02070068 CITY OF CUPERTINO r' "soca
BUILDING DIVISION PERMIT CONTRACTOR.INFORMATION:
M ,. ..,, mol IN
BUILDING noDRlss: MICHAEL NACULINGER
20557 BLOSSOM LA 02070068
NER'S NAME: APPLICATION SUB DATE
W
MICHAEL NACULINGER 07/11/2002
ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
foo LICENSED CONTRACTOR'S DECLARATION Job Description
yd I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
with Section 7000)or Division 3 of Ne Business and Professions Cole,and my license is
inm0tbrceod ffect. REPLACE ELECT SERVICE TO 200 AMP
License Class Lica
Fq Dale Contractor
F=£— ARCHITECTS use DECLARATION
O W U I understand my plans shall be used as public renrtds
6
�0 Lilemod Professional
£ OWNER BUILDER DECLARATION
K R,e E I hereby.(Sec on 1 am exempt from the Contractors License Law for the
�9 a.C O following reason.(Section 7031.5.Business and improve,
de io l h,or Any city or county
a�$ which requires a permit reconstruct.alter,improve.demolish file
repair any structure
rZN
poor to ceased e.also pursuant
theapplicantfor such Contrarmiuoicense ned Law(Chapter
�<
that he is licenseitpSeavanunthe provisions of then,Business License Law(ChopmrY Sy. Ft. Floor Area �y`7x'DIQItIOn
a $ than a Is
(commencing pt harefr m and ml basis n 3for she
the aged exempt and Professions Code)of
— Nn he u exempt therefrom and the bssu for the allegrA exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than As.hundred doll..(S500). a Occupancy Type
❑ I,as owner of the pmWny,or my employees with wages as their sole compensation,
will do the work,and the itracture is not intended or offered for sale(Sm.]044,Business iO3 — UFER
and Profesdov Code:The Commenter Lim me law does not apply in an owner of 304 - ROUGH �L'1.1 1 l'.HLOnS
property who builds or imphows thrmon,and who does such work himself or through his
own employees,provided that such improvements ere not intended orofrered missile.If. 505 — FINAL ELECTRICAL
however,the building ar improvement is sold within one yeti of completion,the mous,
builder will have the burden of pmving Nat he did not build or improve for purpose of
sale I.
❑1,as owner of the property,am exclusively contracting with licensed contractors to
cormsuct the project(See.700.Business and Professions Code:)The Contractor's Li�
cense law dos not apply to an owner of progeny who builds or improves themon.and s
who contracts forsach projects with a conractor(s)licensed pursuant to the ComrgCltos b
License Law.
❑1 on exempt under Sec. .B A,P C for this mason 4.J
ret Dere
WORKERS COMPENSATION DECLARATION
I hereby alErm under penelty of perjury one of the following dmlaratiotu: EXPIR
— 1
❑I have and will maintain a Certificate of Consent to mer-insum for Worker's Compen
satire,as provided for by section 3710 of the Labor Code,for the performance of me
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700of the Labor Curb,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fro.section nerd not W completed if the permit is formic hundred dollars($100)
or less)
1 certify matin the performance of on,work for which this permit is issued,I shall nut
employ any person in any manner so as bt become subject o the Workrri Compensation
LAWS.[California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenilieam of Exemption,you should
become subjmt to she Worker's Compensation provisions of the labor Code.you most
Q O forthwith comply with such provisions or this Permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
in
[-+ I hereby affirm that there is a construction lending agency lot the Performance of li
Ci 7 the work for which this Permit is issued(Sec.3097.Civ.C.)
114
Q Undch N.
z Lender's Address
C.> I certify Nat I have read this application aad am.that the above information is
(—' correct.1 agree to comply with all city and county ordinances and state laws relating to
O U building constmctiun,eadherehyauthodv mpresenntivesofthis city mcrime upnthe
{sr' abnve-memionrd property for inspection purposes.
(We)agree to save,indemnify and keep harnlmS the City of Cupertino against
y liabilities,judgments.costs and expenses which may in any way accme agairm said City
V7 in consequence of tho granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
SigSignatureof APplicaDam
HAZARDODO US MATERIALS DISCLOSURE Type of Roo(
WillmeePColenlor future Muni buildingoccupant stere or huddle Baugh and
az Ocfned by the Cupertino Municipal Code.Chapter 9.12,and the licalth and Safety
Code,Section 2553]0)7 All roofs shall be inspected prior to any roofing material being installed.
El yo ❑No
Will the applicant or future building cecupanl use equipment nr devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdoes Bir cumaminanu as defncd by the Day Area Air Quality Management all new materials for inspection.
District]
0 Y 0 N
1 have read the hmerdous materials requirements under Chapter 695 of the filifor-
m.l lcalm de Safety CWe,Sections 25503,25533 and 35534.1 undr.mnd mat if the building
docs not curmmly hast a tenant,mat it is my mapomihilty to modify the occupant of th,
requirements which must be met prior to issuance mfg Cenificaw of Occupancy. Signature Of Applicant Date
Owner nr authuriud agent Data All roof coverings to be Class "B"or better