02080114 CI BUILDING DIVISION RTNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
644 STENDHAL LA 02080114
AJILL
APPLICATION
A7E
08/21j2002
17mw�
PHONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/F.NGINEER: BLDG ELECT PLUMB MECH
U1 I,. U L_I LJ
LICENSED CONTRACTOR'S DECLARATION Job Descnpll00
pIhertby a0irm that lam licemcJundopn,visinm ofCnapmr9commencing UPGRADE MAIN ELECT PANEL
' dPmfesslonsCede,and I nose
fou for rot -2 I' s "' g1= )EC;?16"1
Dae n tortMA w In TION° timateJ,ympy J�rix x TION
a p C Licensed Licensed Proms
OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law fm be
F Z a following reason.(Smarts 7071.5.Business aryl Professions Code:Any city tactically $1800
Iso whin q permit t construct. Iter p demolish, repairy structureNam n to
.pet issuance,alsomq thef erm
such piuo flea gnedstaument
thane is reeled Noonan tb the provisions fde Contractors Lie La (Chapter Q.,,, tn$�p�Or/,�f1�a Valuation
(commenc n with Section 7910) f Division 7 f theBusiness and Professions Code) 1 l,,,.3 7,`Jts'6V s? `;`! r ( r L"
or that he is exempt therefrom and the basis for the alleged eximption.Any violation 3'" t M1 - 3 .Y, si i t I(4._ t ).L.
of Station 7031.5 by any oirdiesm fora permit sabjccts the applicant to a civil penalty
of not more than rive hundred dollars(5500) 304APNKI�yObf ELECTRI AL" '' Occupancy Type
❑l.as owner or lee property.or my employees with wages as their sole compensation, 501 — FINAL ELE TRI AL ENERGY
Tl'1V T.
'will do he work;ane the'structum is or intended or offered far sale(Sec.76w, SOS — FINAL EL�4LL`Ga QIPi�iCCtiOitS
Business and Professions CotlThe e Contractors Licenu law does not apply to an
owner of properly who milds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements are not intended or _.-
offered for sale.If,However,the Wilding of improvement is sold within Gni year of - - -
dmpletion,the ownerbudder will have the burden of proving that he did not Wild or
improve for purpose of sale.).
CJ I,r owner of the property,oro exclusively contracting with lei The Cisacmrs to
_ - cunswa the does
(Sec.7tola Business and Professions Codctl The Conti hereon,
License Law das not apply to an owner of progeny who builds m improves thereon, tl�4 Oen
J 5 ' ..and who contracts Lim.ch projects.with a cunvucmr(s).licenud.pursuam to chat - --- - -_- - - - - -
" Conunnor's License Law. . ___ _. ._. .. __ -- __ _._.�'O�y -
_ ❑lam aempt under sec: .B&P C ballads reason AIJ; O 2 O n
Owner Dote '' 4 4
_ - WORKER'S COMPENSATION DECLARATION 11
I hem by affirm under penalty of perjury one of the following dmlamtione. BUILDING
yp1
G
._ ID 1 have and will maintain a Certificate of Conseni'to self-insure for Worker's
n Compensation, in provided for by Section 37W of the Labor Code, for the
- performana of the work fur welch this permit is issued.. '
❑1 have and will maintain Worker's Compensation Inxuranci:as required by Section
37W of the Labor Code,for the performance of the work for which this Permit is
i...call,My V at ere C`mPens, ion Inmmncc Gamer and Policy n mber am
map/ 'A U P WORKERS'
;,r'•t ! t ,, ,a.� Iti I ..ie _•_x 5, ,l u,ifiti^ .t1
t7! q vr.l CERTIFICATION OF,E% ON PROM WORKERS[, 3
" COMPENSATIONINSURANCE,`t,.-'
(Thi,ss tlkm nerd not he zmad,red 0th,permit is for one hundred dollars t I o
•
($1 00)or less.)
I enniry yr,a in the performance n the work for which this Permit a issued;I ,
shall notation L'w% person it any manner m ac m Wcome subject to the Wnrkcis'
Compensation Laws al Culit-ssmia.Dine
Applicant
NOTICE TO APPLICANT:IL atter making this Cenilicaleof Exempunn,you should rix
bicome subject m the Worker's Compensation provisions of the L thor Code,you must
Q 0 forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
rL"> 1 hereby affirm that dem is a construction lending agency for the performance
of Ne work for which this permit is issued(Sec.7097,Civ.C.j
PW,. Lender's Name ._-._.�.• .. ... - - -._ _.. ,... _ _ . . _ .... -_._. --_._,.
Z L der's Address, -
U C I cc"try that l have read this application and state that the above information is
C. city I ng¢e to comply.with all city and county oNinances and state laws relining
P.t to Wilding construction.and hereby authorize rtprevcntatives of this city to enter upon
the above-mentioned property for inspection purposes.
F 0.n (We)agree to save,indemnify and keep hamdc"the City'hf Cupertino against
to liabilities,judgments,costs and eireaws which may in any way accrue against said
U Z City in consequence of the granting of this permit., ,
sAPPLICAN UNDERSTAS SANDWILLCObIPLYWITH .LHON-POINT Issued Date
- SOURCr G1 .A N Y:
it ,a Applicant oro ... - 'Date Re-roofs
H )OUS MATERIALS DISCLOSURE
Will he aPPlic t a,future Wilding occupant Wore or handle ha„rdmn material .Type of Roof .... .... ' - ,
Cmc ed by,the tAq,co Municipal Code.Chapter 9 13, d the 11 IN and Safety
ride
Semon 25532(a1 ( - , Y:s. ..,r •xf r ,,'
❑Yea
.All roofs shall be.inspected.prior.to.any-roofing material being installed.- .. .-...
Will the applicant or future buildintio,colvion ase equipment or a vice.which If a roof is installed without first obtaining an inspection,'I agree to remove
rot hazardousit contaminantsas defined by due Bay AmAir Q Iity Management
un t t „r• all new materials for inspection. Applicant understands and will comply with
oY all non-point source regulations.
1 have Health
the Safety
Care. materials tios2 requirements undo C.1 terma rso d the
if the
uil Hmhh&Sufcurendy have Sections itis yospend Jq.lityto none that _ -
ifthebuildingdoes not currentlyhazeastbc, thatnist responsibility is notify the
Oc upas of the rcquim cots which rotor be tact prior t ce of a Ceniricac of
Occupancy m
Signature of Applicant - 1. _ Date .
o rta,ea age t Date All to coverings to be Class "B"or better
. .. -: _. OFFICE _.. -. - . . . .