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05050074 (2) CITY OF CUPERTINO >' ' BUILDING DIVISION PERMIT '�CONTR°ACT , INFORMATION ..i • Roof .�.•- h.., v. '{,.r. xx3a r..„ ,: BUI LDINGADDRESS: ACME & SONS SANITATION/ELE TRIN05050074 - : � - OWNEWSNAME: PERMIT ISSUE DATE ONE: SANITARY C OL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� I� 0 0 �Oo LICENSED CONTRACTOR'S DECLARATION OF, 1 hereby&from that I am licensed under pmvisiam of Chapter 9(Commencing Job Description with Section'1001))of Division 3 of doe Bareness and Profrssians enclosed my license is nI2> infullrodeOnaerr,5g�` Lic. ���/pD TEMP POWER ������� j lao, 'no l/a3Z'S— o7a DaN COnIRtYOf ^ W ARCHITECTS DECLARATION 7 I understand my plans shall he used u public rtmNs � D 6'��� 2005 ; Licensed Pmfcssional .� g OWNER-BUILDER DECLARATION .� to f I thereby afrrm Nat I em exempt from Use Contractors License law for she i pe O following mason.(Section 7031.5,Business and Professions Cade:Any city or county K m which Or.a permit to construct,ale,.improve.demolish,or repair say struaum R1 oil I LZi poor Or its utterance,also R9ums,1be applicant rat such permit to rile a signed statement Z< that he isliccnsedpumuenltoOnprovisionsoftheContrctor'sLiOneTaw(Chapter9 Sq. Ft. Floor Area uation Ya-G (commencing with Section 7001))of Division 3 of the Business and Profemians Cadc)or that he is exempt therefrom and IN,basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to B civil penally of .3���0 Occupancy nor mole than live hundred dollen(ssrB). - P Y Type ❑1,rat owner of the property,Or my employers with wages as their sole compensation, will do the work,and the amlcmre 1,.01 Intended araffered rot sale(Sec.7044,Business and Prefcviaru Cade:The Contrr.mes Ucer ,law does that apply to son owner of - Required Inspections property who builds or improves lnercon,and who doessu be work himself orthmugh his Own employees,provided dousuch improvements are not intended orofrernd formas.IL however,the building or improvement issold within am year of enmpkuon,Ne owner- builder will have the burden of proving that he did not Wild ar improve for purpose of sale.). ❑1,u Owner of the property,am exclusively contracting with licensed conbscmrs to construct Ne project(Sec.7044.Bminess and Profusions Code:)The Contractors U. ccam Taw docs not apply 10 an owner of property who Wilds or improm Ihemon,and. who Rothman for such pmjects with aenntraclor(s)licensed pursumf to Ine Contractors License Law. ❑1 am exempt under Sec. ,B&P C for this mum Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury oro of the fallowing declaratins: I hs ere and will maintain aCerfaam of Conant to self-insure for WorkersCompen- satian,as provided for by Section 37M of the tabor Cade,for On perfmmame of On work for which This permit is issued. 1 have and will maintain Workers Compoemom Insurance,u requited by Section of the labor Code,for the performance of the work for which this permit is issucd. My Worker' rsa[[uu'p/p/n Insurance artier and%li,number am: Cartier._ C C/aC Poli,Na.: yBy/RT�SA CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sectionneed not W completed![the permit is forane hundred dollars(SIM) or least.) I certify that in the performanec of the work for which this permit is imund.T shall not employ any perform in any manner so u an became subject m the Woftof Compcnsauon Laws of C.hfamia.Date Applicant NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should Woman subject In tnc Worker's Compensation provisions of the Labor Code,you muss .J ,z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY (-+ I hereby afro that there is a ConsWction lending agency for the performance of ori the work for which this permit Is issued(Sec.3097.Civ.C.) 1 Q Lender's Nunn z lenders Address U C) 1 comfy Nu 1 have mad this application and state Nat the above mramtaum is L,, -` correct.1 agree to comply with all city and county ordinances and sett,laws relating to 0 Wilding convection,and hereby suthorim representatives of Nis city to error upon the r above-1-cl d properly for inspection an purposes J� („�y (Wc)agree m cove......ify and hi cp harmless Ure City of Carleton.id City / Uzincouncepuudgmcnh,Roaming cepcnsesmit. may in any way accrue against said City m consequence of the Roaming of this permit. APPLICANT UNDE STANDS ANq WILL COMPLY WITH ALL NON-POINT Issued by: Dale a� SOURCE REGUL N AN / l �� L Re-roofs Signature or App nUConlmcmr Da HAZARDOUS MATERIALS DISCLOSURE Type-of Roof Will thea pliant or future Wilding occupant mum or handle haeudous material as dcrned by OnCupertino Municipal Code,Chapter 9.11,and the Health and Safety 'dilicoun.StttioYes L�n 15531(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or future building Ox%pavf use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove 7M.H.1 t hamodmes air contaminants u&rind by the Bay Am Air Quality Management all new materials for inspection. uictT ❑Yes flN` I have mad the haandous materials mquimments under Chapter 6.95 of the Califor- Safety Cade,Section,MY)5,15511 amt i55ld.I understand thuifdv:Wilding s c n11y ere a enanl u 5my 5 3"25 hility un notify the occupant the i m t0, mmfW pn Tai Rc.f.ccnlriarcc!De Panay. nature of Applicant Dale n f or tbomed agent „e All roof coverings to be Class"B"or better r Community Development 10300 Torre CupertinoAvenue CA 95014 Telephone(408) 777-3228 � CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: � C/R 1 PERMIT # OWNER'S NAME: CnJTE X 7j jLM1 PHONE GENERAL CONTRACTOR 4--1-4A5 V- "AltS FAX# I am not using any subcontractors: Sign tore Dat Please check a ct applicable subcontraors and com Tete the followin information: 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical (� rj© 91, ' X P /6 Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile --I113 esu Own r/Contractor Signature Date ~> CITY OF CUPERTINO ZA(la- TEMP POWERoS"z-',S6, 7' 1 ICUPEVINO PERMIT APPLICATION FORM APN # 3 /K l b 7/ Date: /3 �5� Building Address�O Owner's Name:��, �� P pe 67�-o?o7/0 Contractor: �/� Phone: S o�26� License #:�—/// ��/1'IE so N S yD. 0?9 Contact: � �s// hone: /� — Cupertino Business License J #: r7 (� Building Permit Info: Elect ❑ Job Description: Residential ❑ Commercial �— Cost of Project: :5"—0'a Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING