03050091 `I CITY OF CUPERTINO
BUILDING DIVISION PERMIT fO�'�iT�tA.�"TRIIV0X2IVIA' T
BUILDING ADDRESS: PERMIT NO.
03050091
OWNER'S NAME:
"T
LS u5'0/2003
/2003
NE: SANITARY NO. CONTROL NO.
ARCHITEC/eNGINEER: BUILDING PERMITINFO
EO ELECT PLO O
+o oZ LICENSED CONTRACTOR'S DECLARATION I0b Description 1 hereby affirm met 1 ren licensed under provisions of Chapter 9(commencing p
with Section 7 )of Division 3 orlW Business and PosteximnsCode.and my license is
in full forte effect. }�
;fin Lia C X11 TEMP POWER
C° D'lo ARCHITEC SD r RATIO! CONTRACTOR: P & T CONSTRUCTION
f 1 undcrwnd my plansahall M used uMic recuses
c Licensed Professional
7y OWNER-BUILDER DECLARATION
2 0 I hereby affirm that 1 1. exempt from tilo Contractors License city
o for the
❑O following moron.(Smit t B13 s5.Business and Professions Code:Any city s county
S$ which mquima•permit m construct,Blur,improve,demolish,m repair any mmctum
Z prior m its issuance,also mquima the applicamfor such Permit to file A signed autemem
�<
that he is licensed pursuant to the provisions of the Commctor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
27� $ (commencing with Section 7000)of Division 3 of me Business and Professions Cade)or
`�.. mat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by."applicant fora permit subjects the.,dicxnt to AaI pmMy.f APN Number Occupancy Type
not mom than five hundred dollars($500).
❑Las owner of the property,or my eroper"with wages As iloirsom compenssdon, 32630011 . 00
will do the vvmk,and mesbuctum is nommnded as@red hustle(Sec.7044,Business Required Inspections
and Professions Code:The Commoutes License Law does not apply m ns an owner of 10 3 — UFER q p
pro nywhebuildsorimpmwsthermn,andwhodmssmhworkbimselfor Woughhi.
.employ=,provided that mach improvements Mena,intended orofrered prattle.If. 304 — ROUGH ELECTRICAL
however,me building or improvement is sold within one yea of completion,mm
e owr-
builder will have me burden of pmvi.2 that he did not build or improve for purpose of
sale.).
❑I.as owner of the property,am exclusively comncting with licensed conuactan to
construct the project(Sec.7044,Business and Professions Code:)The Contractors U.
sae Law does not Apply in An owner of property who builds er improve them..And
who contracts for such projects with acontneor(s)licensed pursuant to the Comranaes
License Law.
❑I Am exempt under Sec .B A P C for this rnson
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby al fore under pea11Y of perjury am of the following deelwioas:
1 haveand will munuin aCenifiam of Consenuoulf-Insure fm WorkeraCompen-
saeon,As provided for by Section 3700 of the labor Code,for Om performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Wotan,u required by Section
3700 of the labor Codc,for the performance of ore work forwhich this permit is issued.
Myik/r�ricers Compensation lnwn artier Paliry timber am:
Grti E FI ATE OF COMPENSATION
N FROM V K^ 5' O
COMPENSATION INSURANCE
CThb section need not becomplelod if tic permit is forum hundred dellen(SIW)
orinsc)
I enter,that in the Performance of the work fm which this permit is issued.I shall not
employ any Person in any manmr an As An become subject to the WorkersCompewdan
Laws of Csliramia.Dam
Appllexm
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of tix:labor Code-you most
.J O forthwith comply with such provisions or this permit shall he doomed revoked.
CONSTRUCTION LENDING AGENCY
H Ihereby affirm that Nen is a construction lending agency for the Performance of
lYi7 me work for which this permit 4 issued(Sec 3157,Civ.C.)
CQ lender's Name
Z Landers Address
U C I anify that I have read this Application and Marc that the show information is
F correct.I agree to comply with all city and county ordinances and sus laws relating b
OU Wilding construction,and hereby amhorire representatives of this city in color upon the
W above-mendomd property for inspection puryosea
gy (We)agree to save,indemnify and keep humlea the City of Cupertino apiat
M liabilities,judgments.toss and expeaa which may in any wayacaue against said City CZ
W_
fJ? in eonsegmnee of the g g of oris permit.
APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NO -POI Issued by: Date t
SOURC REGUL S. D
_ _ S Re-roofs
silleatere H- n DOUS MATERIALS DISCLOSURE am Type of Roof
Willtheappli ' t froom Wilding occupant Mom or handle bwNous material
As defined by the Cu 'n Municipal Cade.Cbapur 9.12.mrd the Health and Safer,
Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya PNo
Will the applicant or future building oc upantuseNuipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it he=dmts air contaminants a dc0ecd by the Bay AMA Air Quality Management all new materials for inspection.
'Mee?
❑Ya 7No
Ihaw readth hvalloa mMcd.ismquiremenu..d,Cl pw,6.93ofthe Glit.,
niceHI Safny de,Savons257OS,25533and25534.1.&,v ddwifthebilding
does rot currently w a teeent,thus it u my responsibility An mefy the=upem of the
req mcntswIt my neemepderloisuamenf.Cmurmatcora'upMm. Signature of Applicant Date
/ 0
own rs.thome spm am All roof coverings to be Class "B"or better
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MA LIN
2,0940 stow crack Blvd.
CirpatbxN CA.95014
(4M253-Z22
05/23/03
P&T Costtunction
P.O.Box 360999
MOpatM CA 95036
RE: 10M N Staft Road,Capatioo,CA 95014
Dear Mr.Peter Lu&TOMMY.
I haebyto coma tbtoontnact,the a**W coanaact v thtbo signaase deed as 05/19/03
is i�my poser�on sirtoe 05/20s�03,Ido not zeal and wsbc EmtfA dwc6MIhe
comema sW be void aamd ma please notate tbeaapptoved plan back to me as soon as
po=Ur- Tbaalk You.
If yon have any 4uegi•pleaso don't hesoft to ca9 nW aammay 11dr.Mak Sbtooder.
At(408)249-7750
Sixataly,
T=Lin
•
1
CITY OF CUPERTINO
TEMP POWER o3o S
ICUPEkTINO PERMIT APPLICATION FORM
APN# Date:
2 C Z,OD
Building Address:
ozz$
Owner's Name: J Phone#:
Contracto : Phone: License#:
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Contact: Phone: Cupertino Business License#:
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Buil ' ermit In o:
lect
b ription:
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�• Residential Commercial ❑
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Cost of Project: r
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Qty. if
ApVrieEkble Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
�3,
02-