00070161 (2) CITY OF CUPERTINO r
BUILDING orvistort. pER1VIIT'" •. CONTRACTOR INFORMATION:
BUILDING ADDRESS ' - PERMIT NO _
OWNFIt S NAME:'+ APPLICATION SUR DAS'E
i
10055 CARMEN.,RD ' - "` SUNBORO,`"CONSTRUCTION CORP00070161
(PHONE: s ' - n„ ,,. '. SANITARY NO, `r CONTROL NO.
SUNBORO .CONS7'R . 1307 S 'MARY AVE #208 ".07/25%2000'
�n�O ,ARCHIDECT/ENGINFFR -" r „ .t. ' .. BUILDING PERMI"]'INFO ;
' RLDC ELECT'.. S.PLUMB MECH
(408)810-6122
Z > LICENSED CONTRACTOR 9DCCLARATION 1 v 4. T, �, Job Description I' e
so I hereby affirm chat1' I :cancer f CI'd 9(c mm "ng
Dor with Section 9000)ofD Division 3ofmcB ss and Pr.fea' sCode,'in nrylecvm - - - r
4 is' fall t and cffe - - n:
1YS_ p
L N g� Favor,Class___ Lc%�7 1��G j
-°i-O Date Contract.,
w a;Fii CHIf13Cf S IIFCLARAf10N + - '
to hall he.rl . plrereand .TEMP ELECT
N J
w G O Lic al
OWN BUILDER DEC(ARA(ION
I hereby effina I'm isam exempt fon the Contractor's Li ansa Law for the p -
roll w nb r a. n (Set 7031.5,[Tailless d Prefiesomas C le Any city ill county -1 c
."hich neelaicas.permit hcon,am, It p d I p.'. y:t lure ! •• - .�.. _
i 3 lin I t .an rt4 .theappl tf permit fl '6 d t r non r ,, r .
- mall I' 1p n I I m p I tl C t ro L L' (Chapter Sq.Ft. Floor Area , "Valuation
(".mneme'mnee'ag with Salon 7000)of Div'son 3 of the Bls teas and Profession,Coca)' -
or that he Is oxnapt cheroot..na the basis dor the alleged asaindin r.Any violation "
of Seeno.17031 5 by any applicant for a pemlit subjects the applicant to o civil penalty
rn.I..to mad rete n.wrw m,lwrr,(asBB)r APN Number-- - Occupancy Type
° w
I,as owner of the Property,or my employees an wages as their role'cdl•upcosatlon, I-
' will do the k an l the I fail II,aided or micirid on.ala(So, 7044 "Required Inspections - - -
names, d P f C 1,The C noIl,s o e Lax d e' t apply t o ,s -
owfp ty Wind b ldjr,"',II I h d h kh' If
nrnynsw,epy : p IIlnlanennreI Ilm
32850057.'-00
Urad for sale If however, he mild'ng or ini,probluent � tadjavithon one you,of v
Ionplaton,lhe uw e h Id will have th burden ofonw' glhar be did hot Ido
mpr.vmlmpnrpam.rsale.). 304 - ROUGH„ELECTRICAL .
Fl 1. I 'fico ) ).,am exclusiviyeaw6meting withlcn:eacntrat 501, — 'FIh1AL ,ELECTRICAL ENERGY
on conal thep 1 t(S 7144 B Pm f Civ ) lin Cont I
L t prlrt rp p li n b c d eon S0S — 'FINAL ELECTRI AL
a I.contracts f. . n projects with nh nrn,lta) ,a,d cora.nml n,me
Contrnno s L ce de Law. ✓ - -
❑ nnUnder B&PG r;rlhix beitom -
Owne a Dat,.
,WORKER'S COMPENSATION DECLARATION - L
\ Ihereby affirm under penalty of perllry one of the foll 'ng declarmio:
I have td will m' la' a CeniOum f" .Concenl to If'n. a for Workers 1
p s I m asp d l for by Setdate.n 3700 M Lahr Cade; lar the
furcance of thea kf Inch II �p ml': � ed ,
°1 have and will maintain W to Compensation 1 rara,�u're'eired by 5 t
3710 of the Labor,Codm,for the performance of Ilia work for which his pern't s
issued.My Worker',Economical...Insumnee.,.a,and'Paicy mmbcr�mr:
'r
�CuFRM,,
CEO IFICATION OF EXEMPTION FROM WORKERS' �� v - -
,COMPENSATION INSURANCE
- w r •I
I
(Tine.) ion need not he completed if Nn
c'pennil is for hundred Jnllurs
f . -
. ($1007 resnJ
I certify that in ore performance of the work for which this permit is sic ed f
xhall nut employ any person in any number m ac In become smptc,m the Workers' • ,. ,
Compensmion lanws of Calif ander Data
Applicant -
t NOTICETOAPPLICANT:ILarlermak tg lhs Cerfllclle.f Esenplana you should _ -
become subject the Workmscom,proartion provionasot lbe Labor(rude,our must
finthvIth comply with ouch prawr,ioiro,this pe n I shall be flamed roaderd
z r 't ..
F E CONSTRUCTION m,j aNG n, NCYagar, • 4 -
1 h by,ft that d :I f a e e.C.>f the Tx A'nrmunce
W Litt work for Inch this peract si.soul(Sac.3(197,Civ.C) • _
SQ Led ,Noce _
z Leader',Address
V 0 Ic rtfY lhmlb rwd ll : opt ml .dolt mol ul t
s
tTr try enecr l ugae to comply with all cityand county ardirsain,an,shatelaw: elfg
to building constmction'and hereby callaoitze representatives of this city to enter upon -
'� GTS the awco-arenflaredp;pert for oc'lnpurp - '. - p
.Fa
' (We).g an save,indemnify andkeep facades,thM1 CtyfC Pg nt
n.i AIlablllo d dg lents,costs and expenses whicha y in any way'accrue against ao'd '
'V City in cnncequ I the g w I of the permit
APPLICANTUNDE S WILL COMPLY WITHALLN NPO sued b Date
URC EGU yT
��/� ', 7��s'/ea
Signature e-roofs > '•, _ -. '-'” .
HAZARD SNA RIALS DISCLOSURE
-
Will the pliewat or future Final,racialism a co t r handle hazardous mention Tope'Of Roof
as defined by the Cupertino Municipal Code,Chapter 912 and the Heubh and Salary -
Ctalr Seni.n 25532(3)?',
°Yc: '-' El . All roofs,shall be inspected prior to any roofing material being installed.
Will t apppc t Lambe b luei,g.e,apani keep p an n avoice,is Inch �Ai a roof is installed without first obtaining an inspection;f agreelto remove
m n "cod .aircot t defined by,the Bay Are.A Quality,M(nab cent
District°Yes °N.r ' - all new materials for inspection. Applicanl,u nderstands and will comply with
all non-point source regulations.
1 h r d th hard-I a conI. "
c renems I d LI purr 6.95 (one' •'! `
Cafif ruin Health&Safety G de,Section 25505 25537 and 25534,l undershand that -
ifthe building does nm,nrrenay have a n mm,lbar it is my reptoeabl lity to ramify the _
one
pand of the becribroural,which.,,,I N4 are p,err to is t'it C nilie.te of '
Occupancy.
- - I t
Signature of Applicant '•+ I Date _
w atmorzade,cal Dano All roof covering's Eo be Class "B" or better
;y OFFICE .