01030078 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PERMIT NO.
7308 RAINBOW DR EARLY COMMERCIAL SERVICES01.030078
OWNER'S NAME; APPLICATION SUB HATE
JOELSON RONALD S TRUSTEE 128 COLLEGE AVE 03/14/2001
PHONE: SANITARY NO. CONTROL NO.
(650) 967-7525
w O O ARCIRTEC MNGINIiER: BUIL PIiRMI'1'INFO
1— BLDG '.IiC PM
N MECH
�Qy
p�y 5 1.1CHNSED CON'I'RACIOR'S UECLAR11I.N
=C lhemny.arfI nlliaIlunI licenced under,prinvian.of Chirpier 9I, Icmdng Job Description
Py= with.' lion 7(NNq of Division Jnf me tlnsincs unJ l`ndvscinm Cral dnrylimnc
a it aB me" ad, t.
strum m aa., i` C�d Lm.a °/ $b(1 ADD ELECT TO POOL LIGHT
3 m me Comrunor
ARCHITF.Cr'S DECLARA'nON
= 1 r ndernanJ Iny plana shall be owd a..puhlic recoNx
S�r
5 es Licenced rrofe,.rlomll ~
-PJ o OWNER-BUILDER U1fise fie RA'noN
"� 1 much,anirin oral .,it caenml m+nm Icafrac
tor,occas,I..w lin he
F'>< ofir wing a mon.(Section 701 Business and Prafcs6ons Cede:Any city or county
Exp which require.,a permit to consumer,alter,improve,demolish,or repair any structure
ce
63� Prior In its i.zuance.Rho requires the applicant for such penny to file a signed statement
that he is ranvd pasuam to the pmdsiomnhne Conrmaors Llccnsc U,(Cham,9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division J of the Business and Professions Code)
or that he is exempt rhcrefmm and the basis for the alleged cxanprion.Any violation $0
of Section 70.31.5 by any applicant for a fermis subjects the applicant to a civil penalty
mem+tIre+mmanriseIII heddollar.(S50(j. APN Number Occupancy Type
O h ux owner slime pmpeny,ur Iny employed with wages as 36619076, 00
will it,,the work,and tn.etmcfare is sol intended or othred 6r sale)Sec.7,14,
Business and Prnfes61 Code:The Contractors Utr.e Law doe,nm apply m an Required Inspections
orr o'prorery W ho Fuad..or improves thereon.and who docs such work himself
through his own employees.provided that such improvements an not intended to 304 — ROUGH ELECTRICAL
offered for sale.If.however,the building or impmvanent is sold within one year of -
completion,rheowner- milderwill have the burdenofprovingthathedidnotbulldor 501 — FINAL ELECTRICAL ENERGY
i......vernrptlrpexe"'.ale.h 505 — FINAL ELECTRICAL
❑I,as ownar of the proper,nm exeln.ively uontra.in,with licensed onhnaam to
onoructth project(S 7011 Business dral1 I :: J
nsC IgheC lacers
Leccrou 1 J ni ny I hulic p .-thereon.
W G
a h lr el. fi or r such
p J a'With
c t qxl tic : re d pI the
Con t r Cc m 1ee
❑1 aexempt under Sec, .B ft P C Ins this salsa
Owner Date J�
N'ORKIiR'S COMPENSATION DECLARATION /
I hereby ahoo under Proudly of peritoy ane of the following Jcekuadonr, VIP/j
❑ I have and will Inainlain a Cenilic"te of Conlan to wlf-insure Ibr Workcr's
Compensation, as provided for by Section 3700 of the Labor Cede. for the
perrfirea ce of[lie work for which this permit is issued.
Cl I have and rill maintain Workers Cor,,emation Insurance,as required by Section
17 I of the t.nhm Code,for the perfunnunce of the wank for which this rennin is
,ued.My Worker's Cnmpen�cati®on Inamoce enmier and Policy number re
.ZTfL� _Policy Nu:S7,
CHRI FICA'I I ON OF EX lM lION +ICOM WOR KERS'
COMPENSATION INSURANCE
('oris section need nor rte completed if the lennil is for one hundred dollars
ISi INq or Ii
1 certify than in the perfnrmanee of she work for which this permit is issued.I
.hall not employ any person in any manner w as in become subject to the Workers'
Cunlpensminn Laws of California.Dae -
Applicant
NOTICE FO APPLICAN'1.If ager making this Certificate of Exemption,you should
be +e subject to t he Wader's Compensalion poosimu-lithefell rC'olc,YI mull
Q Q nmfnnhwith enmpy waft such novi.inns or this permit.shall be deemed revoked.
F ^ CONSTRUCTION LENDING AGENCY
I hereny affirm than there is a(...barren lending agency for the perfamence
of me sock far which his pcmmit is issued(Sees 3097.Civ.C.)
Lender's Name
Q z Lender's Address
C.I 01 certify brat I huvc rad this uppllcallnn ind Mum That the above ialbrnnnion 1,
W er slices.1 agree to damply will,all cay mol coumy anlinunces and xan laws Ideting
I"buildmg co-loWl a.and hereby authorize reinesrnmtives of this city to enter upon
y ky the above-memioned property for inM1ction puq+oms.
(We)agree it,ave,indemnity and keep hannlca.the City of C.pemms a,miio
W liabilities.judgment,aNs and expentts which+oar in accWc agdrot.aid
TAN canseque a ren+e gmndng assts
�A-LICA 7ERSTANUg AN 1 tlMl'I TH ALL NDN�POINTIssued(]Lj Date
CE LKfIU 5.nG rph. Conn sJ rate Re-roofs
HAZARU(lUS MATT In ,S DISCLOSURE
Will the at"I c'anI rel luwrc building =ii,am,loneommudlc h....drn,sere ed Type of R
SdbthuDye, 255321st! ONo
All too� shall be inspected prior to any roofing material being installed.
WiBtheappfiamtorfuture building ascupantuse equipment orclevieeswhmn If a r f is installed without first obtaining an inspection, I agree to remove
emit hezzNous air eommnimmma m defined by me Bay Area Air Quality Managernenl
Owner? all new materials for inspection. Applicant understands and will comply with
0Yes °No all non-point source regulations.
I have read the nnomlous inef,duls n, en w,under Chapter 695 of Ihn
California He:Jlh A Sid"y Calc.Sections 25511,25513 and 25534.1 underhand Thal
pfd huilJin• not cumnlly haveumn:un,thul'n ism spmsiM1ility n+notify the
upant c u re ant.whi s the io seance of a Cenilicate of
""1'"" Signature of Applicant Date
All roof coverings to be Class "B"or better
s cr or authorized agent Uute
OFFICE