08080145 CITY OFCUPERTINOz' �'er+er>7:i r" "° y21
BUILDING DIVISION PERjyQT a CONTRACTT,0 NFQRMATIO�N
BulLglrlckQltµN PERMIT NO.
TANTAU AVE R K ELECTRIC INC 08080145
1RVS bNAIEE: PERWr ISSUEDATE
NKD CUPERTINO PARTNERS 42021 OSGOOD RD 09/23/2008
PHONE: - SANITARY NO. CONTROL NO.
(510) 770-5660
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PWMB MECH
u O Z LICENSED CONTRACTOR'S DECLARATION - O O O
UW Job Description
� 1 hucby altirm des 1>A Ikeved under provision of Chapter 9(eammencing P
with
Section TOlMp of Division 3 of the,Business and Profession Code,and my license TI—CONNECT NEW PARTITION POWER POLES. INSTALL
in full farce and eBan.!, ( ,'29 O
)a! License Cl V D Lk.11 1'J12KVA
a-q Dam A CHrfECPSDDECCoarmactur RATION UPS TO RE—FEED SERVER RM POWER—INSTALL CABLE TRAY
`� I un J lens s use u public mrnrm
R9
y" FOR DATA COMMUNICATIONS.MISC RECEPTACLES FOR
k Ib� Lict mad eumnal
S 0 -BUILDER 0 ON
'�i 1 Wmby aRm me ucmpt(mm the Canuamors Liccme IAw for me
HO following major.(section 9(131.5.Bulinus and Professions Code:Any dry or county
291. which mt,doet a permit m enmtracL tlkr,improve,demvlkh,car repair my sumime
_i< ales m
prior W its Womed. qums LIC applicant for such permit to file a signed momemot
p that he a licensed pursuant o me prevlstom of the Contractors Ucanm Law(Carrier 9 Sq.Ft.Floor Area Valuation
y�0 (commencing with Section 7000)of Division 5 of the Business and Professions Code)or $40000
15§ dust he is exempt metefmm and the basis for the alleged exemption.Any violation of
section ID3L5 by any Appikabot for a permit subjects the applicant m a civil Penalty of Nber OType
not mom thmBrehundred dallars(SsaDL 316F18035d'. lumOccupancy Y YP
L aj w+a+af de proputy.a my employees vim xgn u Ute'v sok eompertu0on.
willda the warts and me structure is notinkMed ororferc l forsak(Sec.9044,Business
and PrefelVnm Cade:Th.GmmVYmra Lt.Lata doth nal apply he an Owner or Required Inspections
Property,whobuilds orimpmses moron,andwW doessuchwork himselforthrough his
awn employes,provided that such impmsements sum not intended oroffeted for sale.It,
bowewg the building or improvement is sold within arc you of completion.the matter-
Wilder will hose Ote buran of p.A.g mat he did rot Wild or improm far purpose of
ule
❑I.as owner of mePropenY•am ev3usiwlY contracting with licensed conuectaca m
comuuct the project(Sec.TOu,Business and Pmfusiom Code:)The Convectors U. .
came law does not apply m an oxer of property who builds or imperm s memon,and,
who contracts for such projects with a contractor(s)licensed purposes at me Comvutors
License Isw.
lam aemIn under See .B B PC for mu won
Dam
WORKER'S COMPENSATION DECLARATION '
I hemby air under penalty of perjury arc of the following declaratiorv:
Q Thaw and will maintain a Certificate of Comenl to self4rommfarWarkersCompea-
cation,
wprovidW fpe mSection 3700 of the Inbar Code,far the peAomaue of the
ork for
which Nis permit is isund. -
1 have and will maintain Workers Compematlon Imuran¢,as required by section
3700af me labor Code,for the pcdarmume of the work for which this Permit is leaned.
My Werke s Cmmatiup inti ere cm,.cr and Polity nu Aper 0
Cartier. r CJL 1isL�'tr�Polity No.: '•/f w'�z
CERTIFEON F EXEMPTION MOM WORKERS
COMPENSATION INSURANCE
Tinax9on reed amtecomplemd lithe pemttu furan hundrnddoaan(Slag
Or leu)
I certify mat in me perfo erne of the wart for which this permit is;Wood,l dull ml
employ any person in any manner sou he become subject to the Workers'Compcma0on
Laws arcalirmois Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenifica a of Eumption.ym should
become Subject as the Workers Compemitlom provision of me Labor Code,you most
.,O forthwith comply with such provisions or mu permit shall be mooned revoked,
'Z^'"" CONSTRUCTION LENDING AGENCY
I hereby,rfren des them u a comuuction lending
F r g agency Tor me porfurmana of
C> the work for which this permit is iajund(Sec 7097,air.e)
11.1 Q Lenders Name
= z Lenders Addw
U 0 1 cntify 0.11 hose mad this application and We that me'bees Information u
l,, ;'^. corms 1 agme m comply with A]city and county oNtmnms and sok laws relating to
.0 rV' Wilding comuuction,tol hereby mdum>e uPwnwiws of this city to enter upon the .
above-mentioned Propetty,for inspection purposes
F 4 (WA) m care,ind=mniry and kwp harmless the City of Cupcnina against
z in Citi gmentseS.d.ga"Cmuwnich may In any xy,mue agaimssaid City
V z A co nu of the grating of mix permit.
^ APPLI NT ULATI T NDS AND WILL COMPLY WITH AL NON-POINT Issued by: Date
SOUR ULAT
y 11/0 Re-roofs s'
sigma o "pbcaMC tracmr 0 m
RDOUs MA AIS DISCLOSURE Type of Roof
Will the,ppli err(mum Wil mg occupmLsmm mhandk heuNous memrial
Food by the Culmina Municipal Cade.Chapter 9.12 and the Health and Safety
m.
Section 255324)T All roofs'shall be inspected prior to any roofing material being installed.
Tm �Na
Will mea applicant or(//urom Wilding aeca a ma If a roof is installed without first obtaining an inspection,I agree to remove
cap e e component at arses which g P g
Omit ha>,mnm ter emtsmmants aj de0ned car the Bay Are,Ab Quality Mans=m=cat all new materials for inspection.
Diauicty `/
❑Yn �No
Ibe al the houardnmmamialarequirements under Chapmrh95 ofthe Califon
nisHdm ct adoS ed.. 55fI5.25533 and
25534 thaifine Wilding
does mlc d waremen, 'fumy tiryb emery des occupans of me
rcquircmcts re a .crnirm.mara Perry. Signature of Applicant Date
- Cl• L� O
owners nmori>ndagem D m All roof coverings to be Class's!'or better