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03050136 (3) CITY OF CUPERTINO =*" �a,»��"6'a• � + z '`£' M BUILDING DIVISION PERMIT ,COLVTRACTOYt,TNFOt2MATIO .-; BUILDING ADDRESS: RUDOLPH & SLETTEN INC PERMITNO03050136 ER's NAME: 989 E HILLSDALE BLV ; . PERMIT @SIIVOATHs BO8/2003 WLETT P / � PHONE: (415) 572-1919 SANITARY NO. CONTROL NO. ARCH ITICT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 300 LICENSED CONTRACTOR'S DECLARATION O O O O I hereby&farm Met'1 son BacluW under pm.'aia"or Chapter 9(commencing Job Description with Section 70110)of Division S of Ne IS and Prolosed o ,andmylicenscis DIRE I m1�oC an its ctC TI-NEW TRANSFORMER RELOCATIO11--ONIALE93 L Date -' 0Y Convector c I understand my pl...halllbbeused u public rands JUL 0 2 2003 gs SPd Licensed Professional OWNEm BUILDER DECLARATION BUILDING <I I Wroso .(Sinn that 11. eampt from tiro Canine Co License law for the BUILDING 00 following meson.(Section 71U L5,Businer.ma Professions Code:Any city"county $f<i which roquires issuance,permit w cniwnct.alter Wpm w,deermitt ri e sigany tenement Met hoor tot uensedpursuant to ws tM anionsofant farduc sucCahnutme'wNe a,Law(ned stawmco < thatbeiscccuodpunuamwthe pmvivisioofIW eSmicor'aodPmrlaw(Chapter9 Sq.Ft. Floor Area $24 jyl®tion E (cat he is (commencing Section can d)M Division r of Ne B ed axe and on.Any Cade)or 3 g that he b exempt ihen(rom and Ne bub for Ne alleged exemption.Any vlalailon of Section 7031.5 by any applicant for a permit subjects,Ne applicml to a drill penalty of �l er 0 0 Occupancy e not more Nan five hundred dollan(g500). 3 P Y1YP ❑I.u owner of the property,or my employees with wages as their sole c oopcosadon, will do the work and thestructure b not intended w offered for ale(sec.7044,Budnea — and Portal."Code:The Contneeefs License Law don not apply m u owner or 102 — PIERS 1 d Inspections propenywho builds orimprams Ihemon,and whod(sessuch workhimalrorthreugh his ownemployces,proWded thm&uch imposemenu arenm Intended aaffend f"sale.If. 103 — UFER hmxewr.we building or impomment is mid within one year of compleunn,Ne owner- builder wR!hem the burden of proving that he did not Wild or Improve for Improve of 104 - REBAR ink.). 105 - ANCHOR BOLTS ❑I,u Owner of de proper,,am inclusively contracting with llansed anmacwrs w co106 - SEWER & WATER "trYct the project(Sec.7044.Business and Pofrsslans Code)The Com rsous a Li came Law does not apply to an Owner of property who Wilds or Improv"thereon,cod. 202 — UNDERFLOOR PLUMBING who contracts for such prejecs,with a conuactor(s)licensed punuant to We ContractoYa Lime Law. 203 - UNDERFLOOR MECHANICAL c ❑Iannemptuntler Sec ,B&PC!"Nbrea.n 204 - UNDERFLOOR FRAME Per Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury as of the following declarations: 301 — ROUGH PLUMBING ❑I ham and will maintain aCWIficanofConunuo a161nsure far Worker's Camper, 302 — TUB fw OR SHOWER Wion,as pmvidcd for by Section 3700 of the ober Code,f"the performaiwe of Ne 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL ❑I ham and will maintain WmkeYs Compensation 1"unnce,as required by Section 305 — FRAME 37000(Nc labor Cod.,for iW perf.Wmce.flW forwhich this permit is issued. MyW kte,Cnmptnsadon Wurartce e. P icy number am: 306 — HOLDOWNS Jar-tru.icnni Poll WC 34453aIp3 307 - INSULATION ((M1A/aN////T,���yy-ttf4F7�OMPENSA O�NgURANCEFROM ORKERS' 308 — SHEETROCK Lf fDtisrltihiTrYad not he completed lfMe,permit is force,hundred dollan($100) 309 - EXTERIOR LATH cera'') 1310 - INTERIOR LATH e unity that est dw performancers the work for which t thisPermitrl loved,I mall not 311 - SCRATCH COAT employ any person In any mannermuwbecome mbjuu.the warhen'Coope"&tion . Lawacf California.Date 313 - ROOF NAIL Applicant NOTICE TO APPLICANT:If.atter making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to Ne Worker's Compensation previsions of the Labor Code,you must .J'z f.rmwim comply with such provisions or this permit het be darned rewired. 502 - FINAL PLUMBING ENERGY z 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY F� work for which th that Nen is a coiumeaminn lending agency lot f perrmmmce of 504 - FINAL BUILDING ENER a> NcwvrkfarwhichNbPermit isissued(Sec.3097.CIv.C.) 505 - FINAL ELECTRICA IIndee,Name L W Q 5z LentilAddma 506 - GAS TEST U O 1 unify that 1 haw rhe this application and show Nat the atom information is 507 - FINAL PLUMBING {T. F correct.I agree to comply with all city and county ordinanc"and&into laws mlating to Wilding FINAL MECHANICAL OU W ahow-mentioned ree to fm inspection mnify angorpoet %54 FI G (We)agree to am,indemnify and keep harmless the City of Cupertino against y Iiabiilties.judgmens,.costs and expenses which may in my way game against aid City TMIL NGin of g Ong of sanceUN R °ANDS AiND WILL COMPLY WITH ALL NONPOINT Issued by: WORKS Dale s0U GUL S. a Sig re.fA plicae vecRe-roofs D w tor HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Nc epplicam or future building acupem 4orc or handle haurdous material as dcaned by the Cu amnia M W I Co nc,Chapmr 9.12.and the Health and Safety ❑ k.Scrti.n zsslz(a)7 All roofs shall be inspected prior to any roofing material being installed. Yes No Will thea licanl or future building Occupant au If a roof is installed without first obtainingan inspection,I agree to remove Pp g p equipment car devices which P g coil hayardo"air contamipap55.aedafnrd by the Bay Area Air Quality Management all new materials for inspection. District? V�bT ❑Yes ❑ u 1 have read Ne havardoi amamrials mquimmcm underChapwr6.95 of dte Califor- niaH"Ith&Safely Cod• atJJe ns M5,]5533and25534.1unaemandthal Wilding does not c n0y aw I(k Nat h b my responsibility m m, i the.up. Of the rcquiro rut hic mus, npdorwbsuance ic 0ca r currency.�s� Signature of Applicant Dale ower ,'N. .<aasra D,m All roof coverings to be Class"B"or better