Loading...
01070119Ex[ F - ca 3 az Z C V a_> UC m_E _. C. 'a,1 U.2 CITY OF CUPERTINO CONTRACTOR INFORMATION: BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10100 N TANTAU AVE 01070119 DC!g�I r 07%24j2(�01 PHONE: SANITARY NO. CONTROL NO. ARCHITECT'/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L_J L.J IJ I_I LICENSED CONTRACTOR'S DECLARATION IM1crcby alarm that lam licensed under provisions of Chapter (commencing JJ Midi Section]fXN)) of Division 3ofthe Business and Psp risC�{It, and my license infullforecan fLc. 1 INSTALL 2 PIECESob�e;;Sfiption UU1YY License CCJ��a��{{ Lic. p ((Ji�L Dnm //V Contractor RCl use DECLAR 1 unJeraunJ nsy plans mull be used as public rccmrws Is, Licensed Profeesienal OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt form the ComreaeLs License law for the following mason. (Section ]03 1.5, Business and Professions Code: Any city or county- $9672 which require%a permit to construct, alter, improve, demolish, or repair any strvcts e ,. prior to its issuance. also requires the applicant for such Permit file, a signed statement - - - thatheislicensedpursuant m the previsions of the Cour t a License Law (Chapter 9 Sation]0(p)of Division 3nf dm Business Professions Code) pr,. �'ar��r .t.31`rOti'TTIV40r ID• ", sJ : 1 VaIUdIlOn (commea'ing with end mbar he Is eiewipi therefrom and the basis for the alleged away ion. Any violation ( „ _ s. - of Section 4031.5 by any .,Its.. for a permit subjects the applicant m e civil pmoth, of at more than eve hundred dollars (s500). 304ARl'i ELECTRI AL. ' - Occupancy Type ol. as owner of the propeny. or my employee:.with wages as their w1c compensation, 501 — FINAL ELECTRI AL ENERGY 505 — FINAL EL TiFR �I ' will do the we&. -=it the str ening is not intended or offered for sale (See: ]044;' 'Business and Prefessiom Code: Thc Contractor's License law docs not apply to an gTTIIIIT'Bi �e Ctlons 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 , ... -_ .._.._ _ _ _... _ _ —...... __.. _...-; ge provemen yew -:dfread'rn. salf'B, nndaaa; the Eawdin"r ion _.. - -t is Sala :vitni� nob 'r' aprovei the will have the burden of proving Imre he did rat Will or 1 for Purpose or safe.). improve Tor pamnne nr%aled. ' .. .. ..O 1, art Ter of the y Phys am exclusively contracting with l Jcontractors nntmctnrsro ..... . .. .. ... ___. ._... _ .__... .._ ......i. ._ ._._._. _,._...___.. .. . co utma 0e project (Sec. ]IN4 Business d Professions Cud ) TheC mm<tnr % License Law does not apply to on owner f poi h bu Id. p s thereon F I N A L E D � - ..and.who.commcn, for -such proyc¢ with. a.couraelonvO licensed Initiator ,m the __. ._. _ .___._. _ .._.. _ _ ___. ... ...__ crail aerie's License Law tCl l am everom under Scc:' t ' 3 . B'& P C for this reason _. " 1� AU6A*6.20'01' Dwner'r ..�Dnt�.' .. WORKER'S COMPENSATION DECLARATION I herahy affirm under perW tX of pe Jury one of the following declamrions: BUILDING ❑ I have and will malnuln•a Certificate of Consent to sclfinsure for Worker's Compensation, m Provided for by Section 37M of the labor Code, for the 'performance of the work for which this pr omit is issued, f ❑ I bade bnd •will maintain Worker's Compensation Insurenea, as required by Section 37W of the Labor Cal f the Performance f the work f which this Permit is es d My, orke sCmnpeu io 1 sura and Policy numbs m ''`-t,'li. �" lu,ld Ca .PnlryNo .�e _t :r r 1 t,.• • ,f {CERTIPICATION. F EXEMPTION FROM WORKERS 1 "'- it COMPENSATION_ INSURANCE"'.;` -.i' ... .. ___.__..._..._... _._.. .,_.-..: " °IThii seni'nn need �nnt be 11­cl fthe pcomiti, fortune hundred dollars '-'' • less.) ($1 00) or, 1 tfy tk t' Ih p<f n' frhe krf n., u pc t, s` II i I unpiny't ry pc n r t any manner so u. a hero rte mbJeu tit the Workers' Co pe t L' w., id C i f , Date April NOTICETDAPPLICANT If fl rm5k gth: C n ficate ft opti.......In ilw become subject tb the Worker s Compensation provisions of the W Mr CWe, ydu moa forthwith comply with such provisions or this pcona shall M deemed revoked. "'I ' "` "'' CONSTRUCTION LENDING AGENCY Ihembyaffirmiharthele'isaconstmctionleMingagencyfortheperformanre of t&'worR for which Iris permit ix issuN IS«. }09]. Civ. C.)_', . .. ... .. ... ... .. .. ___. _. ... -Lenders Name '-. :-: ..-. -- .. ...--.._._._. ._ ... ._. _. _. ... ........ Lemler's Address - r I certify that 1 have read this application orad sure that the above information is `emitter. 1 agree to comply with all city and county ordinances and state laws relating m building construction, and ncreby authmiu rcpersenmtivvs of this city to enter upon the ahovomentioned pmpcny for inspection purposes. , (We I a,. to save, indemnify and keep harmless the City of cupenino against liabilities. judgments, coon, and expenses whmh may in any way. accrue against said City in cmmquenie of thcg ming of the penny,„ WITH f/}'�1N/-P'OI/%�"1" AP FA/NNY�' UNDFRST NOS AND WILL O\ PLY ALL 5 U ,/O`I d� Issued by: Dale Com`hyi�l oLAppl cam/C nu ctor - Dan, , Re -roofs v HAZARDOUS MATERIALS DISCLOSURE sou nth rric t l t b'n s ap r ro nrn el n rJ6 t :d .. Type of Roof-..... _.„ _ ,.. ... ., _ .,.. .. •+ - .%Jf el by the Cameo M ICad Ch pt 9.12. Jd H IM1aWS ftY •.... a ides - 'r• i C Section 25532() • 1 t r. -{ r .. 0 Yel " , f 1 _ ..All roofs shall be mspected.prior.to.. any. .roofing.ma[erial.being.installetl... ..__ ._.... `. soudiWpli t r building pequipment1a devices If a roof is installed' without first obtaining an inspection', I agree to remove mn J- irnt to efined by theBy AcaA- QaTtyM%gement n trot all new materials for inspection. Applicant understands and -will, comply with - oY all non -point source regulations:'_ "t tl hiic read he rhaiSNous'matenals requirements under Chapter 6.95 of the California I lealth & Safety Code, Sections 35505,15533 and 25534: b understand that _- ----- no i y if the building does not curreml have o tenant. that it is my ms -'bilis t t( rhe r arms y -'- --- - ... e oc of the on, uiremems which must be tact prior to issuance of a Cenificae of ""p' `y' -&- +ya Signature of Applicant Date ..... _ - -- _ _ All roof coverings to be Class `B" or better o, n n antherxee .gent... '• Date - ' - OFFICE Ex[ F - ca 3 az Z C V a_> UC m_E _. C. 'a,1 U.2 CITY OF CUPERTINO CONTRACTOR INFORMATION: BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10100 N TANTAU AVE 01070119 DC!g�I r 07%24j2(�01 PHONE: SANITARY NO. CONTROL NO. ARCHITECT'/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L_J L.J IJ I_I LICENSED CONTRACTOR'S DECLARATION IM1crcby alarm that lam licensed under provisions of Chapter (commencing JJ Midi Section]fXN)) of Division 3ofthe Business and Psp risC�{It, and my license infullforecan fLc. 1 INSTALL 2 PIECESob�e;;Sfiption UU1YY License CCJ��a��{{ Lic. p ((Ji�L Dnm //V Contractor RCl use DECLAR 1 unJeraunJ nsy plans mull be used as public rccmrws Is, Licensed Profeesienal OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt form the ComreaeLs License law for the following mason. (Section ]03 1.5, Business and Professions Code: Any city or county- $9672 which require%a permit to construct, alter, improve, demolish, or repair any strvcts e ,. prior to its issuance. also requires the applicant for such Permit file, a signed statement - - - thatheislicensedpursuant m the previsions of the Cour t a License Law (Chapter 9 Sation]0(p)of Division 3nf dm Business Professions Code) pr,. �'ar��r .t.31`rOti'TTIV40r ID• ", sJ : 1 VaIUdIlOn (commea'ing with end mbar he Is eiewipi therefrom and the basis for the alleged away ion. Any violation ( „ _ s. - of Section 4031.5 by any .,Its.. for a permit subjects the applicant m e civil pmoth, of at more than eve hundred dollars (s500). 304ARl'i ELECTRI AL. ' - Occupancy Type ol. as owner of the propeny. or my employee:.with wages as their w1c compensation, 501 — FINAL ELECTRI AL ENERGY 505 — FINAL EL TiFR �I ' will do the we&. -=it the str ening is not intended or offered for sale (See: ]044;' 'Business and Prefessiom Code: Thc Contractor's License law docs not apply to an gTTIIIIT'Bi �e Ctlons 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 , ... -_ .._.._ _ _ _... _ _ —...... __.. _...-; ge provemen yew -:dfread'rn. salf'B, nndaaa; the Eawdin"r ion _.. - -t is Sala :vitni� nob 'r' aprovei the will have the burden of proving Imre he did rat Will or 1 for Purpose or safe.). improve Tor pamnne nr%aled. ' .. .. ..O 1, art Ter of the y Phys am exclusively contracting with l Jcontractors nntmctnrsro ..... . .. .. ... ___. ._... _ .__... .._ ......i. ._ ._._._. _,._...___.. .. . co utma 0e project (Sec. ]IN4 Business d Professions Cud ) TheC mm<tnr % License Law does not apply to on owner f poi h bu Id. p s thereon F I N A L E D � - ..and.who.commcn, for -such proyc¢ with. a.couraelonvO licensed Initiator ,m the __. ._. _ .___._. _ .._.. _ _ ___. ... ...__ crail aerie's License Law tCl l am everom under Scc:' t ' 3 . B'& P C for this reason _. " 1� AU6A*6.20'01' Dwner'r ..�Dnt�.' .. WORKER'S COMPENSATION DECLARATION I herahy affirm under perW tX of pe Jury one of the following declamrions: BUILDING ❑ I have and will malnuln•a Certificate of Consent to sclfinsure for Worker's Compensation, m Provided for by Section 37M of the labor Code, for the 'performance of the work for which this pr omit is issued, f ❑ I bade bnd •will maintain Worker's Compensation Insurenea, as required by Section 37W of the Labor Cal f the Performance f the work f which this Permit is es d My, orke sCmnpeu io 1 sura and Policy numbs m ''`-t,'li. �" lu,ld Ca .PnlryNo .�e _t :r r 1 t,.• • ,f {CERTIPICATION. F EXEMPTION FROM WORKERS 1 "'- it COMPENSATION_ INSURANCE"'.;` -.i' ... .. ___.__..._..._... _._.. .,_.-..: " °IThii seni'nn need �nnt be 11­cl fthe pcomiti, fortune hundred dollars '-'' • less.) ($1 00) or, 1 tfy tk t' Ih p<f n' frhe krf n., u pc t, s` II i I unpiny't ry pc n r t any manner so u. a hero rte mbJeu tit the Workers' Co pe t L' w., id C i f , Date April NOTICETDAPPLICANT If fl rm5k gth: C n ficate ft opti.......In ilw become subject tb the Worker s Compensation provisions of the W Mr CWe, ydu moa forthwith comply with such provisions or this pcona shall M deemed revoked. "'I ' "` "'' CONSTRUCTION LENDING AGENCY Ihembyaffirmiharthele'isaconstmctionleMingagencyfortheperformanre of t&'worR for which Iris permit ix issuN IS«. }09]. Civ. C.)_', . .. ... .. ... ... .. .. ___. _. ... -Lenders Name '-. :-: ..-. -- .. ...--.._._._. ._ ... ._. _. _. ... ........ Lemler's Address - r I certify that 1 have read this application orad sure that the above information is `emitter. 1 agree to comply with all city and county ordinances and state laws relating m building construction, and ncreby authmiu rcpersenmtivvs of this city to enter upon the ahovomentioned pmpcny for inspection purposes. , (We I a,. to save, indemnify and keep harmless the City of cupenino against liabilities. judgments, coon, and expenses whmh may in any way. accrue against said City in cmmquenie of thcg ming of the penny,„ WITH f/}'�1N/-P'OI/%�"1" AP FA/NNY�' UNDFRST NOS AND WILL O\ PLY ALL 5 U ,/O`I d� Issued by: Dale Com`hyi�l oLAppl cam/C nu ctor - Dan, , Re -roofs v HAZARDOUS MATERIALS DISCLOSURE sou nth rric t l t b'n s ap r ro nrn el n rJ6 t :d .. Type of Roof-..... _.„ _ ,.. ... ., _ .,.. .. •+ - .%Jf el by the Cameo M ICad Ch pt 9.12. Jd H IM1aWS ftY •.... a ides - 'r• i C Section 25532() • 1 t r. -{ r .. 0 Yel " , f 1 _ ..All roofs shall be mspected.prior.to.. any. .roofing.ma[erial.being.installetl... ..__ ._.... `. soudiWpli t r building pequipment1a devices If a roof is installed' without first obtaining an inspection', I agree to remove mn J- irnt to efined by theBy AcaA- QaTtyM%gement n trot all new materials for inspection. Applicant understands and -will, comply with - oY all non -point source regulations:'_ "t tl hiic read he rhaiSNous'matenals requirements under Chapter 6.95 of the California I lealth & Safety Code, Sections 35505,15533 and 25534: b understand that _- ----- no i y if the building does not curreml have o tenant. that it is my ms -'bilis t t( rhe r arms y -'- --- - ... e oc of the on, uiremems which must be tact prior to issuance of a Cenificae of ""p' `y' -&- +ya Signature of Applicant Date ..... _ - -- _ _ All roof coverings to be Class `B" or better o, n n antherxee .gent... '• Date - ' - OFFICE