01050161 C'BY
OF C' NO
ILDI C DIIVISSIIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10500 RIDGE VIEW CT LSI 01050161
OWNER'S NAME: APPLICATION SUB DATE
' CIENA 256 E HAMILTON AVE 05/21/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 370-1970
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w LDG ELECT PLUMB MECH
or i RIN1 kND o Ci4M{t2h 0 r- a 1-- -
�a
Q H LICENSED CONTRACTOR'S DECLARATION .lob DescrlptlD
1 hereby zFtm that 1 am licensed under Provisions of Chapter 9(commencing
Fv, with Section 7000ofDivision3 oflha Business and Professions Code.and my license
reanis in full and effect
m License Class SLic.p
5-1, taQ INSTALL AC UNIT.
X
3 R. Data B k t-� Contr.c or C.a. [ C s
ARCHITECT'S DECLARATION
h t= I understand my plans shall be used as public records
E y�Y
u°i s p Licensed Professiowl
OWNER-BUILDER DECLARATION
R.
w'9_' I hereby affirm that I am exempt from the Convanor's License law for the
C 41 following reason.(Section 7031.5.Business and Profusions Code:Any city or county
SzC which requires o permit to construct..1111.improve,demolish,or repair any structure
toa. p n t [ .bwc aLm r1. ;hen tf .uah i'
that 9a S:lyc ed p rsumlg""Vie Po fthe C �! � Law(Chapler9 1.5'O,Fl- tootAred - 'yY .�7OO��UanOn
(c nancu Ito Scction70m) fDrv'siun 3.t the BuslocsadPmfeuiam Code) tP"' 11�, , v ! ,u a,. E slr
or that be is lumps thcmfrorn'and Ne basis for rhe alleged eudmptio s.Any violation
- of Sectio"7031.5 by any applicant for a permit subjects the applicant to a civil penalty
Iofnrn more than five hundred d.11.($500). 3101�4I]VIT160 Occupancy Type
❑hasw rot the property,or my employees with wages as their sole compensation
,
-,will do Ne work,and the'Wawtmo,is not intended or olterii for sale(Sec.700.1.
'Business and Professions Cade:The Contractor's License Law does not apply to an 301 - ROUGH PLftNft14CPspections'
owner of property Who builds or improves thereon,and who does such work himself
or through
his own employee.,provided roar such improvements am nay Intended or ._- -. -. .3 0 3 _. ROUGH .ME CHANI CAL..__,
.offered for sale,If.however the building-or improvement is soldwithinone year of
'completion,Ne owner-builder will have me Maden of proving that he did not build or 304 - ROUGH ELECTRICAL '
improve for purpose of sale.).
501. -__ FINAL-,ELECTRICAL._ENERGY..__.:_.._.-._- -........_._.__
❑huctthe ofthe propertynm exclusivelyconirussi withlicenuh Contractor's
iLicense theoesno(Sec.]roan Business and FrtywhomildsorTheContheron 502 - FINAL PLUMBING ENERGY .:.
.d.weLawmact.ntr-sac apply man owner wish property whorl licensed p.ovesmereoe _503 — FINAL. MECHANICAL...ENERGY..
.and,who rs License Low.ch projects wiW a comrvcmi(sl licensed pursiant to.Ne .___. _ -
Col som tole License Law.
- ❑IemuemptunderScc.' � ,B&PCfor this rrason 505 - FINAL ELECTRICAL,, >
OWii2r"' dans. . .. !". 507 - FINAL PLUMBING
y„r _WORKER'S COMPENSATION DECLARATION 508 - FINAL MECHANICAL
-" I hereby affirm under penalty ofperjury one of the following declarations:
C11 have and will'maimain a Cenifiu.de of Consent to self-insure for Worker's
_- Compensation, as provided for-by Section 37W of the Iawr Code, for the
- - performance of the woo for which this permit is ivuW. �
Cane ft W rbor' Comof 1 omnce as i 1.t -_
3700iss6ca. the law Cod for theoperformancef the work for wh this pc 'n
❑111 and ill riatua WoHct,l Cmpsm ¢ dPhysw rare:
y � x Compe at n
�.in: k � A,TsiCl P"Imy No..t q(3 3t3'7i. 1
'CERTIPICATO �OF,EXEMPTION FROM WORKERS. '
COMPENSATION INSURANCE
pais section need not be comPlcte i f toe permit is for one�8i.bedddl� - -
($100)or leu.)
I certify shat in the.performance _
t � pe a 1.e f the work far ohne subject
permit a issued,1 .L
shall not employ wi of C.on m any mannas id become subj 1.t t the Workcrn' i
Cbmicator ionLawsofCalifornia.Date-
Applicant PeLIC
'NORCETOAPPLICANT,th'sCtermnsati this Gamins of of Lat,ohiomyeu-haulmbecam ! '
forthwith compyct to rhe suchrsCnmpermation Permit she of
labor Cada you must
z Q
forthwith comply witti tech provisions - his Permit shall be deemed mvaked.
F:N ' f `- {' 'CONSTRUCTION LENDING AGENCY
s.w
of
hereor affirm this permissued
(S c.'lending s.C.) far the performance
Wye work for which thin permit is issued(Sec.'3097,Civ.C.)
a.Q -Lentler's Name. __ .. __ _. ..... .. . .. .. .. _ .- .-.. -__... ..- ... - _ ..
,Z Lender's Address
U
;1 cenify that 1 have mad this application and state that he above information is
ks=Ent correce 1 agree to comply with all city and county ordinances and.itch,laws relating
:. D V no Wilding consmerion.and hereby Unionist representatives of this city to enter upon
(al the abovementioned property,for inspection purposes. ,
:- _ly (we)agree io save.Indemnify and keep hormlessthe City of CitPMI"o against
VJ liabilities,judgments,costs and expenses which may in any way accrue against said
VJAPPLCiiy in umscqun¢e ofte gmntmg of thivpbimit.,,,- NDS AND WILL COMPLYWITHALL NON-PO{NT Issued by: Date
Signature fnpplica .vector ,Dam Re-roofs
s HA ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material Type of Roof - - -.----- - -- - •—
fined by the Cupertino Municipal Code,Chapter 9.12 and the Health and Safety _
., 5u r Oyer °NR
. AlLroofs-shall be .
_
ins ected. riortoan
p p y_roofing.material.being installed.- . ._ _..
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection-,I'agree.to remove
emit hazardous air conmmiwna as defined by the Bay Arta Air Quality Management
District?. , all new materials for inspection. Applicant understands and will,co.ply with -
❑Yea "' r 'ONaI - all non-point source regulations. .
I have read the'hamrdous materials ie,rhemaus under Chapter 6.99 of the
California Health&Sat Cade.Sections 25505.25533 and 25534.1 understand that _
if the Wilding does not currently have a tenant,that it is my responsibility to marry the - - - -- -
ace of the onto.rements which must be met prior to issuance of a Cenific.te of
Signature of Applicant Date
Owner amborieed.,cat Data All roof coverings to be Class`B" or better
1 •" . ,', .,.`; ._ .. — _' _. _. _ .OFFICE - -. .... . .. .. _