01090101 CITY OF CUPERTINO l
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION-
BUILDING ADDRESS: PERMIT NO.
. 19750 AUBURN DR ANDERSON DONALD LEE TRU 01090101
OWNER'S NAME: APPLICATION ST4B DATE
ANDERSON DONALD LEE TRUST 09/24/2001
PHONE: - SANITARY NO. CONTROL NO.
1
O z Z ARCHITECT/ENGINEER - BUILD PERMIT INFO
ty0j ELE PLUMB MECH
a i -_I If
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h
S w Z LICENSED CONTRACTOR'S DECLARATION
I Z affirm 1 hereby arm Nm I am licensed under provisions of Chapter 9nunencing .104 Description
in l- with Sectiun]f1B0J°f Division3of the Business end Profehsi°m Code.and mylicense P.V. SYSTEM, -
ie 0 is inmdfo«e and effect. MOUNTED PHOTO VOLTAIG.
c i a License Class Lic.N
:O
Dam Comacmr
i 3 n vim. ARCHITECT'S DECLARATION
.u O g 1 unJeniund my plans shall he used as public records '
E:
' 2
i 6 pd. Licensed Professional
P<Om-•
I,ceh'cd pars tOWNER-BUILDER
f tDECLARATION
w_ 1 herebyoff that I am exempt from rho Cs
LiLicense
icense wa(wChfauprs the
following reason ]03L5,Bsinessantl Profe.i..s Care:Any city or county
which permit t , alter improve,demolish,or repairany structure
pntt is al.termites dickipplician for alich Pamdat Rleaegnm sat met
i
e1 _
_
...
G } Sq Ft1F100r AValuation
ah Section D' t of the Business ene� fesons cod?
so
-of Section i :
of not mom then five hunaap«palicantforapemdt subjens rhe app,icantmacivil'penalry'
sonars lasobl. APN Number Occupancy Type
_❑I,as owner of Ne property,or my employees with wages ss their sole compensation, 304 ELECTRIL
ROU H AL
-
wdrdo m5 wane wand s o e:Th Contraor'sintended or °Bean for sad,not ap e:;M 5 01 - FINAL ERE PTRMG*,hcti@NERGY'x r:
Business and Professions vara The is our License Law docs not apply t°an
ow
erofpropertywhoWildsmimpmves.hereon,anawhodoessuchworkhimself 505 - FINAL ELECTRICAL
orthrough w employees.provided that h improvements not immaded or
'offered f r sal If,h tfi b Id' g p i Id th n rte yea in rl IF
improve'.
completion,the der ill 1 the bu den fpr B that he did not Wild o
imPro efo .eof ale) - y
c propcnY exclusively contracting with licensed contractors t
1"l.)
extract the p j t(S 7044 Basin., d P n, one Cod )Th C t
nw
License Law does not pt n owner property who builds or p thereon. '
..;L, -.end.who convects for
uc Rp jeers w th 0 a.con0an°r(c)licensedd pursuarsuam to the
' Cantroctol L Lela ���P'aL R��Q ' , ')it
_ ❑1 niinder B&PCfor this reason
tial%11 _._' 0' .
w -WOR C MP- SATIONDCCLARATION DEC O 2001
Ihereby offind und,c.r pe Ity of pepuryo eof the,following dechandions
• O I have and will matron a Ckficate of Conieoi'm self nsure for Workers
Ciummomenumn,-irsnovided for by Sonam Son37M of the Labor Code for the BUILDING
'performance of the work far which`dlis permit is
Ell b eaiidwil4'm5 ntnWorker's Compo sat ,rviranc asrequiredtiY Section
,,. 3700 of th<Lat ur C de for the pert ima f N k for which his pe t s
r.issued MyW rk Compensation In.0 n it d Policy mb r arc it
C0 No '•, .::. t ; . ... tax"
'N't,?CERTIFICATION.OF EXEMPTION FROM.WORKERS y 14'14 1, g '+,
b.._
�. (This sect on need no0i be EomP'ClmNf Ne pe�NCEfor one hundred:t: ..-_. ....,.... .,..,,._ .... ......._ _ ..___.... _...
s ub : dollars- -`,'.' h, ,.'l:•: ru,-.,.,
,
I
i i cent y than in the perfo e" f the rk for wh h N permit ip orkers I t ._
,..n. ,tib ...,
shall am Cmploy nny,pe y man c bkom len idthe Worke
Ca penmw Lewd of Calf 'Dare' -
-'App, ant -- - "
e NOTICE TOAPPLICANT B
afler
N
C' of
pton _. o
zsie s bl v he W rker Comionsanon rnsi.., th.LatiNCmie,youmas,
Q forth th ply nth h Provisions or shall e d< km.
"CONSTRUCTION LGN
;°, TCY
h h co sn herring agency f rrhe perfohnnceIherey af0 m that c
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._.--. .... ._ _... ..... _ ._........_.
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r �vbrk'f( h ch tM permu ed(g 3W7 Cry C
W 'Lender Name: u . . -.,. ;. u i ..:..I . . . .._.. ...-_ . .. . _. .. . _. ... - 1 _
LenJesAdde S .. .. ,d,:.._. ..
;
tT'[ c.mo t 1 D agree
to
comply,with
«ad all c
lfcity and t county
andysNm¢inachnacresthand
bsocvaem ilawsrelating
Erbraiding conswntdn:antl hereby'authorize
repoesematives of this city to corecupon
s
the abwe-mardionedp penYf ly and rip hart
(We)ogre m sol a nJe Ify and keep hw Ie s the City ofCaperion,against C
Fir V1 liab I 3 dgments,c v d expenses ses h h may m any ay amrve again t said,
U z Ci neo sequence df the gr n g f th pp ran : /�
TANDS ANp,NILL COMPLY WITH ALL NON-POINT `� Issued by: Date
1)0 -01-
ac to ofAPPI can n cc r� 'v ':"' ce"' Re-rOOfS
a ❑Yes eCanadian
an mmfeN' Type Of ROOT':
US MATERIALS DISCLOSURE
me Serio 25532( 7 6 Idin6 occPm t h dl hemtd s ,._�.. ._. ...�_.
I' y pe A n c pal Code Chapter 9 12 e d th Health and Snfety d
Will thea Icato ft _
s defined b the Cu nm Mu
T v �t t4 :tJ r'} t"t : a`t, t : 1t- 9�ry fh o' ri wy# hs-�j t. I
'gym t n doacm�contamtnamk a�derneab to ea 9-e :1, I t Management All roofs shall.be inspected.prior-to any roofing material being installed.
� t i + '
s _.
{ Will the app,cant r Tut r b Id g p t use ies p t dMana which If a roof is installed'without first obtaining an'mspection;I!agree:4o remove
District, y y t8 all new materials for inspection _Applicant Understands and will comply with _
❑Ys " - '
1' °N all ion-poor[source iegUlanonsr
, g quo
fthe d n des notcurrently ch ave a tenant,
helm t norms undo Chat .not of Ne
Iha o&Safer Code.SWorts2550525533 end 255341vnderstand that
t e azallo materials regoveme
Calf m N trh
is mY responuM1 I ty t notify the
'-
g All roof coverings to be Cla 2
- _..
« tP i oan P Centficete df
Signature of Applicant Date
!Gane q authonxede cSS B OI;liatter
r -, .OFFICE .. ... ... ............. . ... ... _.
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