01050156 crBUILDING WN
PERTNo
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10435 N TANTAU AV G E WOLFE CONSTRUCT NC010501.56
OWNER'SNAME: APPLICATIONS ATS
COMPAQ COMPUTER COR. 395 PEEBLES AVE /c1 /=001
. I'I[ON17, SANITARY NO, CONIROLNO.
4087796455 ..
''u50 ARC]111 EC%ENGINEER: BUILDING PERMIT IN]:()F
m u_ HLDG ELECT PLUMB MIiCH
<zt CI CI U]
v v LICENSED CONI RACfOR'S DECLARRI'[ON Job Description
c z t E 1 herchy a0irrethat I am licensed under provision,of Chapwr 9lcnmmeneing
C y F 6xi with Section 700131 of Division 3 of the Onxincss amV_M
ensc
<yg� I,I. NETWORK CLOSET DTSTRIHUTT.ON PAIIF_L.
e m S Liccnnc Class Lo_ Lic,p_Fa O H Dara . ContractorlRu, 'IR:}slnic1,nl
I nduntand nrY Plans chain he used xr punt¢rte
E5 0 o Liamcd It...I aonol
OWNER-BUILDER DECL\RATION
u� v 1 hereby affirm that 1 not exempt front IM1e Contractor's License Law for the
H z afalhreing reason.(Section 7831.5,Businessland Profession.Code:Any city or county
z�m which requires a permit to construct,abler.improve,demolish.or repair any strucma
a3 _ prior m its is,uance.also requires the applicant for such pnniuo file a signcd statement
that he is licensed punusnuo the gmvis;one of the Committee,License Law(Chapter 9 Sq. Ft. Floor Area Valultiotpp�,
(commencing with Section 7110Kn of Division.1 of the Bus;n=m and Professions Code)
or that he isexempt therchout and the basis for the alleged exemption.Any violation
of section 7031,5 by any applicant lot a prnh sobjects the appncare to a civil penalty APN Number Occupancy Type
ro
of not om than five hundred dollars IS.5Igu. p y Y1'3
cl1. ronhapmperiy.orly mogloyces with wagesos their sole ooaipcastnion. 31 EChBU739. 011,
wise 1 thk a nh 1 : I f d Ire (See.7044. - Re aired Inspections
he dl f..i C Ie.. 1 L t- l :r eL ] t pply too it"
tMarefenvWho bleooriii thew d hod n rkr...reh 304 — ROUGH ELECTRICAL
or through his own employees.provided that.such impromincros arc not intended or
mrcrcd for,ale.If.however.the building or impmvcmem is wild winrin one year of 501 — F T NAL ELECTRICAL ENERGY
completion,the owner-builder will Imve the harden of proving that he did not(wilder
improve for pugwae of,ic.). 505 '—••FINAL ELECTRICAL—
El 1,as —net of the progeny,am c,tJmivny entreating with teemed hmtracon o
LInntmer the project(See.7194.Basinces and Proresslons Gadc:)ire Comocoh PI N A LE D
icense I.aw docs not apply ban nwncr of progeny who builds or imgmv¢,thereon.
and who contracts Iia such pnijeeb wish a comradur(sl licensed pursuant to the
Conuaco',License Law.
❑I not,scop;trader See. ,11&PC lbr 11111 nc:uoa MAY 2 2 2001
Ownwr Date
WORKER'S C(1MPIiNSA'1'ION DECLARATION
I hereby affirm under penalty of perjury one of the fnllsming deelamliam; BUILDING
0 1 have and will nmalnmin n Cer ificute of Corm or self-imout for W'orker's
Corilisemahon. as provided for by Section 3700 of the Lolwr Codc, for the
performance of the work for which this unit is iswed.
01 have and will maintain Worker's Compensation Insurance,as required by Section
3701 of the Labor Code,tonthe perbmouLme of the work for which this permit is
Issued.M mkc',CnnTone; in itoo: a want r and Policy"I be re
Carrier_ _ �_p I—Policy Nu.r � / 9
—c—wrip ION 01;EXEMPT ION II ROM Wl1RKI.RS'
COM PENN A9'ION INSURANCE
(11n,sectirn need nor Be completed if he permit is for one huMred dollars
IS 1003 e,co.)
1 cenify that in the performance of the work for which this permit is issued.I
shall nor employ any person in any manner so re,to become wbject to the Workers
Compensation Laws of California.Date
Appian
NO[ICE TO APYLICAN'1':ILalteruuakmgIhi,Certificate of 17acnynlon,ymi hucld
hc,onuauhi to the Worker's Cwnlwnet unprovisions of the lahur Cela you most
Q fonbwiln n
to ,ly with such it nr Ws gamer shut be dccmcd revoke,
CONS'IRUC'I'ION I.2NDING AGENCY
I hereby at3imnhot titer,is a etn,otom.lending agency for the prforinume
W of the.,,,it for which his pooh is issued(Site.3097.Ci,C.)
R. Q Lenders Nam,
.= Z Ixndcr's Addreo
U C I,,oily that I have read this application and state that the above information is
Ea correct.I agree to comply with all city and county ordinances and,tree laws relining
Utetuilding comuieion,and hertbyauthoriee mprcsverroves of this city cel enter upon
} Wrhe ahwomcndnned property for it,pdion purposes.
L (We so.redcnmify and keep hermlca the City of Cupertino u8viner
'r W Iianl I" .t 11unenl.,, . 1il n,I
o 'Loch may In..toy way ean x st said 5
U Z cit i coeae pelo= the gn::1re ,- nit. —�'—�/fJ//'/� ^/
w^ A 'IACAN'rU El'
lis )to .COMPLY WITH ALL NUN-POINT ISSUCd by: 1 Date
SI 'tCE RE f LACI' S.
Tar I A,nh,anvc -or Dat= Re-roofs
H ' v.DOUS MATERIALS DISCLOSURE
Will the apps on or future building occupant or or handle hvandous material Type of Roof
as inN by IM1e C n;no Municipal Coale.Chapter 9.12,and the Health and Safety
Ct e,Section 2553 od?
0Yo 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuorc holding occupant use equipment ordevicc.which If it roof IS Installed without first obtaining an inspection, I agree to remove
emit hazardous sur cominfliant%its defined by the Huy Arca Air Quality Management
Do;riv„ all new materials for inspection. Applicant understands and will comply with
❑Yea 0N all non-point source regulations.
have read the hvanl uleneugnlrcn¢mn corder Chupwr GJ5 0l'the
Gdil'orba ' Sat odr.Sc,lians2. 85.25533 and 255?d.l nnderswnd that
it Neh ' mgdtws no rcnrly havcamr nt titre it is my rcepansihility el nmily the
rccu m of the req. naardvolui be m ir o Issuance of a Cenilicam of
flit pansy' Signature of Applicant Date
rno..ea as=n, Date All roof coverings to be Class"B" or better
vancrorOFFICE