01070088 CI BUILDINUOPERMIT
P DIVISION O CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
2111 RAINBOW DR LOPES ELECTRIC INC 01070ss0yy88
D`�i�l`"`I`5SE WATER CO. 1060 ELM ST (��l7rg/I�Z�61
(408) 984-8422
i
PHONE: SANITARY NO, CONTROL NO.
G z i ARCHITEC (ENGINEER: BUILDING PERMIT LNFO
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a, BLOC ELECT' PLUMB MECH
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Z' LICENSED CONTRACTOR'S DECLARATION ,�Ob pescrl non
64-E Chapter INSTALL ATS & RECEP. p
Fat is in full Section andef Division Joftne Business and ProfeaainnaCwe,and my license
aM m I< is in full lass and cRttt - O l� Z
z 6 a License Class C.-'I v Lic.p S E
w 3 w Data e E camncmr
ARCHITECT'S DECLA ATI
LL 1 understand my plans shall W used as public mcoN,
ae
ad < Licensed mal Professial
C
Li
traid o OWNER-esion, R of Contractor's
^_v 1 hercny a(Sco hat I am stint foot Covo.,C's License Lew for the
z tnunw;no im,tn,(stain sm"a Bminer. and Prafe.dnn.ewe:Any city I aLloa' $9000
o wlriub req�,irw a.....tiva snn,u art,dmr,inmrn�e,demofia,,or rapair am svaumra
as
a3 'Prior ranomuance,elso requinothenpplicam forsuch pemaitm fileuaigamd sw¢mem 1f LL]]nn rrCCAAss,, nAs,.nn that he is licensed Pursuant to the provisions of me Comrrctors License law(Chapter 9 .3�C 1a W V 9YP�f V a'^• < t" - Valuation
(commencing with Section 7")of Division 3 of the Business and Professions Cwc) }''', g � /1C1�Lr„• 3 \ ' ,
of that he N esempr thcrcfrom and the basis for the alleged ciemition.Any violation '
of Section 7031.5 by any applicant for a permit subjects the Wheanuo a civil penalty
of a,moat than five hundred dollars f$500). 3044PN"UGH ELECTRIAL • Occupancy Type
E]1,aaawre,.1 hepropmy,Otoy annlayeeswimw.,a,asthuo,nArionn,moon, 501 - FINAL ELECTRI AL ENERGY
will do the work,and the not is not intended tor offered-far:ale(sec.7044: 505 - FINAL E1R '�'P�}I tions '
Bmineas and Professions Castle:The Coaot
mmor"License law does napply to an or
through
of Property Who builds or improves thereon,and who does m n work need or
ar offered
K employees,provided to t 1 improvements t intended or _
of& d f I If.howeven the building p t is told-within one year of
cornplesion,the owner-Wilder ill have the molan ofp gthlhedd notWild or
I ropown for pro of a 1 )
- e t pp ) sce
.701 Business d Professions Cod Thma s_0 I.-Its owner ofthe p ..sabimivelyt with licensed oIrso
License Law does not apply to f prowny who b Td. p vethereon
and whocontracts for such Projects with a contractons).1ficiarsed pursuant to the
Co n rs License law.
0 1 ton aaemt
-
....
under S¢. ,B&P C Por this resort - "
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following decimations'.
° 1 base arid will maintain a Certificate of Conant mself-insure far Worker's
_ Compemmian, as provided far by ScOicn 3700 of the labor Code, for the
performance of the work for which this permit is issued.
°I have and will maintain Worker's Compensation Insurance,as re hied by Section
3700 of the Latbur Cwc,for the Performance of the work for which this Permit is
Iso ed,My Worker's Compensation
pc. t In.{uta cr m y number rc
er a
Cama kaAZSt 1 t�1� CPolicy N j.. .....-
'LF. T1 CA ION OP EXEMPTION 0.1 WORKERS'; I '' ••
COMPENSATION INSURANCE`� •`.. .._. _.. s ......_.--__.......
Qbis section lied not be completed if the permit is for one hundred dollars
IS 100)or less.l
I certify that in the performance of the work for which this'parmh is issued.I - _ - -
shall nal employ any person in any mannerso as to become subject to the Workers
Compensation Laws of Culromia.Dae
Applicant _ ._..
NmICE TO APPLICANT:1L after making this Certificate of Exemption,you should '
0 become subject to the Worker's Compensation provisions of the Labor Cee,you must
forthwith camply with such previsions or this permit shall her deemed mvoked.
'CONS'TRUCION LENDING AGENCY _
I hamby alarm that there is a construction leading agency for the perfu mown
� A of the work for which this Permit is issued(Sec.3097,Civ.C.)
d. Lender's Name-
=,Z LaWcr'.s Address: t,
v Icenify that l have read this application and state that the above information is
I.. [r @saes.1.dice u,comply with all city and county ordinance,and state law,relating
V rebuilding construction.and hereby oothbrize representatives of this city to enter upon
the above-mentioned property for inspection pury,,at.
q (We)agree to save,indemnify and keep harmless the City of Cupertino against
liainhues,judgtnenw,costs and as,r,a which ma I ny way at'eave ugoino said
V 7 City in conscquaam of @e gnamin,of anis ami
^ APPLICANTUNDERST NOW YWITH ALL Nj db ON PO.T IssueDate
SOURCE REGULATIO' ------ ------- y
Signature of APPhcn vtor ac Re-roofs
ARDOUS ATER ALS DISCLOSURE
. N511 the unplicam or Tata wilding mcupum stow or handle haaardom iotrol Type of Roof - -
- as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health:ted Safety
dc
CdSection 2553-2(al^, _ I
°'" No . All roofs shalLbe inspected prior to any roofing material being installed.. .. _ . .
�VOII If a roof is installed without first obtaining an inspection, I agree to remove
emit baba dim,air comadmoren as defined by the Bay Arta Air Quality Management
Diaricr, _ all new materials for inspection. Applicant.understands and will comply with
°Yea. °"" - all non-point source regulations., I
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Cast Sitio - 505.25533 and 25534.1 undentandtha
ifthe building dues not cone ly bus m m.ahm it is myrespmsibilhy to notify the
occupant of tl r e hi Fm met priia m issuance of tr Will of
Or:upancy
S Signature of Applicant Date
All roof coverings to be Class 'B" or better
Own author;-?6, Dl
.7, OFFICE
t