll he used as Public records
OLOU
F-LLa. Licensed Pmlcssmnal
OWNER m BUILDexempt fir DECLARATION
�d '<s I hereby affirm,,hat 11. exempt from me fecioncmr'sLicense: Law for me $2000
W o O following rearm.(Sccdnn]1131.5.Business and Pm(cssinns Code:Any city or spotty
°'X m which requir a Perrin b,construe,.alter.impro m.demolish,or mpxir any su is um
www prior In its issuance.also rcobiresrhe applicant lorsnch fictionto file a.signedsta,cmenl
'=z< thalhci.alianxJpursuantnm
cprnvisinnsaflhcComnnrnrc '1
Contractors 3,fg6B17M,5Bo@A&U Valuation
SFO (commencing with Section 7CXXff of Division 3 of the Business and Professions Code)it
a 3 that he is exempt therefrom and the hzsis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant no acivil Penalty of -"UAPNNURWh Occupancy Type
not more than five hundred dollara(ssm). 501 - FINAL ELECTRICAL ENERGY
❑ L asownerof thePmpeny.n my employees with wages as their vyc compensation,
will do the work,and Be structure is not intended or offered for We(Sic.7(M4,Business a ulre ns eCtIOD$
and Professions Code:That Contractors Liccme Law Jens not apply m an owner of q n=
ions
who builds of improves thereon,and who does such work himself or through his
own employees.provided Nat such improvements art not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.the owner
builder will have the burden of proving That he did not build or improve for purpose of D
Calc.). O 1
❑
I.as owner of Nv
e progeny,am exclusively contracting with licensed conam
crs to
consvuomees not (Sea to
Business and ProfessionsCode.)or imp) Contractor's and
isLi-
he claw does not apply a an owner of progeny who Wildsepor improves theron,and
whonse L w.for such Projects with a cnmranor(M licensed pursuant to the Contractor
License Law.
❑I am hemp under Sec. .B A P C for this..on '
weer Date
WORKERS COMPENSATION DECLARATION
I hereby afford under Penalty of Perjury one of the following declamation:
1 have and will maintain a Ccnificam of Consenuo sel6;nsum for Worker's Compete
sation,as provided for by Section 3700 of the Lalar C,de,for the performance of the
work Int which In,permit is issued.
I have and will maintain Workers Compensation Insurance as"Word by Section
.700 of the Libor Code.for the perfmmanee of the work for which this permit is issued.
My Worker's C�omJ, a I in Insurance earier and Pohcy number a/te
Carrico C/_� PolicyNo.: O�`�IO'V
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
offin soman need not he completed Boise permit is f iumm hundred dollars(310X)
or less.)
I ccnify that in he perf,,.anec of the work for which this permit is iss,md.1 Nall not
employ any Person in any manner so asap become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifeate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code.You must
C) Z forthwith comply with such provisions or this Permit shall he deemed mvnked.
z O CONSTRUCTION LENDING AGENCY
(-. = I Welty affirm mar them is a construction lending agency for But Performance of
y 7 the work lin which this permit is issued(Set.XN7.Ci,C.)
0.Dd Q Lender's Namc
Z 1<ndcis Address
J O 1 ccnify that 1 have read this application and stem that the above information is
U. F correct.I agree to comply with all city and county ordinances and state laws relating to
C) Vbuilding Construction,and hereby authudm mpmxnurivcs of this city to enter upon the
Lk) above-mcminned properly for inssexpection purpo .
(We)agree In save,indemnify and keep harmless the City of Cupertino against /.
In liahifities.judgmenu,CMB and expenses which may in any waysccme against said City l// O
V 4 in Consequence of the granting of this permit. �r
C, APPLICANT UNDERSTANDS AN ILh COMPLY W1111 ALLNNOOO� Issued by: Date
SOURCE RI!GULATIONS.
Re-roofs
Signature of ApMicanvcommelor Dam
HAZARDOUS MA RIALS DISCLOSURE Type of Roof
Will the applicant or future building,mcupant store or handle hazardous material
as defined by the Cupen;no Municipal Cede,Chapter 9.11,and the Health and Sudety
(4Chile Section 15532(.)". QW- All roofs shall be inspected prior to any roofing material being installed.
1 Cl yetWill the applicant m future building occupant uscyuipmem or devices which If a roof is installed without first obtaining an inspection, I agree to remove
cm;,hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DRll;cfl N,�'
❑Yes L�
1 have read me hammu ns materials requiremoms under Chapter fi 95 of the Califnr
nia l lealth at SClely Cock.Sections 25515,25533 and 25534.1 understand that if da building
does not Carmol,ham a moral,that itis my respmsibility an notify tM oe'cu am of Ja
......jLSiawrTr10Irrhmoslb<mIpoorloissuanceofacert,fiea,corl>�, s Signature of Applicant Date
O DL
owner ma or;smagem, Das All roof coverings to be Class "B" or better
all
CITY OF CUPERTINO
Iteri 1 of 2 PERMIT RECEIPT OPERATOR: conniew
COPY # 2
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 36617050 . 00
DATE ISSUED. . . . . . .: 10/30/2002
RECEIPT 4 . . . . . . . . . : 20234
REFERENCE ID # . . . : 02100196
SITE ADDRESS . . . . . : 1423 PRIMROSE WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : FERRARIO ANGELO C
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 -5229
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : CITYWIDE ELECTRIC LIC # 23212
COMPANY . . . . . . . . . . : CITYWIDE ELECTRIC
ADDRESS . . . . . . . . . . : 4686 MERCURY ST. #A
CITY/STATE/ZIP . . . : SAN DIEGO, CA 92111
TELEPHONE . . . . . . . . : (800) 797-8677
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- --- - ---- - - - - -- - ----- - - - - - - - ------- - - ------ - - -
BELEC200 METERS 1 . 00 22 . 20 0 . 00 22 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 23 . 10 0 . 00 23 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BSEISMICRE VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
--- - - - - - - - - - - ------ - - - - --- -- - - ---
TOTAL PERMIT 81 . 32 0 . 00 81 . 32 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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