02060042 (2) CITY OF CUPERTINO. • - - '
BUILDING DIVISION . . PERMIT CONTRACTOR INFORMATION:.•• r„ .,
BUILDING ADDRESS: PERMIT N0.
10757 'BROOKWELL 'DR CHESTER MAZUR : 02060042
OWNER'S NAME: APPLICATION SUB DATE
CHESTER MAZUR,:, .,;, .., 06/07/2002
PHONE: SANITARY NO." CONTROL NO.
ARCHITEC TNGINEER: - -
BUILDING PERMIT ,
u J ... ... ... . ... ._ .. ... ._.. ._BLDG" ELECT PLUMBINFO MECH
ZO zy re LICENSED CONTRACTOR's DECLARATION
=o "1 fel affirm that l am licensed under provisions of Chapter (commencing. Job Description
p_rn, with s«Linn]twalarDi.iamn3a(meBnsinraaandPmleaamnacae.anamyhmenae REPLACE SUBPANEL & NEW LIGHTS
art se Y,-tj is in full force and[Heel,
c, < License Classs' Lick
0 y ca Date •" C.t nwor,
n�• :0.In ARCHITECT'S DECLARATION
1 understand my plans shall be used as Public records .
�}
w o0 Le udProf oral ,+,,'c`: L. C L i
P
1 : DWNER BUILDER DECLARATION, q :
foe
- - demolish:
tLemit I m, th C 1 - Sri the
following reason.Permm]0315 Bu.e.,a d P (e si Cade A y lorcounty
'
h eh requires a pertni,, construct. himprove,demof h' rep any structureEo
_• $800
prauI tu
that lsalimestone to the p fde Contoccow,License
La (Chapter 9
('a n m with Section law of Division r - yp�I t F Qor eaf Valuation
or that he ac m ,therefrom and the h far thvM1OIIBc eml exemd oRfAn ons Cods). (..• .! '3 l)y2 0
e P 6 P y violation < .
..of Senion)031 5 by any opplican(fur a pe T ubjece mthe uppl...... it penalty' 1.7❑❑������
of not wP than ave hundred dollars($50(n), 304 APN ROUG;`I ELECTRI Ali ' Occupancy Type
❑I - of theproperty. Y employees with g s their sole compcn son. -
will do the'work,and the structure s nor intended or'offered for rale'fsee.7044, - - S91 - FiNk'
Bira Profession,Ca':Tn c t t L Law doe,no,apilly't an .501 - FINAL EL 't�� retorts
dwnc
r of property Who builds or improcomma.s tha.and who does such work himself
Or through his own employees.Provided that such vementcmcnrs are dot intended or
-offe,id Yw-sale:lphowesxr;the Wilding _..___._ .._._.._ _._.__......__ ..._____._ _.___.._.._._...
g or,mpmvcment n sold within one Year a _
'c prove for Depose f wilder will have the aNrn of Proving that he did not build or s -
,
improve for puryox of salcJ.
co l t o at he P p ny - dos ly t t i m l'nosed Covart s t
consumer the prosect Pare ]to a Busowner and Professions Code.)The Contractor x
and nsewho
co as noirapplysuch
man owner of pmpeny.wha builds or improves thereon,
to.the
,. p ��_° Dat r(s)licensed pursuant m Ne, _ __— ... ....... ... .. .. ._ gym
c anQ ho va<u for s h proyttU wuh conuacm tea
qPM _ .... . .. . . ___...._.
It ' CmLtcense Law.
dc se ' "7B&PCf r,hisreawn
Wn / KERSCOMPF.NSATION DE ARAtTIIOON�
1 hereby rehired under pennityof pc jury one nRhc following declarations:
❑ I lb�dvc andlwill,innidda
y,-S rc of 3 t w f r,f k s ���Y D���•
pco�p , tp I bh Ss, n 3]UIl e Labor Code,,for the
n VClht Ok f Cn ln.(IC IL t'+
island.M w rk Co r
r' a Pc o nc< J by,S ,
v (m
oIn ew,n' tock( co
3]Op f,h lobo c r th o f k f which at rm i _
ou JPI yn be rc _
Cam i -Ir J , 1 -tP r ..:. _. ...._.,.«
FICATION OF EXEMPTION FROM WOR Rs" i 1T 1' t •...1
f '-COMPENSATION INSURANCE '^ s• "�t,
._,
1` Missal o died not be comply d f th Permit is for one hundred dollars 1' -_.,. 1 Ji' i t (l{•' —�.�.._...
..t Ic n(Y int nth prf ,h kf ch his pem,t ..:site dl
'Shall not mpl y nY M n Y'or1 , w yea, th Wok '-ol. /y,. 1 ol is
Comped t Laf Ifo
NOTICE APPI f k'n6 th Crifcate SEs pt y should �•, -
Z Isco s tat, cW k C pc:t p ms bfthe LaMpr Code,you deux '
Zforthwith comply with such Provision's orthispermit t shell x deemed rtvulted ..
F.y p
4' ST.RUCrIOHLENDINGAGENCY ' r
,
therby irm that Pe , conwamn lending the perfo _
he work which taPerm, (S c309],GId.G) rnLe
.,ors
nder's Name-��, z Ienl Add .. ._ ._.. ... _ _ ,._. ...._..... ...
Ireally that I have read this application=it state that the bo information is Y
e. conest.1 agree to comply with alteity and county ordinances and.e, laws rchoung
Q.V
odWildid,cialitourdidd.andhereby buthi reprewentativer 6fthis city mane,upon
W the ab cmioncd p pray f riper on purposes.
.F..0.' a (W) grel,to liose,'iddlinniry
C.1'VZy ad keep
judgment,. , and ripen aegains
Chs m ren q c sfhe scs which may any y a, aonu said
the pc u T w
AIPLp 5 ERS uSAND,%PILLWMFLy WITHAL L'PO'VT '
_10�
s Rt a Ir 11 - y�r„r � + r i�,s,y, Issued by: Date
gon,I A�11 App'h J combed, ', , 'D t Re-roofs .'
y H RDOUS M\TERIALS DISCI((SURE
�.
Will theppl' t future building c pa t.( h5ndl hoz rd 6.,mat I T e Of.Roof
sJ fin d io NeGppenl0 M pal car Chapter 9.1z a m Hemet dSafety All roofs shall be ens act _ .
Coec Sat b5l 1 1 t `a s t t Y '• r .
❑1 s i s t I. 4 t :t 1
kkk all new materials_ d wiinspection.,ed ,tor t0 any roofing ma[enal been installed.
Will m rpnl m d. rat b 'Id' g p' t : , I ,n n If a roof Is installed with�ou[first obtaining an inspection I�agree to'remove
mth tlui erre tdf eJ bY,h 'B YA qAp Qal tyM gemm
District'Ye .. Applicant understands and will comply with
o. all non-point source regulations.
1
luel,read she hazard us ddaerials nounrements under Chapter 695,of the
Cal foram Heahh&SSrery Cac,Sef,ons 25503-25537 and 25534.1 understand that
d bikingJpes uotc rcmlyh tt- tihit'. yresponsibility, notify the
ace p m o th rc ircms s h"h'lud be i p'o to standee of a Cr fat of '
.. � Cr
Signature of Applicant _ :: . Date
ubhorri gee a in : oatg All roof coverings to be Class "B" or better •
' "• - -' OFFICE