02010072 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7430 WILDFLOWER WY 02010072
OWNER'S NAME: APPLICATION SUB DATE
RODGERS JOSEPH T JR AND JOANNE 01/16/2002
APONE: SANITARY NO. CONTROL NO.
ARC]IFTECT(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR S DECLARATION Job Descri
iIIi T, I notary aff..ongan[.,a licensed ption
n; .,IhS 1 70(1 of Do gard 3 01 the Bavr d P Is"g.,Cre or lice UPGRADE MAIN PANEL
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OWNER BUILDER DECLARATION
I hargh,rififing but I ma ascend from he Contractors License Low far the
hollowing rc,on.(Section 7031.!s,Busincy,and Professions Codc:Any city or county
which require,a Permit to consumer,timing,improve.demolish,or rapar any gorgaing, $1000
fia,ob,yarval,,Monsignor!onagnower
=11imagoal Inuestarrit 16 the p.%rJ.m,,xf me Contractors License Law(Chuggagog?
big with 502fi.11,70)(0) I Dg.i,i.a 3 1 he an...gets ad Professions Carlo)
IN"Cis c;impt therefrom and the basis for the alleged itierription.Any yielding Valuation
of Section 7031.5 by may applicant lot a permit subjects the applicant to a civil candry
of at a a than five hundred dollars 3 0 4PN NOMMH ELECTR CAL-- Occupancy Type
0 1.tj�owner of the propert�or my employees with w ages as their sole conag,onsiggion, ';nl — 7INAL ELECTR�CAT, ENERGY
will do the work.and the structure is not intended or offered for vale'(Ses.7�.
Business and Professions Cadc:The Contractors License Law does a,,,r,dy I,, a 505 - FINAL EMillYWIGAiLtions
owner of property Who miles or improves began .road who doos such work himself
.1 lougg h his own cinplo)ce,prosided that such improvements am not intended o'
offiareld Csole.It.however,the buildirigizir improvement is sold;61hin ane-yearof .7
completion,the mscar-builder will hmorge barmartof po,,gn,,h,t he did or build or
improve for parilasscifial,).
0 L-gas owner of the property,am exclusively contracting with licensed contractors go
construct the pmjcct(See.71�1,Business and Professions Coack:)no Commignor's
License 1-aw does not apply to an owner of proper)who builds or impro th man,
and ja,I,with didAicargagal 'at 11.dr,
0 co= go
Imes
B&P n
KER S COMPEN CLAR
'oggg�h co W S TION DE—ATION
a ors
I hereby affirm under Penalty of parities one mfghc following declamarons
I have and will ...main it Carificatic of Consent 10 self-ingure for Worker's
Compensation. sis provided ficar by Section 37W of the Labor Coyle. for the
performance of the work for which this Permit is issued.
0 1 have and will maintain Worker's Compensation Insurance.as anquirand by Section
37M of the Labor Code,for the Performance of the work for which this Permit is
na.ocid .My Work.er's Cogninarsiggican Insurance carrier an.d P6hey randier.orm:
Cigro,t Pi r —ptinaybm,
Cr.�IPICATIONOFEXEMMONFROM.WORKERS' A
COMPENSATION INSURANCE 7' ----- --
This xoationr�tccl not Ite,acgngpl�accl if the Permit is for one hundred dollars
($100) loss.)
I army that in lba�p,gl .....a r 11, ork I,= ch his eirm,is issued,I
Ploy� h
r "a, I rim. a 1, 0 the Workers
an"I am cda rim. 1. a
ng La or
Cguri.a.lis
on
Afflicting ......
NOTICE TO APPt,]CANT
z theconn'subjeatto he Worker v Compensation provisions of the Labor Code,you must
0 forthwith a,annply. ith such provisions or this Permit shall the deemed revokes.
z .11 1 . - - ____. -- I . . il .
E 7 - CONSTRUCTION LENDING AGENCY
of I hereby affirm that there is a construction leading agency for ilhe p"r.marao
.,he work for hichori, ,.is is ;,god IS 3M7.Cry.C
ad ' No a
t a s0or
z L'�Z,A.do,,."
0 1 cenify that I hj%c mad this application and state that the.1bri information is
PcomaCt.I agree to COMPIY With all city and county ordinances and state laws relining
C) to brilming construction:and lgcmb�iinno rise repimsconakes,of this city to enter upon
the above mentioned property far Hairston purposes.
A. (Way gigroo to gas a.indemnify ql keep 1'.mic"the City of Cup man dionst
liabilities.judgments.costs and,pergw� any way gaccone itgoarget.said
U Z C in con u-ce the got i f,hg
11 S S D .1 MPL ITH ALL NON-PO& Issued by: Dat
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P IC tpU CVF� e
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Re-roofs
Sigairme fAp licano'Conaractor Data
HAZARDOUS MATERIALS DISCLOSURE ' `
tpifican or from building wartiond store or handle Inizandous numand Type of Roof
as confined by the Curnimax Municipal Code.Chapter 9.12.and no Health and Safety
CwH.Section 255320P. ,, - _� , :, , , 4., .;t, , , . I
0 Yet 'Cl No n'i I.,., 1 t� . �i. I
_. � I z z, 1 - - All.roofs shal I be inspected.prior to any roofing material-bei ng installed.
Will the applicant car future building occupant use equipment or devices which If a roof is installed without first obtaining an inspecti6n', I agree,to remove
a.,,Inxigohm,air amamentant,as dorined by the Bay Area Air coal ity Management
I...to,, all new materials for inspection. Applicant,understands and will comply with
0 Ya, 0 No
ail non-point soiYrce regulaiions.,
I have ad he mc,�rdoagi grolarind,rgaapor�rncro,under Chaptei 6�95' i he
California Health&Safety Code,Sections 25505.23533 and 25534.1 understand that
f llgscpt�l sign,does n;v c I h mad h , porsiNjoy to readying,
wan but. Y ""o a-ftteg"2"
_�apxm I�ov, hill f le ron ance afly Certificate of
-pan 5ignature of Applicant
Date
ZO.na,,
L.Lofillbrailed aggia.' i i Date All roof coverings to be Class,"B" or better
OFFICE