03040021 (2) CITY OF CUPERTINO
BUILDING DIVISION
PER y� Ul� �i TOMRYyIhT�'O:�'IA'T ON:
BUILDING ADDRESS: PERMIT NO.
10225 CARMEN RD GARY STREAM CONST. INC. 03040021
OWNER'S NAME: - PERMIT ISSUE DATE
SINGH & KAREN MECKER 922 CHAPMAN ST. 04/03/2003
g; SANITARY NO. CONTROL N0.
(408) 247-2835
RCHITECIENGINEER: BUILDING PERMIT INFO -
BLDG ELECT PLUMB MECH
0
30p
LICENSED CONTRACIOR'SDECLARATION JbDescri eon
1 hereby affirm that I am licensed under provimo
orts of Chapter 9(commencing P
with Section 7DIID)ofDWIdon 3afthe Business cad professions Code,and my Reense is
^ In full foµyAnd affect �!�
�g DOW h1(� TEMP POWER F'NA`E®
p
DOW 1 understand my plan sCHI be wo Contractor
u RAATION
ky, .records
LicensedPmfusimmi APR u 7 2003
50� OWNER-BUILDER DECLARATION
�Z I hereby affirm that I em exempt(rem the Contractor's License Law for the
po following mama.(Seedun 703 1.5,Business and Professions Cadc:Any city or county BUILDING
$ which require,a Permit to construct,altar,improve,demolish,or repair any stmmum
z!n prior an 1%Issuance,also requires he applicant for such permit to file a signed statement
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that Its Is licensed pursuant to be provisions of the Comments's U..I..pChapmr 9 Sq.Ft.Floor Area Valuation
q $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or $500
Q that he is exempt therefrom and Ne hub far the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3�P �� r 0 0 Occupancy Type
arc
not mman fiw huadmd dollen(SSW).
❑1,ex mover of the property,army employ=with"Sea as their sok compensation,
.tilde the work.and the wantons bnotintermed scattered forale(SM.7044,Bumussa Required Inspections
and Praised..Cade:The Contractor,License Tow does not apply to an owner of 103 - UFER q P
propertywh^bullds orlmprow,Neraon.and whodoetsuch work himwlforlhrough his 304 - ROUGH ELECTRICAL
mvnempleyee,,provided that such Improvements are not intended ora@red forwte.If.
however,the building or Improvement i,veld within one you of completion,the owner.
Indian,will have the burden of proving Nat he did not build or Improve for purpose of
Asia.).
❑1,As owner of the property,am exclusively contracting with licensed amrxcum,to
construct the project(Sec.70",Business and Professions Code*The Contractor',LI- ,
mow Lew does not apply w an owner of property who build,or impros thereon,and.
who contracts for such projeele with a co akr(s)licensed pursuant tu the Consomme.
License Law.
❑lam exempt and 4dv:ty
.BA P C for Nb reason
Date L13070M
WOD ION�L•6L1�IONI hereby affirm^nerlof perjury em of the following dmlmflons:
w and will mmnW n aCeNOaw ofConsent w wlf-Insum far Woher',C^mpcn-
n.proelded for by Section 37W of the Labor Code,for the performance of the -
r which this permit is IAsUW.
se and will meinWn Workers Compensation Insurance,u required by section
the Labor Code,for Ne performance of the work for which this pemdt is issued.
rkerACompenuti^niuuranceceni end Policy numberare:.rat( O
CP.RTIP7CATE0PEA NFRAN WORKERS'
COMPENSA INSURANCE
(Thta sec inn need nu Wcompleted tribe permit is hundred dollars(SI W)
or less.)
I eenify that In the performance of the work for which this permit is intend I shml not
employ any person in my exhaust.as W became subject to the Workerroo niamsadon
Laws of Cadfomb.Data
Applicant
NOTICE TO APPLICANT:If,firer making this Certificate of Exemption,you,hould
became subject to the Workers Compensation provisions of the Labor Code,you must
.,O forthwith comply with such provisions or this permit shall us deemed resulted.
CONSTRUCTION LENDING AGENCY
[. I a(Orm that them Is e construction lending agency for the performance of
Cat j the work for which this permit is issued(Sec.3097,Civ.C.)Name
W A Lenders theme
z LeadersAddict,
O Q 1 certify that 1 Mw read this application and state that the show Infamtadun ix
Iy F coastal.1 agree to comply with all city and county ordinance,and state laws relating to
0 C.) building mmwnton.and hereby suNMine repeuentatives of this city to"ter upon the
W above-mcntiowd propert its ction purpuse,
G ( agree m a 'I. a fy sod keep harmtau the City of Cupertino sgainsl
,n liabilities green.: te pens which may in my way acme agmnst Asid City
U 2 to q ,ee^f the g "it f this permfl. j
F7 OU ULATI T S AND WILL COMPLY WITH VN-PO Issued by:S44_Q�&o Date
T� Re-roofs
Slghatu f pl tractor Data
x DOUS MATERIALS DISCLOSURE Type of Roof
1 pplicanl chum building occupant mom of handle hazardous material
as defined by the Cupertino a icipal Code,Chapter 9.11,and the Health and Safety
Code.seeder us3:a)7 All roofs shall be inspected prior to any roofing material being installed.
pYus o
Wbra
ll the applicant a future building occupant Ask equipment m device,which If a roof is installed without first obtaining an inspection,I agree to remove
It hamdous air ronmmi nB As darned by the Bey Ares Air Quality Management all new materials for inspection.
arid]
❑Yet
No
k te s material,requirements undcrChaper6.95 of the Caiifor.
alert ns15305.i5533.d 25534.1 unacrstantl thmlf the luilding
docs tMw e 4 that it b my responsibility m notify Ne oaupsnt of the
mm t Met Poortuissuance ofacerifcate0 cyyi� Signature of Applicant Date
—0.711
(or offit5td c Data All roof coverings to be Class "B"or better
CITY OF CUPERTINO G 3 0 c f v 0 z f
aryold
TEMPPOWER
CUPTINO PERMIT APPLICATION FORM
APN# r ^� D te:
Building Address:
Owner's Name: Phone#: fSyGf�
Contractor: Phone: License#: 760y2S
Cont ct: Phone: Cupertino Business License #:
-
Building Pe it Info:
Elect
Job Description: G�L
Residential Co ercial ❑
Cost of Project:
•
Qty. if,,
A licab a Fee ID Fee Description-- Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License -BUILDING
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