00100025 (2) CITY OF CUPFRTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRI!SS: PBRMIT NO.
OWNER'S NAME: - APPLICATION SUB DATE
10751 TRESSLER CT. DIAL. ONE SERVICE C RMRIONS001.00025
Ory[: SANITARY No CON'I'ROLNO.
STELLA YAN 430 REYNOLDS CIRCL 10/04/2000
nCO ARCHITUCT/ENGINEER: BUILDING PERMIT INFO
c- (408) 452-1174 Bux ELECT PLUNIB MECH
2 j
LICENSED CONrRACrOR'SDECLARATION Job Description
'o v�� 1 nereny nnirm mut 1 nm fianad amles pmvhn,nx nr chalnm 9(vornrmmemm�g
wish Smliun 9110(11 r1Divixiott 34the ltusinov and l'p, 'Gxlgaw
nJ my liccro
QYLJ •in full force and efice. �(��/ �
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Uae�sx�� I.ic.N
3 m y te_S/0.(� Cmmaainr .
LL O g1RCIH U:C'1"S DECI.ARAI'ION
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Imedersmndmyplan.anallbemeedaspublicrernN, TWO A/C UNITS
W
mat i O O Licen.ad F, he xi...no
OWNHR-BUILDER DhCLARAI'ION
=' I hereby affirm thin 1 em exnnpt from the Cnmmaor's Liecme Low for the ,
C?Z following reaasn.(Section 7131,5,Bovine,and Profession,Cade:Any city or county
s o whlal.require.tt,cnoil a,cnnamet.aper,mtptr.e,detnrfixh,or mpah any nfmaure
u
3- pr;olo;fsissuunecala,myuires rhoaPPlleant lhr.wchpnniunlilcusigneJ.aammm�t
Inas ne is hcen:ed pnrsaannn me pmcidrn.mr me Cnnv aor.uccmxe l.wlcnapmr9 Sq. Ft. Floor Area ala•tion
(commencing with Section 7()(1))of Division 3 ofthe Bminesc and Professions Calc)
or that he is exempt thmui and the husk for the alleged excngn'm i.Any vlolelion
of Section 7031.5 by any applicant Into pm,it s.bjc,f,the applicam to a emd penalty
of nntmm than five hundred dt11ars(s500). APN Number Occu any f
40
OLax of ineprmpn......ry,00p,ycu v,kh wagm Its Emit o1r,ontpenxtabn.
776
ll ri th work,
a i h I I _ I t I J IeI d f I (h 771P4.B si d cal Tb c t t L d t ppb man Required Inspections
mfin ptyWn h Il - p . th d o r n work hon 35F07083. 00
Ehr pI ) .......Iedt t och hotpow,nienkareim or ?'1.
odereI her d,II,how ❑be building or initero,,mend 11 whin.one Y m r f
iimpletion,me owner-bu Ider will have the burden of proving But he did not build or
mprove rmparrose ors^la')' 303 — ROUGH MECHANICAL-
0
ECHANICAL_
01.:av owner(11 properly,am exelir,hely conttaeang with Bcenved conutolers to 304 — ROUGH ELECTRICAL- ,
Lons mer the project(Sec.7Um.Bu mess.and Professions Cale:)The Commerce:
iecn.eLawmu,.maapply ,,annwn.rnfpmperywhobuio,oriommecvmereon, 505 — FINAL ELECTRICAL
and win contracts for such pmjccty with a cnnbumorx) I;ecnxcd purooinl to the
Contractors Liceme law'. 508 — FINAI- MECHANICAL-
0
1 am cmmin under Sec. ,B&1'C for this mason -
Owner Date '
W'ORKER'S COMPENSATION DECLARATION
I hereby actino malar pennhy of perjury one of(lme following declarations:
J I have and will maintain a Certificate or Concent m self insure for W'orker's
Compcncmiun, us provided for by Section 37110 of the LaM,r Calc, for the
performance of the work on which this pcmtlt is is.oed,
01 have and will maintain w'orker's Cumpnsation Inmmnce,as required by Section
37M of the LnMm Code,for the performance of the work for which this permit is
mold.M/yr, C'1111'1111�11111.1 lasmwme currier E I lo�llry�•ntndmrab
'cn/Tl Policy No.: J!JY�('v
CEHTIFICAI ION OF LKENIPI ION THOSE WORKERS'
- CUM PEN SAT ION INSURANC Ii
Tnds section need not be completed if the permit is for one bond"dollars
O100) it lcs) -
I cerrily that in the perfonnatme of the work for which Ih is permit is issued.I
shall not employ any person in any runner ws az to become subject to the Worker'
Cnn.(c anion Laws of Cul i rom;u.Date
Applicant
NOT ICV TO APPLICAMI:If,after making this Ceni framer Exemption,you should
become wbject um the Worker's Compensation provisions of the Latour Code.you must
Z
2 I'onhwhh comply with such prnvi.inm or this permit Shull he decmod revoked.
E' Cf1NSem iC;t 0N1.Ery DING AGENCY
CC ' thereby ehich that Ihcre 1acoted(See, lending agency for the prlormana
W of the work for which this permit W isxucd IScc.3097,Civ,C.)
5 Q Lcnder's Neem
7 z Lender's Address
U O 1 vn,ty tial I h:ae read thi.......Neat on and stair hot the above lnl'ortnafinn ix
rmE. correct,i agree m comply with all city and county ord;naneev and state laws miming
C (, to MmlJgconmourtion.andh hYmilhorimre)) . ttves of thiv cityt ter upon
4s1
the rhose-nientioned. i ny f Ire t purposes,
Q
[r lir IW)'b' I 'fy JA 11, acy ty fCu n m" 1st
V] lahilt j dg I. r d I h May in any Y 'gminsf id -
V Z City to consequence of Ne granting o th o t.
APPLICANT UNDERSTANDS A 'OMPLY WITH ALL NON.POINT Issued Date
�' UHCIi REGULATIONS. A -
Signamu Applicant!Conmac Date Re-roots
HAZARDOUS MATERIALS DISCLOSURH
Will the:tppheam..rBoom b"Ading acttpam,finemr hamme hazardnux tmttedtd 'Type of Roof
av defined by be Capr;m,municipal Calc.Chaco"n12.and the Hcaldt no Safety
Calc.Section 25532m1!
Cl Ye, 0 No All root's shall bei spected.prior to any roofing material being installed.
wn me a))))beam nrmmtn nr:;lding a'eapam axe cynipmem or deviac wmcn It'a roof is insta a ithout first obtaining an inspection, I agree to remove
" "
mit hazadous air c.mm nirmms ns defined by the Bay Amo Air puvlim Mawgenum
1i,trier! all new materi, s inspection. Applicant understands and will comply with
❑Yes 0N all non-poin o regulations.
I have mad the hazardous nwteri requirements under Chapter 6.95 of the
COIIIImfea Health K Safety Coda Section,155105,25.533 and 25534.1 understand that / !, .,,✓1
it the buildmildoe,nc
on currently huva lc lltnLthu ii glw
v nnsi hi Ii fy mount,t he ✓� V�/
occurym of the,e9uirensnls which in he nmt/liinJumis<mme of a Cenifieate of
Occupancy. U5/U�-
Signan - of pplicant Date
owner nr aamnrt,c Date All roof coverings to be Class "B" or better