00110090 (2) CITY OF CUPERTINO
]WELDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADIIRCSS: PURIM I'I'NO,
10627 N. STELLING RD VERSATILE CONSTRUCTION COOOII0090
OWNER'S NAME; APPLICATION SUB DATR
SEF_T, WILLIAM 510 S. MATHILDA AVE 11/16/2000
Id
UNI:: SANITARY NO. CONTROL No,
' 4087370891.
MO]O ARCI It I'FCrdENGIN17b IR If UI ING I'IiRMIT INFO
m 01,UG r PLUMB 1014,211
HAW I=1 _-I IJ —I
f- j LICEYSE)CONTRACTOR'S DrcLARAUON Job Description
ZO O I Imrehy uflir.n flat 1 un;IlccnscA msder Pnrvi%ions of Chlanur 9(mmmm�cing P .
whhSecloo 7(XXruI Dlvlsian3otdEe Biomes; Il'nnesaienn Cute.anA my liccnm
�Yf� i..in hall lass and elle �f //-` TEMPORARY ELECTRIC/POLE
Li .w Claw LionM_yLH
me �'N Imelor
ARCHI I'Iw ase as uhh,AI'ION
t_1-"O, I unJmxumd nsy plans shall ba+i vl as pnhllc records
as asw p o Liens J professional i
Oast Ice.OWNER-BUILDER DECLAMATION
R 1 hereby af0mt OW I am GUILD from the DECLARATION
Livcnse Law far the
C ZIi,llowiny,eeam.IScction 7031.5. io
,B.,ines,and Professns Code:Au,clty or County
5 E¢p which regains a Pcrmil Ice....stma,Mena in+pn,vu,dmmrl kit...,repair any%....tour,
n3es es prior to itsirounnce.:dso requires file upplieam pa'ah psnuinn tilear,,ned,tmnso,
mat be is sternest!P.,uanIs,do,pmvi.:an.ofthe cantmnar,Lieen,ehw(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the lousiness and Profession.Cusho
or that he is exempt therefrom and the basis but the alleged exemption,Any violmion $1
of Semon 7031.5 by any al,ica r Ibr-a permit subjects me applicant ,,a civil penxhy
of art.++urn rein five nlmAred dodar.(y5(0). APN Number Occupancy Type,
❑1,asowncrollhepropeny.vantycntphiwith wagesastneirxoleempensmi;m, 32F.. VfF 00
will do the work,and the%mmcmm is not intended or offered for sale(Sec.7(W.
Business and Profession,C.de:'11m Contractor'.License Law does ant apply Io as Required Inspections
nrproperty Who builds or instructs therein,:
mA who does ouch wad hi.nncl
untriedi"Itfor .]o w..unwrWar,s. i ldal that rich Innsarmisprsore,cra,nre.wl linendorm 304 — ROUGH ELECTRICAL
allercJ for..alt 11,howmnr,the building a iotpnncme11t n this within nee year it
cnmpmdan. he aw,+er.naimerwanta,'e me hamennfpravn,g than lte did net build 507. — FINAL F_L ECTRICAL ENERGY
organic,ror Purpose nr%ale.k 505 — FINAL ELECTRICAL
❑Ln nt"Ihe propeny.0 xclusivelyI anmting wish rcen.ed 111.1 roams tar
vrvhuel lherpu,ocl(Sec.7044,Ilnsinm., ad Prnree.ioa,CnJe',)'1is,C'mao', n,
License Law d+cs nut apply to an owner of prnlncrty who build,or improves thereon,
and who contracts lin such projects with a contraire,)licensed pursuant m the
Contracu+tn License Los.
❑1 am socials,under Sec. .B K I`C fir this reason
Owner Duro
WONKEMS COMI'IiNSATI(lN DECLARATI(IN
sit
Ithereby tuffams rude,pe 'lIY oflyUmarryorwoflhef 11 Bd I f .
.JI river insid 1111 arsonists' C i s r C I f II t N rkcra
C...r a : pis IdI try Seen.... 371111 ffl I1 - Cd lot the
pe �trt e f h 'rA f h'ch fl':proud issued. � .
ED have and will maintain Worker%Campenwtion Insurance,as required by Section 38
3700 of the Lrhur Code,fm the actomence of the work for which his permit is
sonL MY Worker's Cnn,ca,',aiun lnwrance can Her and Pol ICY nannhcr are:
Cars cr: Exist icy N..:
Corfu IpIGS70N(117 H.CEMPTION FROM WORKI:RS'
COMPENSATION INSURANCE
ffhis station ns.xl not he colopisid If the per nit la lit,one handled dollars x
(E I0)nr I...)
1 certify mat in be performance of the work for winch his permit is i...ed.I
shall not employ any person in only manner s„as to become%abject to he workers
Cur"n.ation Law,it California.Dine
Applicant
NUI ICU TO APPLICANT:IC allcr making ma,Ccniticate al Iiscayaial,you.should
Neon suhlect It,Ill.Worker's Cnmpcnsainn previsions of the Labor CWC,you fna.0
Q 0 0+nhw'ith comply with such provi%ions or this permit shall he devoted revoked.
F ^ CONSTRUCTION LENDING AGENCY
a ' Ihereby:ltirist that en'c is amust ma,11 on lendi ng agency for fhe,crlbm
rmnce
olbn
f(be wok for whish be,permit is issued(Set 3007,Ci,C.1
6. Q lander',Name
7 z Icndcr'%Admess
U Q 1 clod y ihut 1 have nand this application and slum IM1c Ihc:movc infunontlon 1,
W �`y a rrtYf.I agree Io cu.. I,with all airy mW ca11nly unlinanaes and nate low%mleting U n+bilding consmrction,and hcrehyarldn A,repmscma(ivesol this eiry to ,,ler ulnathe ahovomcmioacd pmlrcry Ir inspectionf We)a'.tosave.inJm11nily and keep harmless the 01,4Cuperim,against
VAI'I N9NU v SA DW OMPLY WI'T'H ALL Nf1F4)I 'fIssued"y. zy Dille
'��j) Re-roofs
IIAL\RDu rf MATERIAIS UISCLor hand
wWydapu,nisnrhnmctvddmgncn Chapter 9.12,
and
nacvnlna.nneenal Type OOf
a,de.Sol by Ihc,2npcnirnr Munieipn a+ale.Chaplcr).@,urn tilt flcuhh:red 4alety
Cale,S yc, 25532(u)P
❑ve, 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant nr fame bailamgoaupanl use erluirvnentm device,x'mch If a roof is installed without first obtaining an inspection, I agree to remove
haeadous:ur a.mun+ilnnm>sv JetincJ by the tiny Area Air Crudity Ma,aard
nfaDun
;,miefl all new materials for inspection. Applicant understands and will comply with
O Yes 0N all non-point source regulations.
I have teal the Ismardous materials myuirements under Chapter fi 95 of the
C'alilim+ia Health le Safety Code,Section.,255115.2553 and 25534.1 understand thin
If the hot lding docs 11,11 currently haw n mnu11n film II is my nuapo...dud ty n+motif y the
cupn d the ra,arent a u nm,prix mwmsa+at'act Bectu of
issol3feas Signature Of Applicant Date
oI r. .:mnorned Igen D.gff All roof coverings to be Class"B" or better
OFFICE