01080023 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10185 STONYDALE DR R C ELECTRIC 01080023
- OWNER'S NAME: APPLIC TIDN UB DATE
HUGHMANICK DOUGLAS D AND KRIS 309 S 19TH ST 08�06�2001
PHONE: (408) 280-1180 SANITARY NO. CONTROL NO.
cat O p ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
y 22<�
1° LICENSED CONTRACTOR'S DECLARATION
Z b h z I hereby (firm Ihm 1 am licensed under f Cha t 9 momm lob Description
OZ- Ya provisions per enang
_f� withScdion]N lofDivisiunJofaeBusinessandProfcesionsCde.andmyliccnw ELECT SERVICE UP-GRADE.
a y- Is In full fore[este( kn`
o i u Licence SDEIf
w 3 w N Dam •� Court,
ARCH CT'S DECLA 1
t: 1 understand my plane shall be used as public re ora
sat` S
pO Licensed Profesumml
a. R R OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Can.,,.,',License Law for the
r 2 a following reason.(Section 7031.5.Business and Professions Calc:Any city m eaumy,
$2000
ce,E C which requires a permit to consumer,alter,improve,demolish,or repair any structure
3= prior miLsissuare..aLsamqui.thc appfc tfur loch Per miuo Gleusigr Wvmromem -
e. that he is licensed parmanuo the provisions of the Comments.s License Uw(Chap¢r9 d spa Valuation
(commencing with ge,,tat7N)0)of Division 3 ofthe Bminen,and Profession,Cute) 1 fJ 3.293.: Ol`VL1 „VVu
or that he is exempt hem um and she basis for the alleged exempJon.Any violation
of Section 7031.5 by any applicant for a permit subjects the vpplicam m a civil penalty
of not more than five onndmd dollars 1S5001304AP-1sitJUB�H ELECTRIAL'':"'' " Occupancy Type
01,as owner or the property,or my employees with wages as their sale compensation.,
will do the'work;'and the structure is not intended or uffceed far sale(Ser.701 -- - -
Business aid Profe„ion,Code:The Contractors License Law ares not apply to an 505 - FINAL ELHiW 2d I3)Ajbctions-�' 0-
owner of property Who Wilds or improves thereon,and who does such work himself
orcredfthrough his own employees,provided ITrsuch improvements wire nos intended or _..._-._...__....._.--.__... _. _._.____...__s...__.._...
------
completion,
for sale.IL Wwevere she ti have s or Improvement ofp n sold within one Wild
in
op....i for the owner-builder will have the burden u!proving the,he did not W ild m
improve for purpose of sale.l,
,
.c
❑Las owner of ae propcny,am a Bushels a d Professions,
with licensed contractors m Il:: ":`:G rt:'?^T la U
_
consumer me project(Sec. .a Business and ernfesh. Gdmq The ConnoteLicooson.
and who
Law docs not apply m an owmr th.cemar who W lids or improves memos,
•. 3 and.who comrnms.foosuch ptolems wima cumrmonsLlicensed pursuant m the. -
01am p under5a - •' „`' B&PC fa this raven .�r,t l,t.•i�fllilla-:
Dw Dat - -
- WORKER I COMPENSATION DECLARATION
1 Ircrchy off nn Boren pevalry nl perjury un<ol ac following talarntinns:
❑ 1 have and will maintain u'&rifcam of Coram In self-inmre fa Worker's r/
_ - Compemmi... as ...viJW for-by Seem. JAN) of the Lam Coale, for me O-
n perfonmmce of Ire work fm which fib is permit is issued; m_r ///7 Q
01 hav��nd will mairmin Worker's Compcnsaiion 1 e quire]by Section
T. ” eLabIHCsdef rthe �tpy�fyn It Camey -/i peran�Yul dI -fir
O:
CERor
T CATION OE EXEMPTION PROM WORKERS I,_ r- t s:• \_ ,} -f + •--
._ (Th a scdion need not
O bPENSANf meUNCE6n one M1unJmJ dollars_
T. s,��. t'','. n• :)C(,p s - �-�j;.
completedPermit
fSl W 1
or lexs.)
. ,I 1- nfyihm incercrommumeofm work Far whish thispe m"s issued,) - .... . ........... _,.. fj ..-. .-.. . _-:
'shall not 2mploy any scrsan in toy rom en.so as tobecome.subject to the Workers m t
Competition Laws of Calihvuu.Date''
t
.Applican , -
NOTICETOAPPLIeWorkeLafmrmaking onso o skircdmaf Exemption,youshouldmust
bcMmesobject ywit such ps Compensdshis ran,hall the LdWlorvokyou must
0 O ----sh con,- with such provisions his p- - ,hull he Jenrmd revoked.
t
FiCONSfRUCT10NLENDINGAGENCY'
�.' I W ehy iffirm,nin Ih contraction on lead ng ape 'y f the perfomu'm'e I .I
of she k f hieh thisr, . s
t' iued(Sec 319] Cis.C.)
O.fqLend r N me
V 0 1 certify that 1 have mad this appliation and state him the above information is '
tss"F.. code..I agree to comply with all city and county ordinances and state laws ruling
to Wilding construction,and hereby aumurie,representatives of this city to enter upon
�j, rites the ahnve-mentioned property far.inspection purposes. _
IWcI'agrce josave,indemnify and kap harmless the Citynf Cupcn'mn against
'fA liabilities,judgments,casts and export.,which may in any way x-croc against said
t U'Z Cityy in'consequence of[He'granting of this permit..
APPLICANT UNDERSTAND NDMLLCOkIPLY- LLNON-POINT Issued b Date
SOD .E .GULATION. S Y
8, t Applcam/C m 1- '. Pte. Re-roofs r�
.- a H V.JRDOUS MATERIALS DISCLOSURE
Wmvmmiul Type Of ROOF- _\U
II Ih pplir i rt
(t Wit I'Idingk p' Lrk k JI r
esJ f cdbyme Cupenm ut u Cd Chapter 91_,andthe Healthand Safety -" "' - - _ -}, s /
cdae Sxt on255p�'(al g p q *,e , if l.roof is installed with
n t _ . ,
❑Ye. ��a ' ❑N ,, ;' e - .. All roofsshall be..mspected.prtor[o.any roofing.ma[erial being.,ins[alled...
Will that. licamo fatme WJdin occa am.see t orde.�ce,whim out firs[obtaining an'ilispecnon;-('agree aolreniove
ems haranloas air conmminan¢as'dcfned hr rhe Hay Area Au Quality Management
y Di,mierr all new materials for inspection, Applicant understands and will comply with
Dreg ono. all non-point source regulations:,"
-:. ;1 .
:.:'
1 he' "mad time hazurdoud'mircrwls rcqui¢mcnt,under Chapter 6.95 of the "
_It
Cnlifm mia Health&Safety Code.Section,25505,25533 and 25534:1 undcntand that
"if she but lain Joes nes cuncml huvcasenamAnbs is is re, mibilil ldnmif me -' `-
H . r r ,o r Y
dchpam of the requiremcros mhRh mist Ip ma ppefm'Rtrnie of d Cnnifram of
.- Occapare .. " _
, - PP Date.
- --" _ - _- coverings to be Class"B" ortbetter -- "
" 6 rsnature o cant
tine,or out opted nI, - .,;1' Dam All TOOT g
-...._I
OFFICE