02030023 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT 'CONTRACTORINFORMATION '
BUILDING ADDRESS: PERMIT NO.
10619 LA RODA DR 02030023
OWNER'S NAME: APPLICATION SUB DATE
DON PHILLIOS 03/06/2002
PHONE: SANITARY NO. CONTROL NO.
O'C O ARCHITECT/ENGINEER: BUU.DING PERMIT INFO
e: F BLDG ELECT PLUMB MECH
a a II
„2 LICENSED CONTRACTOR'S DECLARATION that 1 am licensed under provisions f Chapter 9(com
1 heJob Description
i z x reby fB
vmo omencing
with Section]U00 of DivisinnJof the Buainessand Professions Codc.andra license
,:t5 UPGRADE ELECT SERVICE TO 200A.
u f Lien roe fQry� nae saint n J
p Licenx Cal'uYr v �T O
juo"i Comtiavnooff
ARCHITECTS DEC'LGRAmool
,aj [understand my plans shall be used as public remNs -"
I
,0 Licensed Profes,wriel
so OWNER-BUILDER DECLARATION
I lorchy ufrmt iLt I am exempt fru.the Commeom's License Law for the
F?< following reason.(Section 7131.5,Business and Professions Code:Any city or county
F O
ban require, .,it In c wart,alcor,improve,dmnoLsh nr repv r any aricime $1000
�3$ ..
Poor 1.its wimme.also mcaimstl spplcam for such Permit m File vsignedaatermal ._ ._..-
thathir 111cenxal m eon the provisions mme Contractor I License Law(Chpur9
Bmanwiwing will,Section AIf0)ofDiviimn Sof the Butes paid Proessons Code) _
Valuation
Or that he is exempt darmhO.'and be buns for the alleged euempuom.Any vmlalmin
of Section 9031:5 by any applicant for a Permit subjects the applicant to a civil penalty
:ofnotmtorethan rivehundred anuar,($5no). 10#1FIN Occupancy Type
pe
°1,as Owner of the progeny,or my employees with wages as their sole compensation,
.111 do the work.and the structure is not-intended or'onered'for sale(Set:TiNfa. 14 L rte,
Business nnd'Pofessims Code:The Contractor's License Law does not apply to an 505 - FINAL E$ lewgtlons
owner of progeny Who builds or improves thereon,and who data such work himxlf
or throu h his ms n employees.provided that such improvements um not intended or
dggred ur the IL however,the l have t r ithprov f Ow is-sold withinone year or
improve on,blit mwncn salt.).IAvr will have the hoNen n(proving that h did no,build or "a
improve for purpou o(saleJ.
_ ..as Owner
the
property. 4.c Business
and
Professions
Cairo:)Thertorsmgree sli
Liec ma the project(Sec.]844,Business and Professionsilds or The Contractor's
and wh Law loos not apply to 0j owner o(propeny who builds or thereon, - -'
_and who.rommcts 6r such pmjccts.with e.commnorts)IicenxJ.pursuavLm she _-_..._.__.__._.
Contmnoc License Law.
❑ , ._�• ,t ',
I am exmpt antler Sec.' ,B&P C fonhiz reason
- - Ownei'-, " We
WORKER'S COMPENSATION DECLARATION
I herthy at0im nd Pe by o!pe 3u7 f the following deductions:
° 1 have ad w ll Amo itn itCerary m of Cont to Fins. for Or
J
Compensation, as provided Ira by Section 3700 of the shoe Coda, f1th J
t perfo n f the work forwhich this permit s issued Y
12I have and w II mai Wmk a l open.alto Insuronm s eq irtd by,section
37W
3)00 of the Libor Cod•for the perfonnoncc U the work f'r wh ch'this pet is
issued My W ker C mp mist n Insurance c d PN y n mbcr ere
trm
v �/1�� J p,l yN
CERTIFICATION OF EXEMPT PRO WQR RS
-, ION INSURANCE
.I .. ..._ ..___ . ...
All 1 r CO MI LN$AT
(SI00) rless)
�ncen f cth T the trfurinonca of the ork for whmh IAi perm b �... �_�-. - .-.. _•_'Y. ••• •• - ..,-.
i n as a I
Cmb e ply any person n any manna m a i become 63ttb m bh Workers + -
Com n n laws of Celimam..Dom'
APP( ant. - - -
NOTICE TO APPLICANT If aB r making this Cenfcat fExcmpM1oo you should )� 1 (• .,
become subject the Norke' Compania npr mm
ssofthe Labor Code,you most
00 forthwith comply'with such previsions orbits permit shall he decimal mvoked
z ... . . . - _. _ -_.. .. _. _.
E N ? ° t "CONSTRUCTION LENDING AGENCY - I"
1 h rtby aRmi that then o do t non lend' g agency for the pert Trounce
W ofbh wrkftrwh¢h tN permu isi.ued 15309] Civ C) -`
Lender a Na <. .._. ... ..... . . .. .... .......0 i _
a.jZ Lender's Adtlrtss •. :. .... .. ... ._ _._ ._._..__ ._.... .. . . _. ..
V"� I certify thvJ live sed this vpplicabion and state that the above in(arm.,am is
tsf:F cored.1 ngrce m romply with all city and county,ordinances.vnd state laws relating
Q �J bo building mnstruciidn,ens hereby duthorize mpresentetives afihis"cirymeater upon
r ky the abovemcntinncJ pmpcnY for inspersion purfmsea. _I, .,_ _
�y Z; IWe)'ugrcemsave.indemnl(y and keep harmless the Ciiy of Capenino against
Fr h livbll t ) dg ems c zt a epensss h ch m y m any ey, against id
V Z City q Ince of th g tog mf this emu ' '
Of
A PLIGANT UNDER6TRNDf.rt4tJWl COMPLY N'ITH RLL NONP1
Issued by: Date
-Noambiaco�mumwwr. t
'I
URE
1Re-roofs
HAZARDOUS MATERIALS DISCLOS
brmCuprn Municipal cod Chapter 9.12.and the Health ma Safety
llthee cam l reeddng oc upantst romh dle bL16 mnn`pe of R
oof .. ...
> ..
a:a rmil
Cade Seco5A2(v .. .. -. ._ _ . .. .
°Y "°) '+ " All roofs.shall,be.inspected.prior-to.any roofing material beinginstalled _-
,
. Will theapplicant o futurebuilding Occupant use equipment devices which If a roof is installed without first obtainin an ins ectidn'r Ila ree!to remove
emit Imam us if,Confirmation,v dfiled by the Bay Am.Air Qu]IItY Management g P g
Dista? Ya. r [IN. _ .r. all new materials for inspection., Applicant understands and will comply.with
al] non--point source'regulations
I have mad•the himaims a menials req irements unde dap¢r 6.95'of the
California Health&Safety Cade:Sections 25505,25533 and 25534 1understand that
'ifthebulking does molcurrently h tenant s Bout y responabl'tybd -1 i( the
oc2up t of th recuirtmen b mush be met pd r to ins a e f e C. f¢ a of
oancy 2 aJ, Signature of Applicant Date
:
6x/pa l ag t On All roof coverings to be Class B or better
OFFICE'