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CITY OF CUPERTINO
A
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION
BUILDING ADDRESS:
WONG ELECTRIC INC
PERMIT N006020157
19050 STEVENS CRK BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
UNITED POLARIS
4067 TRANSPORT -ST
03/03/2006
E:
SANITARY NO. CONTROL NO.
(650)813 -9999
ARCHTIECTPENOINEER'
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hcmby affirm that 1 am licensed under provision of Chapter 9 (commencing
P
6ti S_�0 Job Description
with Smdon 7IXNI) efDiviuon 3 of the Buunmand Professions Code. and my license h
in full force and Offset
REVISION - ELECTRICAL CALCS FOR 2000 AMP
Lsense Class Lic. N
DOW i_3-, �z ConmaWr rg
NO NEW PERMIT ISSUED/ORIG. #05100015
ARCHTfECI'S DECLARATION
I understand my plans shall he used as public records
Licensed Pnsfeuional
OWNER- BUILDER DECLARATION
I hereby a1Ern that I am exempt from the Conlracmrs License Law far the
following mason. (Section 7031.5, Business and Professions Cole: Any city or county
which reqres ui a permit to mounter, alter, improve, demoinh. or repair any ssrvesure
prior to its imuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Copuracori License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Cade) or
Net he is exempt therefrom and tiro buffs for the alleged exemption. Any vialadon of
Section 7031.5 by any applicant for a permit mbjecs the applicant to a civil penalty of
fiVe hundred dollars
APN Number
Occupancy
P Cy Type
.at mam than (ssm).
37507046.00
❑ 1, as owner of the Property. or my employees with walla as Nth salt compensation,
will do the work and theawmure u not intended or offered for sale (See. 711$4, Business
and Prefers erns Cox: Th Contractors Liaess Law does not apply W in Owner of
Required Inspections
property who builds or improves themon, and who does such work himself err through his
awn employees, provided that such improvemenu are notinsnxd oroffered forsale. If,
howevv, the building or improvement is sold within one year of completion. the owner -
de
builder will have the burden of proving Noel he sod nod build or improve for propose of
see
❑ 1, as Owner of the property, am exclusively contracting with licensed commactars to
✓, to
\
cause a the Cox:) The
not (Sec. and Rowho
V
Wilds
eve Law cats not apply m an owner of propery.who builds or Improves damson, and
es o an wner of es damson n
who contracts for sash pmfCCN WIN 0 Can49ebl(a) IiarLied pursuant b BIC (.anlraelara
License LaW.
\
1 am
❑ISm exempt under See. ,Bk PCfor this moon
owner S—Iz Ae Cu Due 0 C[�
000 S8
WORKER'S COMP SATION DECLARATION
I hereby affmn under penally of perjury one of Ne following doelaations:
El I have and will maintain a Carti eme of Curator W xlFinsure far WokeraCOmper-
sadon, as provided for by Section 3700 of the Labor code, for the Performance of the
work for which this permit is issued
❑ 1 have and will maintain Worker's Competunion Trammnm, as required by Section
3700 of the Laba Cox, for the puformna of the work for which this permits issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:' _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU ¢Orion need not becompleWd if the Permit Is forone hundred doll=(5100)
in lux)
1 anifv that In the performance of Oc work for which this Permit is issued. 1 shall not
employ any Person in Ny insurer ad as an became sllbfCCI W NC WOrkeR eompnismon
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Cenificam of Exemption, you should
become - -hied W the Worker's Campcoudon provisions of dm Labor Code. you mute
forthwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm Nod NCre is a censsua'tinm lending apenry for the perfurm once of
the work for which thu permit is isseed (Sm. 3097, Civ, C.)
Lattices Name
Lanxri Addre s
I cenify Net 1 have mad this epplicstion and sum that nice above infomiehm is
-
CO=L I agree W comply With all city and county ordinances and sus laws mladng in
Wilding construction. and hereby auNanbc representatives of this city to enter upon the
abovems,judgm Property for inspection
(WC) acids W save, indemnify and keep harmless the City of Cupertino against
which may
and expussea which may in any way same agtiest said City
in consequence nce Of the
inconsequence of tht granting of this O WILL
DERSTA AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SO RC R
SOURCE R CATIONS j
Re -roofs
SLipommacifApplicamikCrinarielgif Data
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will he applicant or forum Wilding occupant s me Or handle lurardems material
as xfrned by the Cupertino Municipal Cox, Chapter 9.12, and the Health and Safety
Code, Steffan zss3nm7
OYes No
All roofs shall be inspected nor to an roofing material being
P P� y g g installed.
Will the a livant or future Wilding Omm equipment
PP a wBa use ant or devices; which
If a roof is installed without first obtaining an inspection, I agree to remove
g P
it harardnus air conuminana u defined by the Bay Arta Air Quality Management
District?
all new materials for inspection.
—/
❑Yes I�NU
I have read the hound — materials requiremens underChapter 695 of Ibe Calif.,.
nu Health @Safety CocO,Se- 505, 25533and2543$.Iunderstandtherifthe building
does Out carte p'y lout a our t at it u my mspomihility m mtifY do aaupant of ds
regmimmcn mmmmR m piorWissunnaar.CeniOcesof
Signature of Applicant Date
G
All roof coverings to be Class "B" or better
worm omho edegc t o