01100097 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10108 BRET AVE . HERBERT SWEATT 01100097
OWNER'S NAME: APPLICATION SUB DATE.
HERBERT SWEATT 10/15/2001
( PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ptF a ELECT PLUMB MECH
i`e C J I._.I I=J G=.1
zm Z LICENSED CONTRACTOR'S DECLARATION
i3 o I hereby affimrthat l am licensed underprovisom,of Chapter (rommemeing Job Descripti n
y to
with Section'7000)of Division 3 offlue Business and Professions Code,and my license UPGRADE ELECT PANEL TO 200AMP.
f m is m full force end effect. -
m 6 License Chases Lic.M
S 3 o vUh'i Dam Contractor
ARCHITECT'S DECLARATION
ej 1 understand on,plans shat]be used as public records
f
sor
Licensed Professional
OWNER-BUILDER DECLARATION
t� I hereby.Poen that 1 am1. aurin from the C Professions
r a License Law for the
y
CS?Q following reason (Section 7031 5 Business and Professions Code Any coy or county
d which requires a permit to construct, Iter,improve demolish, psi any stiunurc 5(]
_ •'Poor
e is. s c s1 q pr inions o for such perm n is 'g W smt4nrnl .......— -_... .._ - - - - - ......: $150
...
a �
(cthe s1' soap a doth provisions the
C !a ( pt 9 , ♦ R a Valuation
(commencing, Ins t 7000)of Division 3 of the Bgsln onto Professions Goa) l;y,ti l;lar' 91 ,C °P-': s.t�I Ati.l-I k)N, t
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 703Itsby any applicant fare Permit subjects the applicant to a civil penalty
rof'no�rcthanfivehundreddollars(a51w). 103APNbipp r i Occupancy Type
P+�as owner ofthe property.or my employees with wages as their sole cmnpensation, ELECTRI
�r�s�hTa�
will do the work,,and the structure is nor intended or offered for sale(Sec.7064,' .Lxntlt`rRY LAS' f
f Business and Professions Code:The Contractor's License Law does not apply to an 505 - FINAL ELIR Y t•Yb"tions"'
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided That such improvements are not intended you,or _ S
"comped forside.'If,h th tandem,t - p f Prov t old within y r of "-
i pit 0 b 'Id will have 0 burden fp ng that be did tbuild or
imp for of aidc,).
L c L d s PP Y p 1 property ) ) ppr improves thereon, .. ..._ _ .._ .. . . t.... C/) .... -. ._...
❑1 f Ih ii perty ti 1Ymoment,4 with 1 eased contract to
co tin t Ih ro rot
IS 7064 Business and�f crorts Cade:)The Connecticut's
nlrm the .... t i
Co m License Law.
1 1 owner fh builds/D-�Sh. - _ -
d h vt`ectsdf `h ro is with t to,
-
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the following declarations: v
i
01 nave and will maintain.CemBfi,te'of'coesent'lo self-i /
Norco for Worker's
Compensation, hprovided for by Section 37W of IM1e Labor Code, for the
performance Nee work for which this permit is issued. ,
01 have and will maintain Worker's Compensation Insurance,as contained by Section
3700 of the Labor Code,for the performance of the work for which this Permit is
issued.My Worker's Cpe,s ti las.. ce murri.,.6d,P.IiFy her arc
Card: 1 16-
i CERTIPIOATTON OP EXEMPTION P
f
ROM RI'ORKER6d T Iv 4' In l ) Ih IYpd Ivy 6 kA s ^ l
COMPENSATION INSURANCET
t ITM1tss on i need not be compleed if the permit is for one hundred declare
1$100) less I
.. .. _ . . .,. 1 . . . .
I mat into inth lose.in cryco f Ih o k f r which Ihm permit is rs u d I t 5
sh II not employ on.fCaliin any mhnner so as to become sub3ect to the Workers'
Applicant
ucn Laws f Cal fomie.Dam '
P<
PP
NOTICE subject
APPLhe Worker
making this Certificate the borode,you mina
after of n
bechwith comply with
the Workers Compensation Provisionsofthe Labor Code,you must.
0 fonhw Ih comply with such provisions or this permit shell be deemed revoked. .
H.h `I`" CONSTRUCTION LENDMG AGENCY ' ., 1 t" '
'a.� '.� I he hY affirm that N on t t I d g eg y f ih perfotmence "'t ..
of W o k forwfiich Ih pe t 'sou d IS '3097 Cb.C)
5
0 I certify that 1 have read thisapplication and smte that the above information is,
w;Fy rreCl.1 agree to comply,with all city end counry oNinenccs and score laws relaying'
Q V to building construdtidn,and hereby iuthoriu reprcsemalivea of Wis city mentor upon
�+. �] the above-memioned property for inspection purposes. „
[.w Gs (We)agree to save,indemnify and keep harmless the City of Cupertino at sat d
r V] li 61 ties rydgmenls ars tl experts h h may in any y croe again t said t,
fJ'Z .Cly n cons ence Of th g ung of th p rmn -
"", 'AP 1 UNDERST 5 AN WLLL COMPLY WITH ALL NON-POINT'
(u uG�Tlo� `N 10 S 1, Issued by: Date 80"'115-:Y
g 1reofApplivent,coutimmor 4. �. ';jDam ' Re-roofs
-,� .HAZARDOUS MATERIALS DISCLOSURE 1 1
wdl the epplieant or flu Ito Id g everpa t t rt r handle herard materialRoof
as defined by theCupertino Municipal de Chapter 9.12. d the Health add Safety
Type
iO, 15 In ! ) II.1
•• e o - -
code set 23¢32(el 5 `tJ a_ {''4 e '3`• kr k,
°Y .All roofs shall be inspected pnor.to.any roofing material being installed
Will theapplicanto f N building occ P tuse el p al de'aa hien '' stalled without first obtaining an inspection;-I agree to' remove
em t hainumbous our contaminant,as d5 t y the Bay AreA Quality Management
D m t all new materials for inspection. Applicant understands and will comply with
4 OYes No -
all non-point source regulations.
7 have read du haz.rdous memNals rcgoircmems under Chapter 6. 95 of the f
.ce fi
echo 25505 25533 and 25534 1 underste d that
Caffomia of ry's insane bltymnaffythep i e fit Certdcel Plobu Idote yhave m 1 Ih t tismon, m h h m t be m Prior to
oton
Signature of Applicant. Date_ PP _ .
_-% poxide,or.amort=a.,on Gate All roof coverings to be Class"B" or better "
OFFICE