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05050076 CITY OF CUPERTINO "' r"•' F§ �' �'" xf` - BUILDING DIVISION PERMIT _4'1111CONTRACT( I2IN 'O MATION ." au1LDLNG ADDRESS: ACME & SONS SANITATION/ELE TRI ND65050076 26 R-A-INPOW PR LOT 54 OW NER'S NAME: PERMIT ISSUE DATE ONE: SANITARY C OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �o''ci LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby of Irm Net 1 am l'emued under provision of CTapw,9(cmmmc=ing p Idd whhS=Oon7OgBo(Divi.ian3.rdeBualnustandPmfenionCode,and mylicense is Cr < in fall reace and tlf a I��LE� '�z� uan®c ud.g TEMP POWER 0 Oee ARCHTIECTS Con61-4 DECoLA TI N '�yl I undcruand my pian KIWI he used a public records, ;u. Licensed Professional 2005 y0 Oat 11.sUILDER DECLARATION 0 0 I hereby.(firm on 11. eaempt from Ne Cssion,,Co Lintner Law for the p o fallowing Ruoa(Section]onstr,Business and ng.deion Code:Any city or county $ which rcyuim•permit re condmct,alar.iniprow,h permit t ri minor ed broom"e thatWor toitsiensedpaleorequime theapplicantof for such permit Limiumo rile A signed �m< (commis licensed pumset 70th.provisions of oft ftheB mufend Ponilaw(Chapter Sq.Ft.Floor Area anon �th (comminutingheisxempt amefsectiom and the Division r d ,W egad em ti ns.Any Code)of jl $ that io la 31.5 b therefrom and de bneie for Ne alleged eaempn=.Any violation of got them any reddapplicant for s($500permit aubjecu the epplicsetmanvil penalty of 36 MWFbp00 Occupancy Type =t more dun Ow hundred dollars(S3W). ❑I,as owner ditto property,or my employcn with wages as their sett compensation. will do thework.and the struoure Ienotma nded ofdffered image(See.7044,Beeline .it Professions Cade:The Conmelor'K Liceme Law dors not apply to an owner of Required Inspections property who builds m improves dercon,end Md doer such work himulf m trough his awn employes,provided that each improvements arc not Intended"Offered(or sale.If, however,Ne Wilding or Improvement IK sold within one)ear ofcnmplete.the owner. builder will have the Wrden of proving that he did net Wild or improve for purpose of ❑1,as owner of the property,am exchadvely contracting with Ileened contractors In contmer the project(See.70",Business and protested.,Code:)The Contractors U. mew Law don resupply a an owns,of property who Wilds or impmws themen,and who contracts for such projects with a eon immur(s)licensed forward a the Commi L.e mis Law. 1 em exempt under Sec. .B h P C for this moon Owner Dale Adkkk WORKER'S COMPENSATION DECLARATION I hereby afDrm under penalty of perjury one of the following declantons: I Mw end will m wndit a CeWfine o(Conum m self-imam Tea WmkehCompcn- Rtion,as provided for by Section 3700 of the ISWr Code,for Ne performance of the work for which this permit is issued. haw and will maintain Workers Compensation Imurance.as required by Section ]00 of she Labor Code,far the performance of to weak for which this permit Is issued. My%rimesc�oo//mpo dotr�n�lnunntt carrier and Policy gum ber/ytP/C�'77 carrim:14 ��U Paliry RO-MWO ERS' /�a r-r CERTIFlC OMPE SATIONI NFROM WORKERS' ' COMPENSATION INSURANCE Me&section need not W completed if the per=t Is fare=hundred dollen(5100) or Was) 1=rrify Not In dR pmfoma=a of the work for which this permit is Wood.I shall no employ any person in any manner se as in become subject in Ne Workeri Compenntion Laws of California.Dau Applicant NOTICE TO APPLICANT:If,after making this GenlRne of Exemption,you should become subject to the Worm..Compensation provisions of the Lah"Cede,you mum O forthwith comply with such provision"Nb permit W decreedd revoke ' z` CONSTRUCTION LENDING AGENCY (-d I hereby alfgn that them is a construction lending agency f"the perromenn of Cithe work for which Nb permit b issued(Sec.3097,Ch.C.) W� Lender's Name M Z 1<nder's Adduu U O I comfy Nat 1 have coed this applhadre rep,sed sue Nu de aWw Inficou r upon t e Iy correct.I agree a comply with all city and county unbosom,and sue laws elating e building conmmnionand hereby anthonRrposes representatives of this city Rene,upon du W above-(We) to salt for inspection purposes Ly,In (Wc)egme to cows indemnify and keep harmless the City o(Ca gamin id City Uy Ilalhiihica,Judgment.commiteenc of cowsuand g espwmmit. try in anywyamue against mid City U� In edneq"ecce of Ne gaming of this permit. � G APPLICA N ERSTANI�AND WILL COMPLY WITH A NON-POINT Issued by: Date SOURCE ATIONS.// a. 3/D S (/ J� Re-roofs Signature A plias dnmnar ere HAZAR US MATERIALS DISCLO E Type of Roof Will W applicant or future building occupant Mom or handle haadoa material as dc0ned by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety Code.Sued..33333(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu Will the applicant or future Wilding occupant use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove it hmAMOus air contaminants as defined by the Bay Arm Air Quality Management all new materials for inspection. isvict7 / ❑Yes ❑No I hew routine hnndousmaurlalsrequirements underChapurd95 dftheCalifor. nab lealth& elyCadc.Savam 25505.33533 and 25534.I unicameral Lu dot building docs not tly a unset,Net It y Ropers hit ty a notify de occupant of the Ryone whi mumWmempri to no faCenifeamor Signature of Applicant Date own or authorixed eget a All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 D Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRES: Q� PERMIT # 81 os-o5©c)t OWNER'S NAME: GN-7FX P&MI5S 1 PHONE # //off S 3—dot O GENERAL CONTRACTOR: 09eloA Y ,<O.AI� I FAX # J I am not using any subcontractors: �/ dr Signa a Da(e Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 9611E -1ONS' 7yaZ Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock He Owne /Contractor Signature Date CITY OF CUPERTINO I NIVTEMP POWER OF $CUPERTINO PERMIT APPLICATION FORM APN# 3 �` 19 0 , Date: Building Address Owner's Name: Phone , Phone Contracto ��� �/s PtteJn(��� a� 6� License �jlvO Contact Q� , l� /V Phh�/)�/ : J Cupertino B>yn��sLicense #: Building Permit Info: Elect ❑ Job Description:/,),7—, Residential ❑ Commercial Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING � � � 7