04100065 'CITY OF CUPERTINO : , ,; .-. .. _ _ u`" ,�„ i:, vsya +* s a�.� z yy _.
'Bua'IN'c DrvlsloN - PEffiVIIT ,`�-`O . a .Re1C" It7R TN1``UI.2' 't'►" 10 •
BUILDING ADDRESS: GURU ELECTRIC - PERMIT N9b 4100065'
21267
OWNER'S NAME: PERMRLSSIIBDATE
TACO DEL MAR
NE: - SANITARY NO. CONTROL NO.
(408) 254-4464
ARCHrIECT/ENGUgEER:' BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
+j 00 LICENSED CONTRACTORS DECLARATION ,lob D � UOn
iF I hereby aHism that 1 un Trend under provisions tf OeCn Chapter 9(commencing p
with Section 7")of Division 3 offt BusiMassoul Prefeaioea Code.wd my It..I. '
p imfull force anderfee. TI-TACO DEL MAR '
q Z Llcenke Class Lat..N .-
tts. Dam Conuwmr
Q ARCHITECI-SDECLARATION -
'y5 dy ) 'I t ndenund my piano shall W uredo public restores
isg
Licensed Professional „-
OWNHm exempt
the CoATION rvpp.� )yr' _
E 0 5i 1 hereby.(Sero that 11. exempt from the Conunal Co License Law for the -- 'L}.Y/U 6�1 � y
E0 o following must.(Sadat 9117 t.5, r.sinus and improve.
domes Cwt:Any city or county structure
- Let// If i� U,Wtl
k$ which requires•permit m contact.Blur,improve,h permit.ri e pair any ememe t V --
La.Z ' pdorbiLL issuance.
ensedpalso
uantto and the
ovisioapplicant for such Connermrtmrcome,Law(Chapter
<
that me cing wit pursuant pmviaisio of the eBuwrf'sIicemla...Codm9 Sq.Ft.Floor Area Valuation,
p
(commencing with dominate
and of basis n 3for of the Budnexcu d on.fturi My
lation of _
$
that io r exempt "applicant
and w bur it bj m the, esmcsomb Any violation of
Semon 78713 by sty appl doll two permit wbjeeu the appikmt boa penalty of p��Q Occupancy Type-
0
77, e
rot mom Nan fiw hundmA dollars(5300). � _. _ P y '7 P '_---
❑I:umwnerdfthepropwywmympldymwiomvjurhbmtemmpcmdon, --will W the we&and the suucwrt is not intended or offered for sac(Sec.7044,Business
mW Pmfeasiwls Code:The Conuwmn I.icenw Law does not apply in an owner of — .- .• Required Inspections
property who bulldsorimprow.efhereon,and whodoeatueh work himw0fwflwugh his
awn employees,provided Nu such imprdwmmsam wtinwndW Mortared for sale 11.
Wilder will
Ingarden owmenNs mid diinaleyur of improve
throw of
builder wiB haw Ne OuNrn of proving Nu ho tlld not build M imprvw IM purpose of -
ssky
❑1:as owner of ct Sec.704,Bsineexclusively;and contracting with licensed cenhmmrs i- _ - pp��
cent La the Meka(Sec.70th•wnein and property
who
ds or I Tic Conuacton.LI- _ )❑ifL� ® p @ s%
«m law does not apply r w owner of property who burps or improv Jeencon.Cromm red ._ ,. . Ih/'[�$dH®Q@Y"[rJ�L"_JgI j -
whdconmcufor wchprlemwiNsconuacrKUliceuedpursuantrit.Cdnuacteh - � � ,�-. . .. .. .. . ,
. Lkenw • .,•_ ...
l am exempt under S. ` ! t/,B&P CtMime Mason _ •.. APR .
0)n ` ! y 10U5
WORKER'S COMPENSATION DEC cam, I ..
I hereby afflme under penury of perjury one of the following decimations:
I howead will maintain a CeNrata of Consent to wlf-bnum for Worker's Cooper. _ pg(g!
u0on,u prodded for by Section 3700 or the labor Code,for the performance of the . . - BUIL ji N
,. work for which Nis permh la issued. uYY
❑I have and will maintain WMkcYs Compensation Insurim,u required by Section -
3700oftheLaborCode.for the performance of that wart fM which Nu permit u blued.
My Workefa Compensation inwrsnce carrier and Policy number art: -
carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thr=I.need not W.ompkui If the permh LL for one hundred dollars fS 100)
M Wool
1 cw0ry Not in the perfdmemceof not work for which this pemeit is issned,I mall nM
employ any person in any mannerse u he become subject to tic Werkerf'Compemtion
Laws of Calfomlu Dwe —”
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should
become subject in the Workers Compemtion provisions of due Labor Code,you mum
0 0 forthwith comply with such prWsions or this permit met W decreed rewkcd.
ti"" CONSTRUCTION LENDING AGENCY
[nom Iherehy a07rm Net Nero lu conefrctinn kn0ing ageMy for ti0)performmce of
C> the work for which this permit is issued(Sec.3097,Ch,C.) _ - -
0.Wi Q Lender's Name
D z Lender's Md. .
C)0 1 anify that I hove mad this application and saw that the abom information is
ly correct.I agree in comply with all city and county on inances and suss laws relating m v
0 building construction.and hereby wNodw representatives of this city a enter upon the
ahwe-menduned property for inspection puryowL
(We)agree to U0),indemnify and keep humlm the City of Cupertino sPint
in con0)y y
liabilities,Judgmencontractsts and contrawhich may in my way amus againni said City
U Z APPLIICCANTOUN ERof qu,RSrANDS AND WILL COMPLY WTI ALL)ON-POINT Issued by: Date
SOURCE REGULAMONh \
✓/ o Re-roofs
m of ppliant/Conuacrr D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII triedapplicant w in=Wilding occurrent uort or handle hauNou material
as armed by the Cupertino Municipal Cade.Chapter 9.11,and fee Heelfh and Safely
does,section 25532(a)? � All roofs shall be inspected prior to any roofing material being installed.
❑Yu AN.
Will the applicant or future building Mcumm use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haurdaus air contaminants u corned by the Bay Ara Air Quality Management all new materials for inspection.
District?
❑Yu XNo
1 have reW the hemrdous materials requimmcm under Chapter 695 of the Califon
tie Health&SaftyCo@•Sm dmu 15505,25533 and 25534.1 understand Nu if the building
eau of cuncnlly hew a enen4 Nat h is my msponsihilit m notil' arc ucup of of the
m rtmcnu ich must bo met Dior m data a of a Ceto o cupwry.
C), ., D3 Signature of Applicant Date
Owner or set rind agent Date All roof coverings to be Class"B"or better