01010118 CITY OF CUPERTINO
Bmi,DIN.G DrvtstoN pERMITt '' t CONTRACTOR INFORMATION:
BUILDING ADDRESS: I'ERMH NO.
.'19000 .HOMESTEAD RD' DEVCON CONSTRI.JCTI;ON -INC,o"t;,:0:;11014�i,i, 1.8„,,„m:.
OWNER'S NAME,-' 3/ APPLICA"1'IONSIIHDATEt . '
JAMCRACNF_.R 55�,,r11 OSa^COChIES Sp ;•y y - 04o/'29/E00i, :r,.
HONE: - •• , t .. SANITARY NO. ` CON9'ROL NO,
_ t. �.,4:408�,A,94c-;F1200+'fid
• OseZ ARCHI'FECTMNCINC;ER: - BUILIIINCIPERMITINFO ,
HI.DO ELECT PLUMBMCCH
¢n
'I,ICF.hat l a COM'RACTOR'S UliC1.ARA]'ION
,z 5 y ' 1 nei26 rain 1nm I am Iianaed under rens ir mm,anlencln � Job Description
pZ—o r' P. :o per: 6
P,mF-u wthS , ]OW) fU 3of the8 dP tssom CWe unJ myr nm - .. -
ad�a< s ruclaxaI I «�qg� xTENRNS IMP,ROVEMEIVT
3 O y
Data—�+_1tI ;W' s Contract.
r ('�.�Lf•��
F 6 v` ARCIInCe use DECLARATIOpr
I } � � 1 d .,and my plans hall b•us J pail' records
,
660 Licensed professional .. � (// .
OWNER BUILDER DECLARATION
ce 1 hereby affirm,'hot I an,axtrain horn the C m , Licalow Law for the
?x a fallow n6 nuam,(Sectin 70l 5,Hinene,,and Prefusi ns Coda Any city,or county O/
which requires a permit m embalmer,no improve,demolish,or repair any structure r ,
n3sca
e prior hoits issuance,also requires the applicant for such pemmiuo file a signed statement
that he is licensed Pursuant tothe provtserns mlthe CoommmtsLicense Law(Chapho Sq. Ft. Floor Area 'Valuation
wommencing with Seeion700(8of Division 3 ofthe BusinessandP r..cions coda)
or that he' ..exempt therefrom and the b for the allege)exeniption Any violation on .. - _..fig 5339^e50.,
of Section 7031.5 by any applicant for o pwmb subjects the applicant o a civil penalty -
'of no,mnorathan live Imumcddollars($50():' • APN'Number - Occupancy Type
(
ElL m awnerofthe pmiscole,my employers wish wages as their sole compenmtion, y' 437 LAO 1 d
will do the work,and the s artme is not intended or offered for wle,(Sce.7144, -
Business and professions Cale:'rhe Contractor's License Law does not apply to an Required Inspections ,
ri pany Whob Id. p :tie s n d 1h1 h k himself
.,marr through h':own employee- p dedthat...himprovements ma ran intended or - 1.011.,,'--•,F;OUNDAT4I4ONLt,,
offered for side If h wevcr,he beaIding or improvement is sold with n one year of ra '
completion,the owncomilder will have the burden of proving that he did no,build or - 102 — P'IERS.."r` '
improve for purpose of sale.). -
1t.103:..,-t LIFERS
01,as owner of the progeny,am exclusively contracting with licensed contractors to „104 — .REBAP, -
onstruct Me protect(Sec.7DW,Bminesa and Professions de
Co :)Tho Contractor's @a..
a License Law Boas not apply to an owner of property who builds or improves themenh' "105 ; ANCHOR=BOLTS- ,
and who contracts for such projects with a comricron,)licensed personal m the - a ii ,. '
Court License Law, 1,!]�0.tF — ,GEl11F_R' & WRTF_R
711 am exempt under Sec. B&P C for this reason - '"o` '" - -
Owner Date UNDF_RFLOOR PLUMBING`,.
WORKER'S COMPENSATION DECLARATION ; •103. UNDEP,F'LpOR„ MECHANICAL
I hereby affirm under penalty ofperjury one ofthc fallowing dedumtions: a
1 204•..-: I,IhIDERFI_OORi:F:RAME-•.
• ❑ 1 have and will mainmiv a Certificate of Consent to self-insure for Worker's - e 'r
Compensation, as provided for by Section 3]0.1 of the Labor Code, for the 205,' -' UNDERFLOOR INSULATTONrlo:.,
facdm
ownceof the work far which his permit is issued. - .-3G•1v-.r'ROWGH; PLUMBINGth
01 have and will maintain worker s compensation Insurance,as required by section 30 TUB R OR SHOWER _
37W or the Labor Cale,for,he performance of the work for which this permit is - "'• .
- iso TryWoaersCompensatonlesa,anef arrierunit Policy mother a,,: „303' -;t•'R0004-MECHANJCAL',
C .is+ �utg hRyl m.:3S 3�'�1-A .,?04h• —' ROUGH ELECTRICAL n:_. ..
CF.RTIFICATIONOFFXFM"IONf WORKF,RS'
tom'- COMPENSATION INSURANCE.
Chis section need no,be completed if the permit is fornoc hundred dollars ,3,06.'ri :HOLDgWNS x,j
' ISI W)or less) , -
»307. :— zT.',IV$ULAT'.LpN;
I c airplay
in the performance of the work for which Nis pemit a issued.1 -
shutCom em employ any person,n any manner ser as m Income ganlect m the Workers' 008 - SHF_FTRf1CK 1
Compensation on Laws of California,Uare ,
Applicant ,-r09�'—' E-xTER:S(lR -LATH. t
N0110ETO APo the Worker's
Compensstar ationng this Certificate orExemption,Labor
de,you 1:U �INTERIOR..LATH:''• '
Q 0 become subject to the N'corker's Cnmpensmion provisions of the Labor Code,you must s:,
form,Pit comply with such provisions or this permit shall be deemed revoked. SC �• inn
^ rA CONSTRUCTION LfiNU1NG AGENCY """1'.LR*—l'' `?t.GRAITGMr1..VMTa, 1
1 hereby affirm that them a construction lending agency For the perlcarnmec 3lo ROOF* NAIL'' '
of, work far which his t,s issued(sec 3119].Civ C.)
0. p he Lender's Name ° 501.,-' FINAlz ELECT RrICAL-sENERGY,-'
Lender's Address
.VZ 502 FINAL PLUMBING;ENERGY..
O Icenfythat Ihave mait his application outside tha,the abrveinformation .
(Oi.Fv _ FINAL--
E-HANTCAL�,ENERGY-
o t 1 6 t comply with all city dcounty ordinances d state I relating Y03. -
tabaldg t t dhereby authrepresentatives fth ityt trnpon 504 —,FINAL' BUILDING ENERGY
Me ho e m rah ed p pony f inspection n purpo j Y
t}„ - (We)agree t .a indemnify andkehcane..the City rCpcn svSDS,' —='FINRI
(Aliabilitiesj agree : cast,and pe which may in way ro ir e aid •'FLFCTRICAL •�'L ��(�f/
...
U z Cityan consequence of he gron i.ng nn pemr't 506 r GAS_ TF_ST ., '
^ APPLI NT hN . SAN DS AND WILL C MPLY WITH ALL NON-POINT
U f R: Issued by: _Date
... ... .
.
atren'Appdi...UConrazo Re-roofs 508 — FTNAL : MECHANICAL4 '
HAZARDOUS MATERIALS DISCLOSURE
Will tha aupficam or future building naarymslom orhandle M1 aha .mat al Typeof Roof 509 'FINALa;GRADE
de fined by the C penmo Municipal Code.Chapter 9 12: d he Health bad Safe,,
..
Code Section 2553200° :' 5710; 'x.! I,NAtc�SF•+LANN'LMG'—r, ' -
11 Woo Eiued All'roofs shall he�q�p Gte gr �o�n fi ,%WSRNg eing installed.
Wilt theppl cant or future budding ncapaat use equipment r m ices which 'l� iT”- �-bb ``}}
emit hazardous air contaminants as defined by the Bay Area Air Quality Management If a roof is insta ed without Ifs[o tauung an inspection, agree to remove
Diane+ all new materials for inspection. Applicant understands and will comply with
oYe` •B'C�m, '.'all non-point source regulations. '
I have read the hazardous materials requirements under Chapter 6.95 of the
California
Heal Cale,Scnions 25505,25537 and 25534.1 understand that
ifthe buildin not cumnt halon tewne that it is my responsibility mno,ify,hc i -
occ path of he y.am ems inch nus be met prior to issuance of a Certificate of n
°�0r Signature of Applicant Date
,�{� �� / '�- All.roof coverings to be Class "B•'or better
ram t red a6an, .f>am g
' -
OFFICE•