06020038 CITY OF CUPERTINO s+s5vax a sox r ` "I?I
BUILDING DIVISION PERMIT CONTRACTOR INFO MATION
BUILDING ADDRESS: BJ ELECTRIC INC PERMIT No'06020038
10735 PENINSULAR AV
OWNER'S NAME: PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
(408) 971-6849
ARCHITEC(ENGINEER: BUILDING PERMMNFO
BLDG ELECT PLUMB MECH
uop LICENSED CONTRACTOR'S DECLARATION
u`F� 1 hereby affirm that l am Hanscd under provisions Or Chapter 9(commencing Job Description
n�n•
with
Section
Division 3 of the Business Aral Prufeasions Code.and my license is
;'q_ mf.IIfLiceranM tie.« UPGRADE SERVICE PANEL, REPLACE RISER, FIX WIRIN
&�o Dam c9n amr IN ATTIC, ADD GROUND TO RECEPTACLES
ARCHTTECrS DECLARATION
or1 undersand my plans shall W used As public recordsor F'
'g6D K" VL�
Licensed Profcssim.l
3 Oat I am exempt
from
DECLARATION
ContrON
9 e I I maxo .firm that 1 1. exempt from IW Contractor's e:Any c Law for the
Kp O which ng mason.(Section 71131.9.Business and Pmfevsiu dcroul Cale.Any city structure roomy
$ which mquirta•permit re eon s,the aluf impmsu h Permit t m e a sig any un
Lzi
poor miss issuance,also
ntto me the Applicant rot sochpermiuo Bcruse ncdsuamcm n
< (thal he CommsliccmcJpmman70B)ofDivision3 ftheBuracmraniceneelaw(Chapmr9 Sq. F[. Floor Area Valuati 1355
(eommca exempt
Section Tandth basis Division the eavand
on.Anynvi Coot)of
that he is ezempl thcmfrom and dte Eau for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of pE NpT
not more than fire hundred dmlara(S5)U). 3 2 6 0 3 0 21er 0 0 a y Type
I,u owner of the ProWtY•ar my employees with waguuthev sole compwtion,
will do me work end Ne structure is notimended oroQemd Ratak(Sec.7W.Business
and Professions Code:The Contractors Llcers c law docs not apply in an owner of Required Inspections
property who builds or impnm merman,and whodocasuch work himself or through his
own employees,provided met such improvements arc not intended croRered for ale.IL
however,the building or improvement is sold within one year of completion,the owner.
Wilda will have the burden of proving that he did not build or improve for purpose of
ale.).
C(I,As ownef of the property,am exclusively contracting with licensed mntrannrs to
construct the project(Sec.7060,Business and Professions Cam)The Connector's Li _
cense Taw does not apply to an owner of propertywho builds or improves thereon,and
who contracts for such p v*b;with o contncmKO licensed pursuant to the Contractor's
License law.
❑lam exempt under Sebe Bk P C for this reason
aver � DECLARATION N
I�hreby
affirm under penalty of perjury one of the following dmlaammis:
❑I have and will mainuie aCenificute of Coment to self-immeforWormesCompen-
sation,As provided for by Section 3700 of the I-m r Code.for dm performance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compcnation Insurance,as mquired by Section
37W of the labor Code,for the prformanec of the work for which this permit is issued.
My Workers Comp ommm Insurance Cartier And Policy number Am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu smith aced trot hecomPkmd if the prmir u for one hundred dollars(5100)
or ksa)
1 certify Nat in the o forsou ec of me work for which this Permit is issued.I shall not
employ any person in any manner so u llesu bbeccome subject to the Workcff Compensation
Laws of Califomia Dau >-/X/ r%f+
Applicant . 1/11— 1, 4 rl
NOTICE TO APPLICANT:if,-fur making this Ccofiau of Exemption,you mould
become mbjcct In the Wmkcrb COmpentaton provision of the labor Code.yeti muss
.,O foMwith comply with such previsions of this Permit shall M deemed Invoked.
ZN CONSTRUCTION LENDING AGENCY
F+ IWmbyaffirm mat inert iso croatmctur,miningagatcy l'm the performam:e of
ce the wish for which this Permit u issued(Sec.3097,Civ.C.)
a0 Landers Name
a z Lender's Address
U Q 1 certify that 1 have mad this application and sum that the above infmmauon is
Correa 1 agree in comply with all city and county ordinances and sum laws minting to
U building construction,And hereby auharim mpmscnutiws of his city to cater upon the
F yalmvc-memioned property for impeuon puMCAma
(We)agree to ase,indemnify And kap harmless the City of Cupnino agaimt
Cn liabilities,judgmeau.CWU ndexKm whichmayinaYwaysmucagainsterid City
U,Z in consequence of the grating Of this permit. sy �+
t-w APPLICANT UNDERSTANDS AND PLY WITH ALL NON-POINT Issued by: Dale ` '- O 7 U
equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
C.11 hazardous air conuminans As defined by the Bay AMA Air Quality Management all new materials for inspection.
District? `'
❑Yin QiJu
1 have mad the Wsardous materials requir men s underChapter 6.95 of he Califor.
nix Health✓E Safety Codc,Sections 255)5,25533 And 75530.1 undco and that if the Wilding
does not Currently have A mnank that it is ttymsponsibility m cooly the occupant of the
mqv' mcntswmchtutWm m6mane, I.CcNric.an
//ccy��cy. L Signature of Applicant Date
lv
r authomad aFcm Dam All roof coverings to be Class"B"or better