01060088 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
7359 RAINBOW DR ACME & SONS SANITATION/E ECTRI01060088
OWNER'S NAME: APPL[y.TION UB DATE
1880 S . 7TH ST 06/ 14/2001
PHONE: (408) 275-2263 SANITARY NO. CONTROL NO.
l
BUILDING PERMIT INFO
seARCHITECT/ENGINEER:00
BLDG ELE -PLUMB MECH
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Z N= LICENSED CONTRACTOR'S DECLARATION Job DCSCrIphO❑
z- 1hereby affirmthat 1amlicensed under provisionsofChapter 9(commencing TEMP POWER POLE .
r_s_w with smforce ml effect.Division Business and Professions Code,and my license a in fall MAIN OVER 200 AMP .
ec a is
Clens� Z —e 9 G uc.a 5-11 a 117
3aa Date fie/ +1 Corvus or Saaa.a W/RECPTALCES .
ca ca DECLARATION
F-so g 1 understand or,plans shall be used as public records
Licensed Prnfessinnal
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License law for the
L•3 following reason.(Section 7031.5.Business and Pmfesslum Cade:Any city or county
Y s o which requime a permit to construct,alar,improve.demolish,or repair any nmaum
ro priort t analrequires.mapplicantf ch Permit File a tognedstatement.
han he is licenscid Ornoukinni the P a foe t i r L L (Chapter9 S 1. ;t: !(; ' , I $l O br�u cion
(commericng with Sat u 7Wbj of D'vi,om3 of the Business dProksim,Cade) i ' •. 1s - 'Sy F[: FloorArea t
or that he is exempt therefrom and the basis for N<alleged exemption.Any violation
of Section 703 1.5 by any applicant for a romit.subjects the applicant to a civil penalty
of no,more than five hundred dollars eS503l, 3 6 2,313P1 L`9mb�p vl Occupancy Type
❑I,as owner of the prope.,,or my employees with wages as their wle compematom,
-will do the work,-and"the swcwre is not intended"or'offered for sale(sec:70 1. 3 0 4 — ROUGH EL�tTLR�Qd9�ectiohs
Business and Professions Cade:The Contru.,-,License law dnes not apply w an `
owner of property Who Wilds crimproves thereon.and who does such workhimself 501 — FINAL ELECTRICAL ENERGY
or through his own employees.provided mm such improvements oto not intended or ,-_- -_. .
oft for salt,-lt however,me Wilding m imprnis
mvemt sold"wimra yea or 5 0 5 in o — FINAL. ELECTRI CAL
iompletion.the ownerW Bder will have me thunder,of proving thus he did not Wild or
mprove for Purprse of sale.). i
peer,to
withPd mmc h.Is1 tenon omittotme .-.
❑1 fm . am exclusively withl h t uvsto -I- 1 C,,
t ten project(S 71}0 B 9'1 I I, _ .
Lit, La d m I t f n h W la tan this
and who colluder forh t __. _ -
Cont ctors License Law,
i r
0 minexempt under Sec B&PCf for reason -r' )�• - rIt
- Owner - :. 'Eric .`
400
WORKER'S COMPENSATION DECLARATIONIh by Ilirm derpen lty of Pel y Imc.toll gd .tions
I h d will-roadromn .&'nificroc of C n' t'to If for Worker's 6/
Cmnpemaumi, as provided far by Seanum Seat37W or the Labor Code, far me O
peff.mearce of the work forwhich this
mail isissued l /
❑I have add wdl'mainaln worker's Compammion'In....ncc,as required by Section
- 37W of the Labor Core,for the performane7of the work for which this permit is
issued.My Worker's Compensation Insurance carrier and Policy number are:
Carter: 47W7r' Policy No, 671- 00 t ( ( '. '.k„ it (.
:'i CERTIFICATION OF.EXEMPTION FROM WORKERS'C' "1 I'
COMPENSATION INSURANCE 'f
(This sell en need ndt W completed if the permit is for one hundred dollars st f, 1s'U1L s'
-
r;,; 1 certify that in me,performance of rhe work for which this permit is Issued-1 I mCi .`.L'• '
shall not employ any person in any manner'so'as m become subject a the Worker,
C..'arat on Laws of California.Dme
'NOTICETOAPPLICANT II 'iter mik gro xCen'tsatcof Lxcnpti n-you chruld , ` ' 'k
bee a bl 't to the Worker':C pens t p ns of[heLabor et,,C yut ou't
O
ftorhovilli arsoply with suchprovisions o this permit.hall be,deemednokcd
ZI ' ' " y •CONSTRUCnON LENDING AGENCY
l I Hereby affirm that there i...omd fSer. lendings.C.l for the performance I
X1.0
Under
work Nfor Name'
which this Perot:t is issued 1 —.1N7.Civ.C.1
-Lender's Name•. _... ...- .r. ....1.....__. :_._._... ._ a.
4' Lender's Address'
IccnfYmat I base readthis ml'itationand.mte that the above information is
correct.1 agree to comply with all.city inJ coanty ordinances and_store laws relaing
:.Q V tobuilding cen.smiction,and hereby authorize Fepresmoives of this city to enter upon
the above-mentioned property for inspection purposes.,,--- -
(We)agree to save indemnify and keep harmless toady rl Cupertino against
-V] liabilities judgments.cats aM expenses which may is any way acme against said
(.) z. City: mnxqueree of the.....ngottnispermit. ' ._
_ AY .ICANTUNDERSTAN SAND 'ILLCOSIPLY -NON'-POINT Issued b Date t/!3•
5 RCE REGULATION. Y'
Slgrutex of Appli• Contractor,. ": " - ate'' Re-roofs
IZARDOUS MATER1AI.S DISCLOSURE
'•
will aic ppli t or fretum tor handle mupshw,material, .Type of Roof
as defined by the Cupertino Municipal Code Chapter 9.12and the Health and Safety ,
Code.Semina 255331a)^.., t,;-I: ..::i)_:..,
0Y., . ..oNo,.", ' All roofs.shall be.inspected prior.to.any.roofing_material being installed... .
— —
Willtheapplicanwrfutu¢building excursion use equipment ordeviceswhich If a roof is installed without first obtaining an inspection; Piigree'to'remove
Quality Management
emir rannxaircnnmminantamaefnmb the Ba Area all new materials for inspection. Applicant understands and will comply with
r v o
Da tO Ycs ,ONo .7- .. ,. ..
all non-poen[source regulations. ;"-,..,y,yl,..' -
1 hu've'read,he'bazuNons materials re-t itm tins under Chapter 6,95 or the
Iifornia Health&Safety Code.Sections 25505:255J?and 2553J..1 undemand that
me building does not curxmly have a rental,that it is my responsibility to notifythe
uccypnf of the xyoiremems which musrbe met prior to issuance of a Certificate of
Oce.�amav Signature of Applicant _ . _ Date
All roof coverings to be Class"B" or better
Ow aumonzcd agent.' - Date
.� -'OFFICE" l r