02080157 (2)I
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CONTRACTOR INFORMATION:
DINDIIVIISIONPERMIT
BUILDING ADDRESS:
PERMIT NO.
10461 MADERA DR
02080157
OWNER'S NAME:
MRS. SIMA
APPLICATION SUB DATE
08/27/2002
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: a
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
To
To
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LICENSED CONTRACTOR'S DECLARATION
Ihereby eRrm,hmlamliccnudunder pmvisionsofChapmr9lcommcncing
Job Descrippll0❑
O
W with Section 00001 of Division 3 of the Bro, 'ad Prof essions Code. and my license
in fol fo and ,.
SEVICE UPGRADE TO 200AMP
Uis `
Liccnse5 L p
Da¢ acmr -
Fn 1 SeDa 0d
I
s}4on n r, ahli'
g 1 undcrst d my plans shall be used as puhlic rc<nNs
pLicensed Professional
OWNER -BUILDER DECLARATION
It I hereby affisn that I am extmpt from the Comocmr's License Law for the
afollowing mason. (Section 7031.5. Business and Pmfessiona Code: Any city or county
$1960
O which requires a P rriI t contract. aIter, nprove derarlida. or repair y structure
tb . pdo, to itsane . also acquires Hicripplicarm for such permit a fl e ii,itedouncrarit
$ d ���(#iS 'S,.1,?'x(-t,:;
Valuation
—
psedp Sectiot binpiovyition dm theB"unes Utt seW (Carr9'
nJProfessions CWe)
ng.„nhSeun]WB1nfObsiso
(i,comsT
(comms of rtheaBgedex
or Nat he is ,hcrcfmi,tantl the basis for the allege) dcmPdon. Any violation
xf-11'e'f32 ”
1.5 b oll foe a permit suhlecu The apPliam to a civil prnohy
a703than by arty, hundred
- of not more
or not more manfrve handrca douars (a50(0.
304 APNi '�(4(§4i ELECTRIAL''�1"''n,o
Occupancy Type
I. as owner of the pty, or my cmployces with wages as their sole compensation.
❑ roper
— FINAL ELECTRT,
ENERGY
505 — FINAL ELEQfDBeaQt T CIIOII$
will do the work: and the stmmure is not intended or offered for sale (sec. ]UtJ,-
usineis'd I'mfesdons Code: The Contractor'a License Law docs no, apply to an
`Ban
owner of property Who builds or improves thereon. and who does such work himself
or through his own employees, provided that such improvements an not intended or
--_......_..._...._._.\'-
-: offered for .sale. If. M1owever, the huildin- enl is sold sci,an-imeyear of-
Y
gob urden
.. „AGA qq� dr)t
The owner -Wilder will have the burden of proving that he did not Wild or
of
completion.rov
improve for puBnm ofere.).
f
.b leas rof the Ptopen&are eadus ly contracting with licensed contractorsm
..L L.:Ia 1. .'"c
_nswn the Project (See 7 W. Business and Pmfcssions Codd The Contractor's
LL �: _'-: t' ..\I'+ V-1 I:
License Law does not apply to an owner ofpmpeny who builds or improves thereon.
_ _carfobo contocu.forsuch. Projects with.a.contmtot(s).licenud.pursuant,w,ffie.
_ _.__ .. _,.._ _.._..__..__.._.._._... __.--------
Coronations License law. ,.. .
[II am exempt under Sec.'"s' ' .:B d P C for this mason
E@tl� (r
Owner'. n:. .;.., :'Dais':. .I•_i .,. .L, ., -
WORKER'S COMPENSATION DECLARATION
_
SEP 0 3 2002
I Wmby aRrm under pctmlty of perjury�one of the follo rm, sleclantioner
❑ 1 hove nnJ will maimaio'u' Ccnifcam'of Consent ,o self insure for Worker's
Compensation, as Provided for by Section 37M of the Labor Cade, far the
BUILDING'performance
_
of the work for which this permit is issued.,
n s.
❑ 1 have dnd'willmbinmiv worker'n'Campensa,ion Insurance., required by Section
3]00 of the IaWr COJe, for the performance of tM1e'woik for which Nix' permit is
' S J
..
'• .. _ -iGi �l Qi%
't s qya s l l i
i
colt ' C .R IFICATION OF E%b Py FRO Int ERK�S
di s' t 11 al 1 if, l a �
_ ... _. __ _ ..._,...... _
(Thrs iccuon need ret M complaed iftbe perms is for one hundred dollars
ISI W)or less,) m, 1,.., ..... •.., s. ., •, ..
i
v
''t Iea0, fy th t athepert rm- ftM1 rk fo ,M1 h,h pc_, t ssucd I
�-,
I. C....I !., ,_ifli!I Ct s✓
"fall Lem )toy any person ' any manner 5 m Wum object ,o the Workefu
-
Co. o u LowriActilifarri.. D te
- - - -
ApPI cant _
PIN OTICETOAPILICANI If ❑ k g thim Certificate a E p, you, should
_ .. _
Z be es b) Ire the Worker's Cpc t po'.mns of the Labor Code von trust
.� fotihwith comply with such pro .'ons or this Permit shall be dorabod amorked.,
- I'f• C0NSTRUCt10N LENDING AGENCYi
-
" I M1e b Ilirm @ t N on t t { M g cY ( the performance
Bo,Cj
ti ohM1 kfny high th t l
___
-Led s N me
Cenders Addrtss ^ -
(. r' r �„D
• 1 BIW,
. certify Lhavc read IM1is application onJ nme,hm me about informmion is
'e. saucer. I agree to comply with all ci,y,onJ couory ordinances end am¢ laws rclming
V Ito bwlding construction. and hcrtby authorixc rtprcunmtivcs of this cirymrnmr, upon
L (W I Brc m e d ri fY oidk pharml .soh Cry fC pedind Bainm
/jp
Vi li 61 t j dg nu < t d < Ixnu h ch m Y n any Y < aga1 t said
Z Cty q"ce hhg gofth pc , '.
-kPP CANTDNDERBTA SANpNILLCOhIPLYN'ItHALI NOWPOLNT
'E
Issued b : Date V
y
REGUL.' ION _0Z,
�Z
- SOUgnm�
Re -roofs
iuu of Applican on mo '. V. r >-�:' - Dam",,,;':'
HAZARDOUS MATERIALS DISCLOSURE
N6khcrappficiiat onfuturim building occupani'.treohandle lantairtioustareacrial
'as
.Type. of Roof_
defined by theCupertino Municipal CW Chapter 9.12. and the Health and Safety
;,
Code. Section 15532181 a I
'..
�(' k .. s l . , y . .. I 4. s, v ..
All roofs shall be..ins ected nor [o an r
P P y oofing.materialbeing.installed.____.. ..
�..-;.: ; •, -.-' -,:-
, ywntnapplicantorrutur b "Id goccupantuseequipment devices n n
-
If a roof is installed'wi[hout first obtaining aDinspechon;'I agree t; remove
em,h b rc t retire. a tl f ed by the Bay Are A Q ItyM nage t
I
all new materials for inspection. Applicant understands and wi_1.1 comply, with
District'
dr I
all non -point source regulations..,.,,, ,
I have read he hazurdaus momr als mcnimmen,e under Chapmr fi.95 oLthe
California Healtls d Safety Cods: Sections 25505. 25533 and 8530: 1 nedersmnd that
'- -- _ ---- '----- - _ _.
if the Wilding does not currently have a harm. That i, i5 my- responsibility to nmiNum,
"oacupam of the requiretimms w "It W me, prior to issuance of is Ceitificam of
`0 cy"
_ Signa[ure_ofApplican[ Date _
All roof coverings to be Class "B",or6etter
m is -d rt ;. T. are
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