01070002 CITY OF CUPERTINO - -
BUn.oINIG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10220 DUBON AV MCS CONSTRUCTION SYSTEMS 01070002
OWNER'S NAME: APPLICATION SUB DATE
hk WRIGHT HOWARD E AND BETTY J 5177 PHARLAP AVE 07/02/2001
HONE: SANITARY NO. CONTROL NO.
(408) 225-5151
u�i O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
GU BL ELECT PL MB MECN
yad L IJ f_ CI
z in_ LICENSED CONTRACTOR'S DECLARATION JOb De$Cllpn n
O Z=n I hereby affirm that I am licensed under Provisions of Chapter 9(commencing
Job with Seennn7oowofDnismn3ofine Bmine:nanaProfessor,Crde,andmylicense ADD GAS & ELECT LINE.
a is in full forte and effect. J .�
z a License Class__. __ Lic.# Cly/
w 3 u.y Dare den c or
ARCHI C'T 9 DECLARATION
FyLL O f understand my PARCH, be used as public Taco
WN
icc O C Licensed Professional
x to R'pEC ATI N
W I hereby affirm that 1 am exempr from the Comracmr's License Law for the
L�Z< following reawn.(Section 7031.5.Business and Professions Code:Any city or county
3 C which y p n 5 t f p d I F p y noir,re
Sm P I t "I 9 M1 'lll tl II "II II .. I lam u, _
.... .. _. OO . ....
thatl PI Roots] It d p'e til C t"t - L L (Cut ") Valuatlnn
Ice t rg -," t ]roan the r 3 the aPii.An �oae) '..{ ".:j;345�'1F'(
or Nat he is 31.5 b tang apnm and the buss for the cts thll'exempt on.Any violation -
or
Section 103 LS by any applicant for a rami[subjec¢the applicant m a civil Penalty
or not mare than r hundred dollars Poon), 10 6"pN'�irR & WATER " Occupancy Type
°h as owner of the properry,or my employees with wages as their sole compensation, _
"'w
ill'do the work,and the structure,is not intended or ofiered for sale(Sec.]044,
'Business and Professions Code:The Contractor's License Law does not apply to an 301 — ROUGH PjVKjtrj4jMspections' i "
Owner of pmpeny Who builds prov thereon,and who does such work himself
or through his awn employees,pddtht suchimprovements ant intended pr 302 — TUB & OR SHOWER;-, -
Offered far bele.If,lo ee fn biding -'p emet Id with sine;a., _' —' -'—- '- - - -" '"" . _ ,_ ..._ .. .. ._._ ._....
completion the owner lou lder will have theburden(b that he did not build or 502 - FINAL PLUMBING ENERGY
improve for Proving
patmne aroma.). 506 - GAS TE_ ST
❑1 m -serpa"N p pen' .. . .hal
awrycontracting ml'"nseJ "ontrau tut 507.-.— . FINAL - PLUMBING .
rttstms the prolem(5 .]044,7sine and Professions Code)The Cod "for"
License Law dcea not apply to an owner of property wh.huiltls or improves[hereon,
and who commas fo .uch.P oleos wit,a.coatmc...l, bceased pursuam ro the ------
to . ..... ._ _. ....._.. .... ...�. ._....... .... ...
Contractor s Lie,
cense Law ,"
❑1exemptunder S<c ',B&PG for this rca,On
sonar
WORKER S COMPENSATION DECLARATION FI IV A L E D
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will"m t " Canificate OfCameras to self-,nsure for M'arker's JUL 0 6 2001
-
Compensation. as provided for by Set 00 37of the Labor Code, for the
— - Pertannhnce of the work for which this permit is iswetl;.
El I have and 11 willnars Wth l .tCompensation 1 "c rwhici this
permit
BUILDING .
3]W of the L b i Code,for the pert rmnn<of the k for which[hie permit i.r
issued.My Worker's Compensation Insumrce carter and Palmy numtwr are:
Cartel. I, .,r - ' pulayN .. ` Is r .
CERTIFICgT10N OF EXEXE MPTION FROM WORKERS`s , )` -
„ COMPENSATION INSURANCE'
(Thi.s.,action need not be rnmpleted if the perms is future hundred dollars -
(SIp0)orlessJ '
r 1 11 rtflht' th ac In ark f° hhm. pthe helw dl 1• -_-
shall t employ any p nn any' to become subject m t WorkecK ' '�•t�' "
Compen n
t Lawa of Calddmm.Damp
Applicant :'.'.1 .. .. .
g p me of Exe pt e,you oa,,
OQ forthm�ubn PYwt�W hpvinort h Cen shall
of the Labor Code you must `
I LI
be ] the P P
h such _.. revoked.
... _. . .. .. .. .. _.-. .... .. . . ._.r _....... .. . _.....
.. .... ..-.
sort nt5 a e ted
CONSTRUCTION LENDINGAGENCY
�. firm thatM1 a rums dog ape Yf thererf'tmance 1
W Lenders Narre.Add ss p te t s sdefl(See 9
3 11] Civ.C 1
ftIhbyh okf which this r
;1� 1 nifY that lh read this application and state that Ile ab information is
(.n conecr.:Fagme a comply with 11b.crawand com,lablinamealand late laws reh[ing
Q-V m building conswctionaadhe'reb,anum i,a reprepe" uses of this citym enter upon
W the b_ me f sedpnrc ty far_ recti p rp:es
� d (W�. g t .a indemnify Ik pha 1 she Cty ofC p toabvinst
'rn liab t p rime ns.,c is and done nms h h y t any say ¢int said
Cr n y of th 'rannin,oflhis Pej
'1 ICANT UNDERSTANDS AND MPI Y l4IT ALL Nb P01 T'
oURCE REGULATIONS - Issued by: Date
riga t f kPoli ort et Re-roofs
rre�H-�A��Z,B,RDO R ALS DISCLOSURE
y.y: t future n la" g caP t ,are or handle hemadaim,dencrial, ..Type of Roof - . _ ....
as d fed 25 CuPen Municipal Cud Chapter 9.12.anJ II Health and Safety
c3a nil s t zs53x) a,f�' If a roof Is all.beed inspected
first obtaining-t
°Y _.All roofs shall.be ms acted poor to any roofing material being installed_
-
t. ll the applicant future bu ld ng oc t are eynip nein devices which '
mit h rd a nm m t t rca A Q l ty M'I age nem
dining an inspection, I agree to remove
A def
yt aYA
all new materials for inspection Applicant understands and will comply with _
°Ye °N t all non point source regulations: --
1 h ad th"hum d 'noted.l Tey re ncnts and Ch pt r 6.95.df the
Cali
forn n Health&Safety Code.Sect ons 25505,25533 and 25514.1 understandmat `
if theb ilding dues not r,h ate, t that 's Y sp n.ihlty ad notify the
occupy t of me reyuucme t wh ch muse be met prima, Ormse.f.Centirealcof
r
: Occ pancY I ..
Signature of Applicant _ _ --_. ., Date
^= rnoar.=dagain,' " Date Al]roof coverings to be Class "B" o2lietter'; '
OFFICE.— -- .--. .. . ... . �. _.. .. _.. .._ . - �