01020033 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRAiSS: P12RMIT NO.
10123 N WOLFE RD 01020033
OWNER'S NAME: APPLICA11ON S(IH DA]'E
WESTLAND PROPERTIES N 02/07/2001
f. PHONE: SANITARY NO. CON'I'ROLNO.
ajQ 00 ARCHITECT'7ENGINFER: IIUI )ING PERMIT INFO
— - BI,UG Lli PLUMB MECH
: J C1 '—I
SNC LI n thin I a CGN'nRAenOMS DEC 01 Ch fa lob DCSCI'IpI0I1
O 0 1 hereby aBirm thin i n 3 of he R under p and
Poon,yon,C Cale.
(ronnnencing
�vJCw IhScctiun]IHllp nl Uivivinn3nl the llu,inaa unJ Prulcsviud.a Code.and mylicenec
='e y, nm full fume and ell TEMP POWER FOR TODRI
cenClue
03a.a m Lix„tea. _y �Or( � Cmm.e'A PINALED
ARCh ll beuse UECLARA'1 l
1 unJennnJ my plan,shall h used as public record.
wcep
e O LiccnxW I'mfessi.nal
OWNER-BUILDER UECLARA'1'1ON MAY 1 0 2001
I helcby at)! IIna I and csempl fir the C.nnacun's Licence I.aw for the
bilowing mann.(Seetinn 7031.5.Business and Profa>inn,Cod,Any city or county
G which reclaims a pm
etit do ia
consumer,alter. yw
me,demolish.or repair any urhaure
ad prlirtI,ill mtcacc.al,..rvynire,me applle.nd lod'.,urh pennid du lil�aeignnl ntmunwntBUILIN
a. mal M is licenced pursuant to the pmv brans of the CnmrutoG License"w(Chapter 9Sy. Ft. Floor Area - a n
(commencing wid,seermn 700x)of Division 3 of the Basins%and Pmressitav,Code) $1
of than he is exemptti
thehnm:cul the h:ail In the nllcgcd ex,mpd..n.Air,viol ni..r
of Section 7031.5 by any applicant for a pemait subjects the upphcanl Ina civil penalty
of not nmre than live hundred dollar.($s(s). APN Number Occupancy Type
01.as owner of the prnperty,or nay employee,with wages a,their.nlc cnnp.uadoa, 31620063. 00
will do the work,and the wtucmre is not intended or offumd for sale(See.7(44.
B.,ine r nod pmfe,c Cale:'rhe Conaaenr.Lice-,1.aw h,,act a,1, ,,in, Required Inspections
r of pro,sen,who build,o,nnpmve,mere..,and xroa does such work hitawlI
throngh his own employees,provided that such h6 n,cocmm� are in103 — UFE Rt intended nr
offered Iia sale 11 however,the building or nnpr.vement is cold Within one Year.f 304 — ROUGH ELECTRICAL
completion,the owner-builder rill have the burden of proving that he did nor build of
nnpm a lir puryax.m sale.).
01,us oxncr of the propect nor exclaively conrmcting with licensed contmcwn to
cwntruct the project(Sec.7614,Busioc,s and Pro(es.suco Cod1c)'Ihe Conlrac is
L'ae+sc law does nm apply to;in owner(it property who builds or improrcs diction,
and who contracts for such projects with a contractors)licensed personal to the
Cutnram ce,Liccanc Law.
❑1 an+exempl under Sec. , ,If A P C lin Ihi,fca.n
Owner Mite
WORKER'S C'OMPRNSAI]ON DECLARA'I']ON
I III uRirm under panully or perjury one(It he(ull.wiag decWrmioro
• ❑ 1 hada and will maintain a Certificate of Consent to self-insum for Worker's
Contpca:lion, it, provided for by Section 3700 of the Labor Cade. lot the
pnonaenace of the work far which this permit is issued.
01 have and will 'Franca Winker',Cmnpencwion b suara,;is ac,ared by Scot r
3700.f the IaMn Cole,for life peritanamae of the work lir which this liermil is
J.My Worker's Cuawwroation Insurance carrier
and Policy
Cxrriee � _.Tolley No.:
Rl1i)1@h*)`N OF I XLM17TON FROM WORKERS'
COM I+ENSA'I ION INSURANCE
(Ihis.anion need not be completed if the permit is for one hundred dollars
($10)or lessd
I,citify that in the paRnrmanct,u(the work tar which Ilii,permit in iswul.1
,hall nil employ any,03.x03:n city dna ar,cit as iI,hcamm r.hjc,l m the Wodsav'
Compensation lax)of Califomia.Dam
Applicant
NOTICE TOAPPLICANT:IL cell,,..nuking this Crnitivac or E,cnd)If t.you shoe lJ
hcome subject to the Workcls Compensation pmrvisions of the"NCalc,you nmst
Q O fnnhwim country with.lah providons nr this permit xhall be deenmd revoked.
z
` V] CONSTRUCTION LENDINGcactiAGENCY
C ' hereby which that there ss nmed(S,en Ic9Jing agency for the farhsamanec .
a7 Mme work rnr which Ihis permit is smnl ISm.3097.Clv.C.)
Q Lcndcr'a Nam.
5
z henJcr'.,AJJms'x
V Q 1 ccnify that I have read this application and state that the atone information is ,
s l y cored.I agree to cmnply with CII city and county ordinances and sone laws relating
Q 1-) In holding construction,and bcreby talhorim rcpresenmtivo.f i,city In cnlcr uimn
} Dd the aMwe mentioned property for inspection purposes.
lay cay (Wc).Srcc orv0se.indemnity and keep hannlean dhy ,ly of Cupertino ag:.irva
V1 liabilities.judgdnents,cost,and s,wI wirdth may in way aecme again,d said
V zcirri onsaae.ee I,( csontf s
ng onit, �7JJ
S nCERRGULAIIONSNUS .1.CO 'W"DnLI},NONnPo�r -Issued by: / Date
it 'ignauvu of Appli,,r,1 d eel /('y// h:ufc Re-roofs
I IA'LyRIy U, ltA ALS DISCIASURIi
Will flat.,Iie:na Mumrc building txcup,m store or handle haa,Nnm anterial Type o' of
as dermd by Ihn Cu,niao Manicq.d Gale,Clu 9.12.cad me Hcahh;aid Sdnal,
Code Section 25532(a)l
ores 0N All roofs shall be inspected prior to any roofing material being installed.
Will mcappnca.I or future huildnag overlent use eyuipmcrrr,of devices which If a roof is installed without first obtaining an inspection, I agree to remove
emir Mrardnu,air ounariner,as defined by he If.,Arca Air QualipMaret,t cut
UI,lEclr all new materials for inspection. Applicant understands and will comply with
Ores ONo all non-point source regulations.
I hove read the h:vnnlnus dnmcnalsqun/34.
Clu+phr 6.95 sal me
California Health k Safety Code.Sections 5115, 1 unJercmnJ mal
ne.I ly ha tam,ahan<ihilifymmtifythe
c pmt of the rrynircnacnts w d IDI le 0 a Ccnificwe of
it'urnaney. Signature of Applicant Dale
Oxner.r aninoae<d age - 'Date All roof coverings to be Class "B" or better
OFFICE