06050221 CITY OF CUPERTINO
'BUILDING`DIVISION PERMIT � `` � '
BUILDING ADDRESS: ROSENDIN ELECTRIC INC. PERMIT NO-06050221
19320 PRUNERIDGE AV
PERMIT ISSUE DATE
OWNER'S NAME:
APPLE 880 MABURY RD OS-/2S/2006
SANITARY NO. CONTROL NO.
NE:
(408) 286-2800
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
.ZMwith Section 7000)of Division 3oftheBusiness and Professions Cade
in full force and eff and my license is TEST FEEDER AND MAIN BREAKERS
y ( �g 8
? License Class -1 Lic.a
[—tp Date Contractor
+j ARCHITECTS DECLAR TION
Z C e I understand my plans shall be used as public records
)yU
U.H Licensed Professional
OWNER-BUILDER DECLARATION
'r 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O� following reason.(Section 7031.5,Business and Professions Code:Any city or county $1000
< p
m ta. which requires a permit to construct,alter,improve,demolish,or repair any structure
u—H prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
S Ft.Floor Area
Z< that he is licensed pursuant to the provisions of the Contractor's Licease Law(Chapter 9 q
YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.lf.
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the contractor's
License Law.
❑I am exempt under Sec .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION {j
I hereby affirm under penalty of perjury one of the following declarations:
Q I have and will maintain a Certificate of Consent to self-insure for worker's compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance or the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued
My WorkF�fompensa on Insu cc carrier and Policy n mber area
Carrier. I MUD Policy No.:
CERTIFICATE OF E PTION FROM WORKERS'
COMPENS TION INSURANCE
(Phis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(~i►�.h 1 hereby affirm that there is a construction lending agency for the performance of
Q! the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0Z
Lender's Address
U O 1 certify that I have read this application and state that the above information is
LU" correct.l agree to comply with all city and county ordinances and state laws relating to
0Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Hf/j liabilities,judgments.costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of s permit.
APPLICANT UNDER ST AND WILL MPLY WITH ALL NON-POINT Issued by: Date S 2 �-
SOURCEREGUL
J Re-roofs
Signature of Applicant/Co for ate Type Of Roof
HAZARDOUS MATERIALS SCLOSURE yP
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Muma Code,Chaptcr 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants7o '
ncd by the Bay Area Air Quality Management all new materials for inspection.
District?
[3 Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code, tions 25505,25533 and 25534.1 understand that if the building
does not currentI tenant that i is my responsibility to notify the occupant of the
reyuiremcngsw be 'oM
anceofaCcrtiec�nr Signature of Applicant Date
'� All roof coverings to be Class"B"or better
Owner or authorized agent Date