01060071BUILDING DIVISION v PERMIT I CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10480 RIDGE VIEW CT
OWNER's NAME:
WDCI INC
PHONE:
0 Z ARCHITECT/ENGINEER:
Z
f <
LICENSED CONTRACTOR'S S DECLARATION of CION y — 1 hereby affirm shat 1 em licensed under previsions of hap¢r 9 (commencing
F9wiH Section 7") of Division Sof Ne Business and Prok9i Cod dmy license
S mm is in full forte and t.
6 C a License Class ce Lia tr S6 LS �6 Sn
� Oae — Contractor
ZrsL
qARCHITECT'S DECLARATION
t so 1 hmoffd rpyplans shell be vud as public rccordx
y<
e. v, p Licensed Professional
66 a OWNER -BUILDER I six .p, fo DECLARATION
1 hereby etRrm Nal I am exempt (mm the Contractor's License Lew for the
1Z followingmmmn.(Section construct.
and Profession Ca de: Any city structure Sd which mryuires a permit to constmn. alter, improve, demolish, or repair any xuunurt
a3_ priono ns issuuntt, Nxorryuires Ncapplkam fm such penniuo fikasignN aammcm
Ihotdfq i%II¢eMed peck&iia tb Ili provisions ufihe Gimmctuh Lieense Luw (Cbapmr 9
LSI
01060071
APPLICATION SUB DATE
256 E HAMILTON AVE 06/12/2001
(408)370-1970
BLDG ELECT PLUMB
Job Description
INSTALL A NEW SHAFT FOR HVAC UNIT.
(commencing wish Seciion,%XQO)of Division] of the Businetsand Peofeations Code)
$290000
valuation
MECH
or that he a exempt therefrom and the basis for the alleged exempdoh. Any violation
of Section ]031.5 by any applicant for a permit subjects the applicant m a civil penalty s
iofnot more than five hundred daEan(s5W1. 204APNFLOOR F El` -'.II', Occupancy Type
❑ I, as owner of the property, or my employees with wages es their sale compensation, i ni -
-will'do-thework; and the structure Is'nbr imandW or offered for sale (Sec. 7044; aa g,a
Business and' Professions Code: The Contrector s License law does not apply m an 3 03 1 — ROUGH Mzsaaaysep{syI sec *mons
owner of property Who builds or improves thereon, and who don such work himself
or through his own employees. provided that such imprevcman, ' are not intended or 3 04 - _ ROUGH ELECTRICAL
� completion,
mle:ILhowever:the ll hav theburenori usi. sold hot he did one yeu oor 505 - FINAL ELECTRICAL -'t
completion, the owns"builder, will have the burden of proving Nm he did not build or '
impmve far pupouofsole.). 507 - FINAL PLUMBING
--owner.._ _._-._.._.. ..--_..._... _de - - --- - - --- --
ol. aamvnmanheproperty.amexewxmelraommnmgwhnhaename¢nvammam 508' - FINAL�MECHANICAL
= = construct the project (Sac. 7014. Business and Professions Code, The Con�tora 514 — FINAL PUBLIC WORKS" '' " `
License law does not apply man owner of a cony who builds or improves Hereon. '
md_wntious License
for such.projecn.with e. commcmr(s),IicemN Punuant m Ne ._... _..._ ._...... _. _. __.. 1.. .. _... _ _..._
Contractoh License Law.. „ _ _ __ _... _.
❑IamexemPt,rabr Sec.' o"' 'B&PCfmthis rearon r!`h DC'Y.'.-I7�4ui
_ 4(
Dam
WORKER'S COMPENSATION DE
,r 'CLARATION 1
-1 beach, aRrm under P"!W of perjumy,ane oLNe following declarations:
❑ 1 hive''and hil'riminuin a'CMEcuie of Consent 'in self-insurc for Workno'a
g' Compensation, az provided far by Section 3700ad the labor Code. for the
$ehommunce of the work far hich this permit is iasued. e
/ - _ . _ .,
❑ 1 ha p?nd will ma ten Wmk s Confai'vithat Insumntt as reqred inion
37W of He L bor Cod , for the performance of dse work for h chuiNi mtitiss
isadMMyftrkees Compensation lnsursricteart¢gndPly number .I
Carter v Poly N1.6 111
N"
FEXEMPf10N FR 0
I, COMPENSATION INSURANCE '-,'
` '1r6dii scalae need not be complated If Ne Izrmit is for one hundexd do
(glW)mlexsJ,.
�jR~ i"1 coni(,y thatin the performvntt of the work for which this Permit is iasucA, l
hall'not employ'any pedon in any manner oI ax in be ...he subject m the Weaken,
Cofnpemmtiod Law. of Celifomia. Dale
. Applicaai_' - - - — -
'NOTICE TO APPLICANT: If, ofo r mekias phis Cenifwu of Exemption, you should
(0Q become subject to the Worker s ComFensvnon previsions of Ne Labor Code. you most
fomwith comply with such prwiainns m this permit shall be domed revola d.
CONSTRUCTION LENDING AGENCY ,
a"�1 hereby affirm Nofthem s a construction lending ag cy for he performentt
'ref the work for which thix permit is issued (sec, 3!19], Civ. C.)
Ia1"Q -lender's Nome -•.... '''d=r__._o_.
�r Leadcra'Ahrtss
U-0 ay�l certify Nm I have mad His application and shat, that Ne above information is
LRt F wrrtm: Dagrce to comply with all city and county ordinances and state laws existing
h0.J to buildingeonsm idn, and hertby authorize represertan;esoftnis city toenter upon
-tgt the above-memmned property for Inspection purposes.
-Q (We)vgmZ to save, indemnify and keep harmless the City'uf Cupetinoagainst
' W liuhililao. judgments, costs and expcm
ases which may in any way cae again said
V Z City
m cons m of thn permit -
7. :APPI STAN LL COMPLYWITHf' ALL NON -POINT
-Signatureio App .iW YY Date
HAYARDO S MATERIALS DISCLOSURE
' WI1,,I a Cupertoofumrt pal Care. Chapter
store or and
th h Health
anmaterial
as d,finctl by the Cupertino Municipal Coda Chapmr 9.@, snJ the Hcahh orad safety
CodfSection' SANdI]:
❑ Yes ,ti.N.}I•
Will the applicant or future building receptor use equipment or deviceswhich
eNnu;air contaminants sdefined byN Bay Area Air QualityManagement
Dhwict?
ea1 feTfv
❑Yes ON I
I hove rewl'Ne hazvrdnuama � I . LnNr Cbnnier. fi 91 of ihn
s eror uiho
cw
9 —zd -6/
Issued by: .�9 Date
Re -roofs
Type of Roof _.... _ .. .. '--• _ ' _ ..
_ All roofs shall be inspected prior to any. roofing. material. bei installed.-"__ .._. _
If a roof is installed Without first obtaining an inspection; I'agrea to remove
all new materials for inspection..• Applicant understands and will comply with
all non -point source regulations.
-p ( Signature of Applicant Date
Do,, All roof coverings to be Class B' or better
OFFICE