04120152 CITY OF CUPERTINO - • '� <'�_+� n =i` '" '�"'�*'��'�^" £'
BUILDING DIVISION PER 3 +�1 'T 8 T12.INFORMA'TXgN• . . .
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BUILDING ADDRESS: GURU ELECTRIC PERMIT N004120152 -
21267 STEVENS CR BLV
OWNER'S NAME: PERMIT ISSUE DATE
'r` JEFF MINARD 1911 RESENELFE CIRCLE
E: SANITARY NO. CONTROL NO.
(408) 254-4464
ARCHITECTIENGINEER: - - - BUILDING PERMIT INFO
- BLDG - ELECT PLUMBMECH
�oij LICENSED CONTRACTOR'S DECLARATION -Job DCSCrIpnOn'
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umucd ussrWaw Cham9(Momeetng .
mthoDm74vBuuaydd .nmYlicewis
mmdDEMO FOR INTERIOR
LeeRadCertem w co
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�LAPF"lyEcl'sDEcu 4L yr—•1',.1/{//y //��
I undcrwnd my plw,lull be usedupublic rteonb il,` /(�..�
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Licensed Professional
OWNER-BUILDER DECLARATION
Y I hemby affirm that 1 am exult fmm tie Commencers License Law far Loo /ry/ n
p o following won.(SWUM IRE 1.5.Busioess and Ro(esaiw Cade:My city or county son
/' //Q fJ"/} / aI✓
$ which requires,•permit w eonwrsel,almr,improve,demolbh.or repair any urucmm lV 815000
Fjr priaren its issuance.alsoollo es thoappliwt fWsuch Immilw file asignedsl.mment .-
gg F c Valuation
that be is licensed punuent w the Prowsiw of the Conmcoarl t locw law(Chaim,9 "Sy.F[.Floor Area u� ''' i k:
p$ (cosern I.SwiLh ned.n7ODD)d DivW.3.ftie Busin=and Rofmi=Code)or -
3 WI be Is,cvmpt therefrom and the buss for Nc alleged meMirdm.My lio4Um,of \•
Sccdon?03L5byu0'appnansfm.permit Rubjectalhnappncsooenacivll Penaeyof o _.,- ..,_ Occupancy Type � *-
Out mom Nan 0w hundred dollar,(5500).
❑L u owner of the property,ar my modoy=with wags a Ibeirsoe compewdm.
wBmuewak.naue.mnanl,naunwwaaartemdfmwe(sa.?oe+.eathwe uireProfessions; Re ections
andProfessions; mu =ml Code:The Contravenes Limse Law dapply en an owner or -- 9 P .
propertywho builds or improv,Nemon..nd whodomeueh workhimaelfor through his ...
own ami loy=,provided tha Rueb lmprovmenuw noointanded molfemd forule.If.
however.the building of improwmml is sold within one yeu of roroPletion.the owner• . .... _ ,
builder will hew the burdon of proving thus k did not build m Impsow for Purpose of ...._.. .__. . . . ,. -
sale.). -
❑I,as .,of the proper.em exclusively contracting with lianad conoacum,w
cowrocs me pmject(Sec.7044,Business and Professiw ConieJ The Commicmh LI-whoco - ..
rowlawd=nsap,*Mwimrofprop,(,whobudpo .twft C.eon. eI
Liecom Lacu(m surth projeM with econtracmr(s)Ilawdpurwmenthe Convacloes -
L'mew Lew. _
❑lam uempi under Sec, .BkPCfor this
Owner Date _ ..
d WORKER'S COMPENSATION DECLARATION-
P, I hereby affirm under penalty of perjury one of the following declarations:
? Nm and will maintain a CralOae of Cawntenself-inure for Worker'.Campen-' -- f
abort,u PmWde,d for by Secthan 7'K10 of Ne Labor Cnle,for me performance of the
work for which this permit is issued.
❑I haw and will maintain Wmker's Compensation Insurance,se required by Section
17Mo me LAhor Code.for me pncfmmantt,(the woo,fen which Nu permit is issued.
My rket's Campewdts hwranceeamu and number are: -
e �O
e o.:
C RTIFI A ^O• (EM N FROM WORKERS'COMPENSATION INSURANCE
(This section need Out Mcmnphati if the permit is rmone hundred dared ara(5100)
or Ws,)
I uemfy that in the performance of the work for which this permit is issued,I sine]]not .._ ... -
employ any pe...m any manrmrso as en boverm subjecl11 tM Workers'Compewtion
law,of Califomis Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of EameptiM,you should
become subject m the Worker's Compensation previsions of the tabor Code,you mum
OfaMwith comply with Ruch proviaiom or this Permit ahsil he decmW mwkcd. -
Z.rN., CONSTRUCTION LENDING AGENCY
E1bemby.M.that Nem ha construction hudingagoncy forth.porfurmancc of
E
> the=role for which this perms is issued(Sec.Sam.civ.C.)
qLendle,Name
z Lerems Addrua
U 1 certify that I howply read this city
and county
and sum Nn the.bow information Is,
0,F building 1 agree ct comply with sit cid and county ordinances and same lows minting 10a
DU buowt-coanurroj Pnand hereby anthosiarePmxnmiw,of this city wenmrupon the
W above-mentioned property for Impaction Purposes
CM•y (We)agree in aw,indemnify and kttp May
in
the City o(Cu 2L r agumt
h
in
equnce of thea granting
of this
may in any waya=ve ageiw said City
V'l A consequence or UNDERSTANDS
S A permit.
rr^^.• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -
SOURCE RFAUL
qJ -4110 0 Re-roofs
tura of Appliesm/Commemo em
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me apPI1.1 or fulum building occupant uare or lundkm..rw
u defined by the,Cupertino Municipal Code.Copier per 9.11.W the Health and Safety
Code.Section 15532.? All roofs shall be inspected prior to any roofing material being installed.
El Yes `F�Nu
Will the applicant or f"u�l'urc'budding occupant tare equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
I havumna air loon inenta u dollmd by the Bay Arca Air Quality Management all new materials for inspection. .
District?
❑Ya P.
I hew mad the haasdaus materials mquimme as under Chepmrli.95 of tie Cxlifor.
-is HWdth At Safmy Catle,Scow15505.25533 mu125534,Iuadomtand institute Wilding
tl=not currently how a mnant,Lou It is my responsibility in notify de cecupant of me
requbemcnuwhi b. Ipriorwiuuanwof Cvmneato foccupancy. Signature of Applicant Date
Q eronumomtdescnt > D, All roof coverings to be Class"B"or better