01080136-BUILDING DI IN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10300 TORRE AVE
OWNER'S NAME:
CITY OF CUPERTINO
0 « z ARCHITECIENGINEER:
00
u
<a
i LICENSED CONTRACTOR'S DECLARATION
;Z4, 1 hereby aff rn has I am licensed under provisions of Chapter 9 (commencing
with Sec don 1000) of Dns inn 3 of the Business and Professions Code. and my license
in Intl force and c e `t"��'
0 w License q Lic. R _
Dae fi 13u�Ui- Comrac or�]fr(�f
U.
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
p1 kens<d Professional
OWNER -BUILDER DECLARATION
a I hereby affirm that 1 am exempt from the Contractor's License law for the
F z a following reason, (Section 1031.5. Business and Profusions Code: Any city of county
ce r a which requires a permit m construct. a111 , improve, demolish, or repot, any arucmre
6 {=.0-griprtniuis.cuanCC,alwmqulrestheapplicantfnrwChpantiuollleasi,neW sio¢m<nt
ami Le , Hrcniid nnrvinm in d6 mmwanoa of th, rommuMa I cc-, low (Chanter 9
PERMIT N0.
01080136
APPLICATION SUB DATE
08/28/2001
BLDG ELECT PLUMB
Job Description
MOVE AC CONDENSER
/1! /C
.,..3
Q k/1. L $1
Valuation
.1 that he is ckcmpr theretmm and the basis fur the alleged exemption. Any violation
of Section 1031.5 by any upplicant for a permit subj¢ts the applicant m e civil penalty
f<fnotmoreatanfsehundreddollars(S5om l 301APN1* PLUMBIN "' Occupancy Type
❑I. as owner ofthe properly. or my employees with wages as theirsnle compensation. 1 03 -
will 'do mrwork: and the-swnure is aormtemkd-o, offered for sale (Sea. IDu.- 3 O 4 - ROUGH E]BEQ'tiD'RffKd�pgctioiis"
Buk i.s and'P.NsThmm
sions Code: e Coctor's License Law does not apply to an
owner (if h his," b Intdd.mi..kedt thereon, and who atm., such work himself or 505 _ —_FINAL ELECTRICAL
ter erect h his own employees. provided Nor such vementeis sol arc not intended or _ _-
offcrtd or tale. If however, the building - mem is sold within one f _. - _ -... -_ .._ ;.. -_..._ s
- gmimanof Year 507 - FINAL PLUMBING '
completion, the owner -W l will have ,h< buMen of Arming that he did not build or
impr9we r« pnrPme dials'), 508 - FINAL MECHANICAL
- .,_._..._._,..___._,._...—
a 1, me, hendthe pmpenR am ex sines contracting with licensed, cmarosem to
License he does
(Sec. U,sm Business and Professions Chep Theoes tnreon.em"s .. .LPt. t� t. ;U
1 and wh Law does nor r. such
res en owner of property who build or improvesa to the
;. .unntrach sLiccts focsoch pralects.withvcon[renonU.licenced Pursuant. to the .. _. - ._.. .. .. .._-. ..._... _...-_. ___------ _...__....._. _.... .___.
01 moor's Liccnsc low. „
t rtr .,�...
❑lam exempt nnaci see: ., n'&Perm rtes mason
S :.• .'
c - 'WORKER'S COMPENENSATION DECLARATION
,// 1 hereby ffnm under pe by f perjury f thefollowing declarations: ;/C, • 00'r nn, a end 'ill ma r C nfcat f C xnr to self nature for W«kcr's //�
Compe o x Pro d d f by Sect 3100 f the Lobo, Cade, for rhe 3/
'pert ce f the work for which rh ,P9 it issued.
I? ]/base 'd will-triiinamW k aCompensation I. c nq rcJ by Section
3100 of be Uteri Code Lear h performance of he wirk for which this permtt,is
ssu d. My Wt, Cmrri'eUwshrai histimmob came and Policy be _-
Ceire'Poli yN
.•10ERTIFlCATION OF EXEMPTION FROM WORKERS': - -
"''�'
COMPENSATIONINSURANCE
_
. - -
' (This:ieaiah'need nor Fe cbnrplcicd if the permit is for one hundred dollars .v '•Ii'. .• ..i il,:Clb", ,,
151001 nr leen,.) _ ,
.I btufY that in the pert rm ince of the work for is:hich this Kinnit is issued. I. ' a f - [ I ,•K �.�s
hall
not co, y any jii'eson'in any manner so as to become subject res rhe Workers
Ctimpe . ion L wr of C l khat Data
Atip,amNOTICETOAPPLICANI If, 'afternakinglos Cenfcomof bxempron you should' r " 'S " t I'
becomesubject to the Worker's Compensation provisions of [he Labor Code, you must'
0 0 forthwith comply with such provisions or this permit shall a deemed avokcd.
;Z:4 'CONSTRUCTION LENDING AGENCY
1 h by itfifirat tha,,here is si commaefimnJ g eP acy for [tie performance
WInf[he work for which his perm, is issued(Scc 3 7. Civ.C)-
Q"Lbmde'rs Name a -.....-i. :r.. .....- _ _. ... .... ..
Z Lender's Address'" [.. ;'I llbi
V C) I cenifythat I havereadthis application and state that above information is
kat E.. Correct. 1 agree to compygwirh all city and county ordinances and stem laws rtlaing
V ,o Wilding c r r and hcrebya p rrycs of cry[, ter Pon
r� the bo e r d pmpenl fm pea o P s.
L two) t v dann land keepl le.s rheCty lCuFrom..goinst
VJ liab I r s. )udg���ii++''{{�e�r rM <x uses h M1 y' ny ay Fcma g Inst zaid
�.% Z City onayuyge of� r f thi
ABPyCANT U, ER A•IS MPLY WITHALL ION.PoIhT
ebonl•E REc An - r i . Issued by: C' /�h'7��1.�/GC.f Date
Cod :S a u 25532(a)
OYn '1' t0 1-I, E' '. a*
a rr Will he applicant or future building occupant me equipment or devices which
:mit hazoidou' esti conmminunts a( defined by rhe Bay Arta Air Qualify hfanag<mcm
District?
-- ❑ yet.(� o ,
I ha e� rcad(}} h\ haimdo s t 31 req ancaracm, an cr Chapter 6.95 of the
Cal ( He ITh &\Safety Ifv,fdp S f is 2550 25533 an 5534 I d .fad that
if the bold ,docs rrfff{{{kbboppll wn(•oil Yhga, to f th tit resp nsibilny m ramify the
05Ctparl
Owner or nmhonzed agent
t
q�
Re -roofs
Type of Roof„ _::_..._ --= ' — • = _— - --
_._All roofs shall.be inspected prior. to.any.roofing.material.being.installed...__ _.
If a roof is installed without first obtaining an inspection;'I(aoree'to remove
ail new materials for inspection. Applicant• understands and will,eomply,with
all non -point source regulations.
Signature of Applicant _ Date.
All roof coverings to be Class "B" or better
_.OFFICE