01070051 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7909 RAINBOW DR HUSSEY BROS INC 01070051
OWNER'S NAME APPLIC 'HON SHE DATE
640 TAYLOR AVE 07�12/2001
PHONE (408) 733-6360 SANITARY NO CONTROL NO
I
ARCHITECTIENGINEIN: BUILDING PERMIT INFO
BLDG icf.EUI,� PLUMB VAECH
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LICENSED CONTRACTOR'S DECLARATION Job Descnption
0 L11cochy affirm that I am liecourd under provisions of Chapter 9(commencing
'Z4 wild cen INSTALL 4 TON AC WITH"
fulloameard fie COIL 50 AMP CIRCUIT FOR AC
2;:. Lima..Class
am Co.,. or
Lic�
ARCBT,,. or
S DECLARATION
E:m I undle...and my plan, hall be used., chhous.da
m.,
ou— C Licensed Professional
ei OWNER BUILDER DECLARATION
I hereby off. bar I am exempt farm the Cimmucho',License Law for the I
fidlowin,reason.(Section 7031S. and Pchfix1in.,Chile:Any rity in carry
�Xim which requires a permit to construct.almo improve.demolish,or repair any struclum 3
u, "icu 10 its hard.the awikaom formaJ,'hand".file a'i'mad'aniamereat $4
a.ca!� ...a Low(Chapter 9 Sq-Ft. Floor,Area,,- ftation
Marnmercing with Section 7")of Division 3 of the Business and Prefession,;Code)
...that he is r;amid,hiincrumn hands,basis funme alli:edy!atmomalor,Any violation
ofSoction 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty
of nor room than fivo hundred delta,,($500). APN Number MECHANI� i -i Occupancy Type
0 1.as owner of the property.or my employees with wages as their sole compensation, 303 — ROUGH AL
will do the wark.and the structure is not intended or offered for sale(Sec.7(N4.
Business and Prodessions Code The ContractioN Livero,Law ducy not apply to an 304 - ROUGH EIF5qTW CaWoctions
owner of paxi who Wilds or improves thereon.and who does such work himself 505 — FINAL ELECTRICAL
or through his own emdoyccs.provided that such improvements am not intended or
offered for sale,If,however.the Imilifingor improvement is sold within he year of 508 — FINAL MECHANICAL 7
couipletion.thicuomer-builder will loycilue,burden ar'provingiort he did con Wildm
improve for Purpose of sale.)
b L a%owner offfia,prorxdt�am exclusively contracting with licensed contractors,to
construct the prqcct(Sec.7044.Business and Prolfiessions,Code:)The Contrachou'v
License Law Mary not apply to an owner of property who builds or improve%themon.
-and-ody,contracts for such phojeces.wid,a counteracts)lacraccal,purationt to the
CmdeachmsLicamorl-aw.
0 1 am exempt Under Sec. B&P C point,reason
Owner Date
WORKER*S COMPENSATION DECLARATION
I hereby affinan under petwity of perita moofthe following declarations:
I have and will nairman a ccrtificzhr of Cori to sell-insum I Worker a
Cmar,chismima. as provided for by Section 37M of the Labor Code. for he
El I have and will maintain�ymkcr's Compensation in.ourance,as requiri:d by Section
37M or the LaWn,Code,for the performance of the work for which this Permit is
issued.My Woular' Compensation Incidence carder and Policy number are:
ciarn e I: it,I i c,N '0,
CERTIFICATION OF EXEMPTION FROM WORK RSl
FqMP NSATI URANCE
INS.
muchoar I r�Or
I ha he fair f h k for which thi�p'emat ii v,suc s.
shof an',na"rom in./y o.hicad 1. he Work,,'
not
n, lancer so 1.themon
y, 1. am
coal
,pdnn,,,hI...a Ir
I C __4 � 7",
CE 10 APPLICANH:If Nali'makar,pro,Mrofic.d,ot Exechn000l,71h..1d
Z become stinect to the Workers Comshasation provisions of the Laten-Codo.younbus,
recall comply with tachpinvisionsonflais Permit shall the damoned revoked.
z0 — - - . - . I. .-
' ' ' I CONSTRUCTION LENDING AGENCY
1 lx�mby dfrnb,h.,meta i,t....induction rodia, 9 for th r c erfinin,com
a the work far hichdii, .it is issued.(Set.3.007.Cim C-L.
Learader'x Name
Z) z LeMel',AM.11
I cedil ry that I have read ma, ,pl cannot ad ,are that I he buys of It is
correct.I agree to Comply with all city and county ordinance%and state)a%%relatin,
!O:U to Witcluagconshoudion.and hereby audimnize representatives ofthis city theme,upon
>i UI he aloove-nocatmatia�pari for mW,cy.
�.l P4 (We)agree to save,indemnify and keep harriales,the City ofCapertum against
:iG I bit it to-at cost, oil 11pa.,sl hall mr,in:toy we,tyclue simin't laid
he emitting of his"am'.
-7),z 'd'y':'
AP ,CAN'T - DERSIEAN A D H ALL N N- 1, Issued by: Date
S ;R G LATION.
ijhal�m.1 ApplacarroContoremn Date Re-roofs 2L�
1, . IALkRDOUS MATERIALS DISCLOSURE '', '
WBIfla,.,licam or fmarm Wild.,coupon u.mhmdRxhaza�.u;makarml Type of Roof
as defined by the Cownum Municipal Cods.Chapter 9,12,and the Health and Safety T'.
ChM.Srx6dr25532(;d1
0 Yc'
_-All roofs shall.be-inspected.prior.to-any roofing material being.installed.
wi�]*;ha applicant or future Wilding occupant use equipment or M,re%which If a roof is installed without first obtaining an inspection,-'I agree to remove
..it Imemik.,air eman,achart,a,defired by the Bay Are.Air Quality Management
Dwifc,? L. all new materials for inspection. Applicant understands and will comply with.
[3Y., Obba all non-point source regulations�'
I have to ad the hazardous materials requirement,under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533 and�534,1 madammed that
11 %hot chorally have a arrant.that it is ray res,ho,holity to notify the
hich has,the met prior moarce of Cmifi....a f
Signature of Applicant Date
�o Date All roof coverings to be Class"B" or better
OFFICE