01060111 (2) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: '
BUILDING ADDRESS: PERMIT NO.
10766 BROOKWELL DR 01060111
OWNER'S NAME: APPLICATION SUB DATE
LAUER CHARLES A 06/19/2001
i' PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
.0- BLDG ELECT PLUMB MECH
Ni� CJ - I LJ C1
as
'8to= LICENSED CONTRACTOR'S DECLARATION Job Description
O Z-O I hereby aRrm that 1 am licensed under provisions of Chapter 9(commencing
F:F wiNSeaion]WO).fDivisionJoRheBosinessandPr.fessiansCde,andmylicen SERVICE UPGRADE.
a m I� is In full fore:and z ec a effeq- v�0.� FROM 100 AMP TO 125 AMP & AC
z ate Class Lim.#
w 3 t'o.y Date Ecr—
O ARCHITECr'S DECLARATION DECLACLARATION
I under rand h me Ns
ou 25p o Licensee Professional
as OWNER-BUILDER DECLARATION
r�i =, I hereby offon that 1 am exempt from the Contracrors License Law fame
I-Z a following reason.(Section 703 1.5,Business and Professions Code:Any city..county
ISG which requires a permit to construct, It p demolish,or repair any 1NcwR
war, P t 't. tance.aL -9ulvsthcepPl tl Iper,'t lot l�a.igaJ ewteinent. - - -- _.- - .....,.., .
0 -sat uv lr'h s .w rn c m 1 I (a i t -� Sq ;Ft Root'.Aie t aluation
a, -i%ionni s t 7600)ofhe b six a ohe a lewd ne ion.An violation e J 7 .i '1 ,,C. pA v y C f, i
nr that he is exempt tang apple and the nays for the alleged applicant to Any natty -
of Section]OJ LS by any applicant for a permit subjects the applicant m a civil penalty
,of not mare than Five hundred dollars(5500). Um er Occupancy Type
°1,as owner of the property,army employees with wages as their sole compensation,
will dothe work,and the-Machine is not emended or offered fr sale(See:7N4,'Business ad Professions Cale The Contracror's License Law does not apply to an 501 - FINAL EL W9V C$A@ Cg9NERGY 'r.
owner ofpropeny Who builds or improves,thereon and who does such work himself
improvements e tintendedor 505 - FINAL ELECTRICAL
o,offered
through h- n howevY a lea that h o - _ .._ _. . .completion,
om eYn,oe the wf.me in building b pod of mmont
sthat th -hey dor- _ -o'�:,�
.prove for
the owner sa Idcr will love Inc burden of Prov ng that he did not build or
improve e f f I ) � --
". construct tnh project
r p f Jthe t(Sce.
ly]IH4 B
I,n e,,and
d imfe,,gonwtChofd )- d C
jt mmt trt
License Ladoes not apply t owner f property who builds improvers thereon,aull contracts, such projects.widna c va tons)limensial,pusumaltothe
Contractors License Law.
I arn comma uerSec. 6&PCfso
' ._.-. . .....__. ._. ._...
1 .1
t
WORKER'S COMP NSATION 1...'
t �
e s�sL
t
DECLARATION
h'. I hereby affirm under Penalty of perjury,one of the following declarations: f
❑ 1 have and will maintain�a Celiificam of Consent to self-insure Pod Worker'
Comp rrectton;-as provided for by-Section-3]W of the Labor Cade, for the
r= - performance of the work for,which this permit it issueJy., .
[Illowelandl will,m t W k is Co p n ton Insurunee,'as required In Section
37M of the Lrhor Code,for the pniformance of the wark for which this permit is
✓ is. ed,My Worker's C pe rim,thrummed cimu d Policy number arc
C Prilill No
t{ CERTIFICATION OF,EKEMPTION FROM,WORKERS
COMPENSATION INSURANCE
ar
(Th s iectmri need not b:completed if the permit is for one hundred dollars "' "''' t - . , ^
ens.I j
y1 ..ybih athe performance fine work for,which thpiisissued:I
i.
sh II t employ any pe y a e o as to'befbme bmcct'b jhc Workers '
C mpens i n Laws f ' l f 'u:Date '
..
Applicant_ _... .. _ ......_..___....__ .._... _. .. _ ,_,_ ...... _.. ...__..__ -_.__.__...._... . ,.._
:'NOTICETO APPLICANT:If.aftericakin,thl Cenuhime ofEstraptior.) i, nould
Zyou
O
be b)'ct 1.'h Woke C' P t provsons of the Labor Code,yo oust
f Py
Q orth th comply with such provisions.1 this p omitsholI he deenced .ked
o
a fi- that CONSTRl1CTfONLENDING AGENCY "y - '
I h b nh n t t lending 6 Y f Ue perfolar ace :, '.'n..
of the wo kfy which th Permit sued(See,3097Civ C
Q -ie
5-z dersAddress"
Icenify thatlh dtns ppllcuu n dt to th tth b infmartionis'
IT+.[r eco t I gree tgromplY M 11 c ty d my rd'nan a and t to laacialic,;
V lab Idl ge nnrGct n dh by 5uth r c p e tate fth ryt eater upon' qq,,
ra/i II bit(Wel s em Jn fy vita keep hit I.'th Cty tCtp tinort sid
3uagl encs t a a e peps: h h m y i,vny wey c
cid
id`
Ar U 'z cry y fine grm gormap
SAP I IDA DF�R DS ANt/�ILL mPLY wITx'ALL TNT Issued by: Date Q
sg t at Pppncanvcnt' trr.' ..• . ' Date Re-roofs
as defneeb the HAZARDOUS'MATERIALS DISCLOSURE t_
WII toe tic torft hJai ort tsmrcoh dlh a
slat 't,
Type of Roof . . ..._ .._ ...._........ ._,_. ..... ._ _...,. ......
y Cup rt o M ti 'pal Cod Chapt 9.t d th H Ith and S f ry :
✓ a t :
No'!
. ✓ u y ,
O '
e
_All roofs.shall be inspectedP rior.to an roofing material being installed
W ll th pl' tf f t building occupant s equipment ri cc which -rv,.
p . . use P 1f a roof is installed without firs[obtaining an-inspection; P agree roYelhove
la t h a a :n w ' � t. Baer a by m Bay'v5ree n Quality Stnnag em
n t ' _. all new materials for inspection.,,Applicant Understands and will comply with,:___
° all non= oinf source re ula[tons. ,
❑Y ❑N
- 1 have mad.,he hs d e' neals req nts d Chapter 6f tho-
California Health&Slaty Co 'Sections 25505,25533 ad 255n4-1 ardrstina
ifthe building d",n,omrioll,nmeatntit the it is my responsibilityto
o-notefy the
dicc pm mfmd rec,' m tvnnam,,h t ita o, ceoF a Comficumof
_ 0 pancy
-
-- '. _'... _ ._.. - - .. ..........-- . . _:.... .._. ..
- " -
Signature of Applicant _ Date _
r ; : All roof coverings to be Class B or better
g e g
iter or authonzeda eat Dat,
iL..i. .1..1
.. OFFICE-..._ .. .. -. _ ... . ..... . .. _ ... _