01080080 CI nuOF UDN
PERTNO
BUILDING OPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10600 RIDGE VIEW CT GORDON-PRILL INC 01080080
APPLICATION SPB DATE.
OA 1245 PEAR AVE 08/16/ 2001
PHONE: (650) 335-1990 SANITARY NO. CONTROL NO.
pO BUILDING PERMIT INFO O ARCHITECl/ENGINEER: BLDG ELECT PLUMB MECH
baa
z LICENSED CONTRACTOR'S DECLARATION
Job esen
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing N
„tom withscaion9000)ofDivision3oftheBusincssenup fcssimacre,and myfive INSTALL 2 EMERGENCY GENERATORS .
is in Pon tura ane cff«t. n
s�a Licenu Lic.x
l DIC for a
u O,e ARCHITECT'S DECLAR N
� , d as ny I m shall he used as public records
r
i o Occn d Pmf sionol
•° OWNER-BUILDER DECLARATION
1 herebyaffirm that 1 am exempt form the Contractor's License Law for the
t G following reasn,(Section 7031.5,Business and Professions Code:Any city or county $300000
O which requires a permit to construct,alcor,improve,demolish,or repair any structure
era -primm,irs issuance,alsorequires 11m.,lkam forsuch Rnonmfla esignedsumtrcm. _... _ _. _.—. —.._.._.. -_-._ ...__ — _ _ _ ..___—.__ _—____
_ fambeislicensedpursuesmJepiovisionsoftheCommuctofsLicenuLaw(Chap.9; tivr63%01 GAlP,fr"a�� Valuation
mrtm
Iconcing with Section 7000)of Division 3 of the jusinem mil Professions Code C(,l, _ _ _(_ k tAi[t�:\�;
or that he'is exempt therefrom and the basis for the alkgM diamption.Any Indiana
of Seminar 7031.5 by any applicant for o permit subjects the applicant to a mvil penalty'
wof not more than five hundred dollars a500). • 304AP-NI$®V9Fl ELECTRIAL;v"' ':1 Occupancy Type
❑Lasown«ofrhePmpeny.m.,wriploreeswhm
hwages.theirsolempemonmi, 501 - FINAL ELECTRI AL ENERGY
_will do the work,sad the someone is not intended or offered far cele(sec.9014, KNTp 5 0 5 - FINAL E11SS GAjeCIIOn$ it
Business and Pmfessions Cade:Tho Contractor's License law does not apply to an WP6LL
owner of property Who builds or mapawes thereon,and who does such work himself
or through Ns own crapl.,c.s.provided that such improvements am not interacted to - . . . . _.... .. .. . .. . . . ._ .. I
offrid f 1< If M1 the troldin-jo,impinvemsewis Id within...year of
completion,purpose,
Id 11 h the bunlen of proving that he did t Wild or
improve for WT^ f"I 1 J t/ l/
01 fimethe P t7 exclusivelycontracting iwith d t caorsto
License
t rhe .roc(ti ID3aai Business,and Professors Code)Th C ire econ, 1 1. A,.(
c „ ,
and wh Law does not apply to an owner of property who builds se rmpmvea thtom e 0 l
. . ,. .and who.conexm for.m<M1 pmjuta.will.e commnor(s)licensed Wrsuant or tor: . -
Contractors License law.. .
❑l am eumpt under Sec s. h .B&PCfor this reason
Owner . - :Date •. , ,. .
WORKER'S COMPENSATION DECLARATION
I hereby toff rut under Penalty of perjury one of the following declarations:
O I have and will maintain a Cenifictie of Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of the labor Code, for the
'performance of the work for which this pmait is issued.
❑1 have End will maintain W law's Compensation Imuence, I required by Smfion
3900 of the labor Code,far tart performance of the work for which this permit is
issued.My Wicker's Compensation Insu, a turner aM Policy number we:,
e
PolcyNe: 4 N/Le✓ .,, CO. , 112,-k d-, ° ;11_'vIf:2=�rS.
ATION OF,IXEMPIION FAN,CE, �R }.
.
CERTIFICATION aS
-C MPLNSATION INSUR
t" (This union need not be completed if the permit is for one hundred dollars " ) pt.
I certify taxi in the performance of the work for which this Periost is imid,l
'hall not employ troy person in troy manbecome
answer so as to subject to the Workers
Cma'a,-Swim laws of California.Dale
Applicant ..
NOTICE TO APPLICANT If,after making this Certificate of Exemption:you should
become subject to the worker's Compensation provisions orthe laborCade,you most
Q O forthwith comply with such provisions or this permit shall be dttmed evoked.
F "• CONSTRUCTION LENDING AGENCY - f
1 thereby afflorm th t them is a construction lending agency for the peAuroance s In
bon mk for which di perm t is issued S 3097.Civ.C)
IQ.
IQ. Q Lender's Name - -
Zi z
• Lender's Address s' . ,. •" , •3
,1 certify ohm 1 have eat ails city
and
and sore that she above information is
"IL'[,r connect.1 agree a thorax d he ell city and c reparorm6ees end sem laws eluting
Q f,) the mo building n;and herebieuNoKicuposes. v<s of Nis city mrnmr upon
r W the abovWe)all to pmpeny for inspection p harmle , _._
F p„I es.j agree to most indemnify and keep harmkss m wa ,s Cupertino m inst
said
liabilities,juJgm<ms,costa and expenses his
which may in any way,se said
U 1 y City -consequence f thegranting of Ih .it.
APPLI ANTU )) RRSyTTAR.'DSANDWILLCOMPLYWITH/ALL ON OIM Issued by: Date
soUR IIP GaL7 P'W /� fO /PDo t
Si t t fAp fico VC nt o 'j -- - orb 1= Re-roofs
' : > HAZARDOUS MATERIALS DISCLOSURE
- l the applic t or future building me pant store or ha dle hazard; material' - Type-of Roof
as d fried by hhe Cupcm o Municipal Cod Chapter 9.12, d she Health and Safety,
Codd Seetion 25532(it - ``•' k e' ;` • .. tla,.v'
. i i I V h ,t ;. r,;t•7�. fir :A -< .5. .
Eyes oNn., k-. t f All roofs shall.be.ins ected.prior to an roofin material.being installed
- ,f P Y_ g. _..
Will the applicant or future building occupant use equipment or devices which,. ~If a roof is InSlalled without first obtaining an lnspectiOt1,`I'dgree tO rEmOVe
it
heivdous air conmminants os defined by the Boy Areu Air Quality Manegemem
District?.'- all new materials for inspection..Applicant understands and will comply with,
❑res ON. -,, all non-point source regulations,.
I have read the'hhirimmis materials acquirements under Chapter 6.95 of he
California Henhh&Safety Code:Sections 25505;25533 and 25534.1 understand that _ --
-if the building does not normally have a Imam,that it is my responsibility to notify the -
escapism of the firemen which most W met prior to jor"ce of a Ce 'III or
°" (7 Signature of Applicant _- -Date.
aamcomea agent', ate All roof coverings to be Class "B" or better
OFFICE ) . .