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04120152 (2) CITY OF CUPERTINO - • '� <'�_+� n =i` '" '�"'�*'��'�^" £' BUILDING DIVISION PER 3 +�1 'T 8 T12.INFORMA'TXgN• . . . a 'rm z ti BUILDING ADDRESS: GURU ELECTRIC PERMIT N004120152 - 21267 STEVENS CR BLV OWNER'S NAME: PERMIT ISSUE DATE 'r` JEFF MINARD 1911 RESENELFE CIRCLE E: SANITARY NO. CONTROL NO. (408) 254-4464 ARCHITECTIENGINEER: - - - BUILDING PERMIT INFO - BLDG - ELECT PLUMBMECH �oij LICENSED CONTRACTOR'S DECLARATION -Job DCSCrIpnOn' I b rue I- umucd ussrWaw Cham9(Momeetng . mthoDm74vBuuaydd .nmYlicewis mmdDEMO FOR INTERIOR LeeRadCertem w co - �LAPF"lyEcl'sDEcu 4L yr—•1',.1/{//y //�� I undcrwnd my plw,lull be usedupublic rteonb il,` /(�..� D Licensed Professional OWNER-BUILDER DECLARATION Y I hemby affirm that 1 am exult fmm tie Commencers License Law far Loo /ry/ n p o following won.(SWUM IRE 1.5.Busioess and Ro(esaiw Cade:My city or county son /' //Q fJ"/} / aI✓ $ which requires,•permit w eonwrsel,almr,improve,demolbh.or repair any urucmm lV 815000 Fjr priaren its issuance.alsoollo es thoappliwt fWsuch Immilw file asignedsl.mment .- gg F c Valuation that be is licensed punuent w the Prowsiw of the Conmcoarl t locw law(Chaim,9 "Sy.F[.Floor Area­ u� ''' i k: p$ (cosern I.SwiLh ned.n7ODD)d DivW.3.ftie Busin=and Rofmi=Code)or - 3 WI be Is,cvmpt therefrom and the buss for Nc alleged meMirdm.My lio4Um,of \• Sccdon?03L5byu0'appnansfm.permit Rubjectalhnappncsooenacivll Penaeyof o _.,- ..,_ Occupancy Type � *- Out mom Nan 0w hundred dollar,(5500). ❑L u owner of the property,ar my modoy=with wags a Ibeirsoe compewdm. wBmuewak.naue.mnanl,naunwwaaartemdfmwe(sa.?oe+.eathwe uireProfessions; Re ections andProfessions; mu =ml Code:The Contravenes Limse Law dapply en an owner or -- 9 P . propertywho builds or improv,Nemon..nd whodomeueh workhimaelfor through his ... own ami loy=,provided tha Rueb lmprovmenuw noointanded molfemd forule.If. however.the building of improwmml is sold within one yeu of roroPletion.the owner• . .... _ , builder will hew the burdon of proving thus k did not build m Impsow for Purpose of ...._.. .__. . . . ,. - sale.). - ❑I,as .,of the proper.em exclusively contracting with lianad conoacum,w cowrocs me pmject(Sec.7044,Business and Professiw ConieJ The Commicmh LI-whoco - .. rowlawd=nsap,*Mwimrofprop,(,whobudpo .twft C.eon. eI Liecom Lacu(m surth projeM with econtracmr(s)Ilawdpurwmenthe Convacloes - L'mew Lew. _ ❑lam uempi under Sec, .BkPCfor this Owner Date _ .. d WORKER'S COMPENSATION DECLARATION- P, I hereby affirm under penalty of perjury one of the following declarations: ? Nm and will maintain a CralOae of Cawntenself-inure for Worker'.Campen-' -- f abort,u PmWde,d for by Secthan 7'K10 of Ne Labor Cnle,for me performance of the work for which this permit is issued. ❑I haw and will maintain Wmker's Compensation Insurance,se required by Section 17Mo me LAhor Code.for me pncfmmantt,(the woo,fen which Nu permit is issued. My rket's Campewdts hwranceeamu and number are: - e �O e o.: C RTIFI A ^O• (EM N FROM WORKERS'COMPENSATION INSURANCE (This section need Out Mcmnphati if the permit is rmone hundred dared ara(5100) or Ws,) I uemfy that in the performance of the work for which this permit is issued,I sine]]not .._ ... - employ any pe...m any manrmrso as en boverm subjecl11 tM Workers'Compewtion law,of Califomis Dam Applicant NOTICE TO APPLICANT:If.after making this Certificate of EameptiM,you should become subject m the Worker's Compensation previsions of the tabor Code,you mum OfaMwith comply with Ruch proviaiom or this Permit ahsil he decmW mwkcd. - Z.rN., CONSTRUCTION LENDING AGENCY E1bemby.M.that Nem ha construction hudingagoncy forth.porfurmancc of E > the=role for which this perms is issued(Sec.Sam.civ.C.) qLendle,Name z Lerems Addrua U 1 certify that I howply read this city and county and sum Nn the.bow information Is, 0,F building 1 agree ct comply with sit cid and county ordinances and same lows minting 10a DU buowt-coanurroj Pnand hereby anthosiarePmxnmiw,of this city wenmrupon the W above-mentioned property for Impaction Purposes CM•y (We)agree in aw,indemnify and kttp May in the City o(Cu 2L r agumt h in equnce of thea granting of this may in any waya=ve ageiw said City V'l A consequence or UNDERSTANDS S A permit. rr^^.• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date - SOURCE RFAUL qJ -4110 0 Re-roofs tura of Appliesm/Commemo em HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me apPI1.1 or fulum building occupant uare or lundkm..rw u defined by the,Cupertino Municipal Code.Copier per 9.11.W the Health and Safety Code.Section 15532.? All roofs shall be inspected prior to any roofing material being installed. El Yes `F�Nu Will the applicant or f"u�l'urc'budding occupant tare equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I havumna air loon inenta u dollmd by the Bay Arca Air Quality Management all new materials for inspection. . District? ❑Ya P. I hew mad the haasdaus materials mquimme as under Chepmrli.95 of tie Cxlifor. -is HWdth At Safmy Catle,Scow15505.25533 mu125534,Iuadomtand institute Wilding tl=not currently how a mnant,Lou It is my responsibility in notify de cecupant of me requbemcnuwhi b. Ipriorwiuuanwof Cvmneato foccupancy. Signature of Applicant Date Q eronumomtdescnt > D, All roof coverings to be Class"B"or better