00030034 CITY OF CUPERTINO - �--y.� PERMIT NO,
BUILDING DIVISION PERMIT CON. R T =O RINFOR+MAoTION': ob 06)
BUILDING ADDRESS: -
10115 Saich bray Cupertino, CA 95014 - R SANITA RY NO. APPLICATION SUBMI °ATE
OWNFR'FNAME: Werthmann Electric Co. , Inc: • . 3-3 w
Eric Bash/Arie 5 Hanna Bash 1711 Little Orcahrd St. , UC Nrc CONTROL#
PHONC: San Jose, CA 95125
087733-4002 408-279-1433
it 211I7ECf1ENGINEER - LDlfi ;1'ERMn 1- •Q;
Doo artik Patel ARCHevon 408 279-0320 FAY• l
LLZ�Z-
510-909-7914
X
o N M LICENSED CON'TRACTOR'S DECLARATION a
O Z'—e� 1 hereby alf shat 1 m licensed um pmvisiona or Clupter9(commencing Job Description
F:ty wfillf ion]000)afDivision3of NeBminaa and Rofessions Cad<.esd myli«mcia
N in full farce an R - -
, V Lic.# s
a�3LL Date — Co
O ARCHrTECs' DE CLARATION Lc Co., Inc. ,
i.vy ¢ DE
J 1 usWertmW my plans shell be used s public recoNs ooTemporary Power Service 100 amp, 120/208 volt
°m °Rore Professional single phase. Two 50 amp, 120/208 volt 4 wire
OWNER-BUILDER DECLARATION
t Z< - I hereby eRsm Nat 1 am exempt from she Conmacror's License taw for the outlets and one 5/8^x 8ft. , ground rod.
f O following ret(Session 7031.5,Business and Prof ions Cade:Any city or county _
z which requires a permit m commum,alter,improw,demolish•m repeb any nrucoue
Sq. Ft. Floor Area Valuation
pnonoalleenence ua.Iloso ireepe is'.icansf r sucheCm pemdOL!conw nedmsemem O J
dusheialian punuenuoNePmvixionsofNe[onuacrolLLicenselaw(ChePter9 O�
(udheit cine Swoon]000)of Divi is fr ort he Businw rod..A,ona Code)w APNNumber-
Nn he i Ise from is for Ne 1. Phan.Any s+peri is of Occupancy Type
0 0 I f a 'ts lecU PPI noacivil petWtY of
pimmian. Required Inspections
] Business
f los , Iw owner
an N gh
I M n to ins or oRcree for
rcimnle 1 improve fon Ne
improve for Pur- _
Pc sad C and contractors to
s c f at. Conaacmr's Li-
Ic 8 I
p 0 1 Ncrcon,and '
• LL a e ntracbfi
s. Nis
'cense aw.
{]1 em zeros w er Srwon V irk '
Owner Date 7
WORKER'S COMPENSATION DECLARATION
1 hereby eWm under penalty of perjury one of the following declarations V
❑Ihave endwilLnsr by Sadon37M of ft LatunCodenmrerererformece of the -
work, r phich his
for ni 5s ism 3]00 of the labor Cade,for Ne performance of she -
�O I for which this aintaiis orisn.
I 1 have and will maintain Wnher's Compensation Wurerce,m required by Basion
J]OpofNelsbor Cork.fm the perfortnam'cof the wort for which thisprnnit is ifaucd.,
Mrwnt�[�Ir(rt Sni@y`Tn and Policy T417G
Carrier. AWY No.: -
CERTIFICATEOFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This section nced not be complmc.if Ne permit is(arum hundred dmlars($100)
or less.)
I eemly Ilial in she performance of Ne work for which this pismul is issued,l shall '
rot employ any person in any manner.u m become subjar ro Ne WorsenCompcn-
sntimLawsofCaliforms.Date
Applicam
NOTICE TO APPLICANT.If,after meting this Certificate of Exemption,you should I
Wcorm subject m the Wmker's Compensation provisions of the labor Code.you must
fovhwiN comply with such provisions or this permit dull h darned revoked. J l
CONSTRUCTION eIONLENDINGAGENC'Y J MAR'•0 3 2000
I hereby affirmft,
Permit i issue (See.3n lcrCim .) for perfamumeof LI
Ne wort for which this permit is issued(Sec.309],Civ.CJ
Londer'I Name
a > Lender's Address .. r�
kl 0 1 agree Nu 1 have mad this city
and coup and some that the above hJamution is y
0. correct.)agreemio. it with all city and county ordinances mfnW cum laws relnin8m 1
L) z bui ii.minnauhi lunenJ M1embepectu izereprefenutivea of this city m enar upon Ne
C.7 0 above-mentionw Property,for impadan Purposes.
Lz U (We),igma to save,indemnifyexpenses
elk kap may
in m the City of Cupertino s against ,
0W incritailueecadb,s raming exp speohich mayinany way some against said City
} k: in crosequeme of thegm ANDor Nis permit.
[� AP .ICANTUNDF.RSPAND.S ANU WILL COMP YWITII ALL NON-PoINT r
V � tipU '.RF.0 IATIONS.Afi
' 1
'li etere -APPIICMUContnctor ( Date �fJ Q /9�/7s.�n,✓CC..�
HAZARDOUS MATE .ALS DISCLOgURC
Will the applicant or futon buil 101,4
cupant smrt or Muffle hazardous material Re-roofs
.1
s fined by the Cupertino Municipal ode,Chapur 9.11.eM Ne HedN arW Safny
Cod,Satian 25532(x)? Type of Roof •' �'
0Yes [}Ito
Will the applicant or rP,are bu;;d;ng occupant use equipment or devices which All roofs shall be inspected prior to any roofing material being
cmil hvudo,air consamirmnu as defined by me Bay Arca Air quality ManeBemeet installed. If a roof is installed without first obtaining an inspection
1W, "' I aree to remove all new materials for inspection. Applicant
❑Yes Lw^�
un,erstands and will comply with all non point source regulations.
rwni xae1N a s,rery code,satian zssos,sss3 ane sss3a.1 aMeunM Net it Ne �
buedi sna�rnmlY havicemmnl,Nat is is my ibili mnotifY�t[h�e occupmt / 1 .ZU ` \, - 7. - 9 /r-ry )
a Ne� m qe Ipriws usu y_ t of ✓ c fff VVV i ll /�U t/f_
``1I ✓ ignatur of Applicant � - Dale
caner or au orixed a8ent / Date
All to coverings to be Class"B"or better
OFFICE