02050096O2
z
CITY OF CUPERTINO
BUILDING DIVISION
'
CONTRACTOR INFORI•TION:'`
PE&T
BUILDING ADDRESS:
PERMIT NO,
10050 N WOLFE RD.
02060096 '
OWNER'S NAME:
APPLICATION SUB DATE
06/17/2002
ENLO EQUITIES
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTMNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
TEMP. SIGN
with Section "1000)of Division 3 of the Business and Prefassiona Code. and my license
INSTALL
is in full force and effect.
License Class Lic.0
Date Clinometer
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
-Liamsed Pmmi,imal
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the CommcoWs License law for the
following (Section 903 L5. Business and Professions Code: Any city or county
$5000
reason.
which requires a permit to construct, almr, improve, demolish, or oc,m any structure.
-, "noors its issurnme. also requires the applicant for such permit in file aligned rtatement
that he isjumocd puRaant 19th�p-pro,smons of da Contractors License Law (Chapter 9
Section719)of Division 3 of the Busjni and professimaccde7
Fpg Op.,(kg',. ,.,,,
Valuation
(comojcncing p,M
is the basis for the all2gcd cxem. U. Any violation
-
or that he exempt therefrom and
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
APNP8,8ftAT
Occupancy Type
of not more than five hundred dollars (150)).
101 ION
01, as co ner of the popery, or my employees w'ithwages as their sole compensation
I Q I - ITPF.R
_
104 - REBAR Required Inspections
will do -the work: and the structure is not trimmed or offered for safe (Sec. 70eeq-
'Basin.. law does to
and Professions Code: The Communis; a License not apply an
Owner of property Who builds or improves thereon, and who does such work himself
105 - ANCHOR BOLTS
or through his own employees, provided Nat such improvements not intended or
" ' "' -
is solan
-oompld for tilt. II, howdvcc the building dr improvementenofgss n sold year or
304 - ROUGH ELECTRICAL '
be did not
=ampl=tmn, the owner -homer will have me burden of pressing that be did not bmudm
Improve fin"o,axe Of sale.).
505 — FINAL ELECTRICAL
aowner0im=Propartya.'reclouvelyenmraedng with ransedcontractors na
514 — FINAL PUBLIC WORKS
o Z the ,rafter (SCC. 71144, Business and Profeasims Cade:) The C9nvaClOr'a
u law does not apply to an owner of property who builds or improves thereon,
ndcn ho contracts for such o iectr with a contrectorts) licensed .pursuanl.to the.
License Law.
_ CI�yALED
moo➢tractor's
I . B & P C for this reason
1 der Sec.
�" .
O at 1+(�
O s 2002
JUL7
„With
R•S COMPDid ONbE RATIONa
J
1 hereby affirm under penalty, of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insurc for Worker's
BUILDING
Compensation, u Provided for by Section 3700 of thc labor Code, for rhe
peAoon.oce of the work for which this permit is issued.
01 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the labor Code, for Ne perfmormce of the work for which this permit is
issued. My Workels Compensation insurance carrier and Policy number arc.,_-
CeiricF: •'' �:, r "t ': .' •_. Policy No.:
'. �'.��', df `. �.,. ... ;; II is 1•
:'t„CERTmCAnONOFEXEMPTION FROMWORXEItIS%-
'
\. ..
COMPENSATION INSURANCE ',.
_ .. _ ._... _ .. ._... .... .. - .
(This section need not be completed if the permit is for one hundred dollars
”
(SI W)Or less.) -
-
I mify that in the performance of the work for which this permit is issued, I
-
shall not cmplay an rson is tray f`ner sat o IC. subject m the Wodnd
Contra... i of California. D
Ap ¢ani-
�,T1ICE
��' TO PLICANT: If. (term wg U) s Ie Of Exemption, you should
sM\dome subject tithe Workers Compcnxmio(A ovi{ion bf the Labor Code. you mater
forthwith comply with such provisions onhis perm all he deemed revoked,
3 • CONSTRUCTION LENDING AGENCY
1 hereby aRrin that there is a construction lending agency for the performance
of the weak for which this permit is issued (Sec. 3097. Civ, C.)
-,
Uo Nam
Le der s • Address
I certify that I have read this application and state that the above information is
aborter. 1 agree to comply with all city and county ordinances and state laws relating
rebuilding construction. and hemby authorize representatives ofthis city to enter upon
the above-mcmionW prci for inspection Pm,mx,. .
(We) agree to save. indemnify and keep harmless the City of Cupertino against
Iliabilities, judgments. costs end expenses which may in any way acerve against said
City in con u cl of the granting Of this permit:
a 'DE0.5TANDSAh LL COM 'WITH ALL NON
r
AP
t Issued by: Date
SO R LATION
Re -roofs
amrt Apprcanvcanmmr ¢
HAZARDOUS MA CLOSURE
Will the applicant or future building occupant store or handle hazardous material
Type of Roof ... .... ... .. ._ . .
as defined by4he Cupertino Municipal Code. Chapter 9.13. and the Health and Safety
- ..
Cade: ❑ tion 2 532001 No r .
i. '.
t . ' a :. ,
All roofs shall be inspected prior to.any roofing material being installed.
/y/�\
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants u defined by the Bay Arca Air Quality Managcmcm
all new materials for inspection. Applicant understands and will comply with
DiitrictO Yes rva
all non -point source -regulations.
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Cada Sections 25505, 25533 and 25534. 1 understand that
ifthc WIdin dosenot currently have a tenant. that it is my rcsponsibilitg to notify the
'
«cupanI of uir=mrnu nun a prior to iaauawe of a Certificate of
,p
Signature of Applicant Date
All roof coverings to be Class "B" or better
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