04090291.,
CITY OF CUPERTINO ' "'"'''`
DIVISION.., a�PER1VIIT s
77`' 7`�
7 n}a,}
CQN7'RACTf)R�iN'k'aQRMA�IOA\♦
•' M, ., 1 ,�.(_: -,
. BUILDING
BUILDING ADDRESS:
NICE & RIGHT CONSTRUCTION
PERMIT NO.
20 04090291
OWNER'S NAME: -..
J!04 SO
3-6a
PERMUMUEDATE
3 8
ONE: -
SANITARY OL NO.. -.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
' G ELCT PLUMB MECH
0 _
LICENSED CONRACI'OR_S DECLARATION
-
p - -"'
1 hereby affirm that 1 am licensed under pro mm^ r Chapter 9 (commencing
witl(SCctian]C(gl)af Divixmn3ofthc Business and Prpfdi5lgns Codc, and my hccavc is
- - -
in fuRjW¢ and effect. (
rClm Lfe g 1 45�
-
TEMP' POWER POLE SEP 30 2004
Dam Connmar
Dole -
ARCHITECTS Ds
... -- -
he
1 Lind ranad my plans shell he used u public s
- - -BUIL ■ ■ ■ ®I -_
R U L
Licensed Professional
OW NEm DECLARATION
�
C.CraDER
I beauty Law for me
enseAny
affirm on 11. cxcmpt from the Costume
o e: c
fallowing mason. (Section ] Business and Profcssiuoa Code: Any city or county
_
which myvires a permit to cnnsucet, Hmq impmvc. Jemolkth, or repair any xwctum
onalpe
---
pd., to its Wearee,elsu acquires the applicantarsuch permit to file aligned snrement
Ft. Floor Area
ValDatlO Itt.
that heisllConscd punu.nt to the riparian. of the Cantmctnr's License Law (Chapter 9
Sq.
....
(commencing with Section 7") of Division 3 of the Business and Professions Code) or
mat W is exempt therefrom and the basis for the alleged exemption. Any violation of
3'pt��i g111aer0 p
,
- Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penally of
.at more men five hundred dollar (g51X)).
--
-
E] 1. as owner Crude prefatory, or my employem with wages m meGmlccompensatlon,
- - - _
_
Required Inspections
will do the work, and lie sweure isnot inteMed oroRewd forsede(See 7W, Business
and Professions Cade: The Connector's License Law doe, tat apply m an owner of
property, who builds orimparwat thereon, and who doessuch workMmselformrough his
'-' •- -
awnemploycm, provided that such impromments are not intended oralfened foraak.If.
-- - _ - _---�---- ..., %-
however, me building or improvement is sold within one year ofmmpletion, the owner-
builder will have fie burden of proving that he did not build or improve for purpose of
sato.).
0 1, as awner of the property, am exclusively contracting with licensed conneww s to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's U.
cense Law does not apply to an owner of prepeey who builds or improves themes, and
who commcts for such projects with a contnctor(s) licensed punuanuC dm CanvaeaYs
License law. .��... _..._�___
01 en.mmpl under Sec. ,B&PC for this matter
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of life fallowing declarations:
- -•- - - -- -
I ham and will maintain aCcnific s of Consenuo mir-olure far Wmkera Compos-
-
sedan, m provided for by Section 3700 of the Labor Cade, for the performance of the
- •- �- - ---- --- ------ --' ---- - --- _
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Iran==, as required by Section
-
3700 of the labor Code, for the perfarmanceof me work(rwhich this permit is issued.
My worker's Com��en-aa�ti/on�lrmu�nnC. carrel and Poli aa/m:
�umober
C.
✓ CERTIFlCAT OF EXEMPTION FROM WORKERS' I
COMPENSATION INSURANCE
Connection wed notbe completed if Jud permit Is panne hundred dollars (SIO.)
or less.( .. ,._
._. e...
1 cenify that in the performance of the work for which this permit is issued, I shall sot
-
employ any porton in any manner an as to become subject to the Worker' Compensation
Laws of Caliam .. Data
-—
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
become subject re the Worker's Compensation previsions of the Labor Code, you must
forthwith comply with such provisions or this permit shall M deemed revalued.
-
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the Performance of
udc work fur which this permit Is issued (Sec. 3097, Civ. C.)
Landers Name
Lender's Address
I cenify mat 1 have read this application and stoic met the show information is
Counsel. 1 agree to comply with all city and County onfinances and ante laws relating to
building construction, and hereby suthodae representatives of this city to enter upon the
about-mcndowd property for inspection purposes.
(we) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, casts and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
_
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCER ATIONS.tA
-
w
}'Re -roofs
Type of Roof
V ,
sign r plican t/Convocmr �-- D.
HAZARDOUS MAT LS DISCLOSURE
Will the applicant., fumm buil mgoccupantsmrc or handle Weardous m.mdai
as defined by the Cupertino Municipal Code, Chapter 9.11. and the Health and Safety
ode, section 25531(a)n
Cres
-'jell roofs shall be inspected prior to any roofing material being installed.
a roof is installed without first obtaining an inspection, I agree to remove
wits the applicant or future building«aapae.m equipment arJevmes'rvm�h-If
mit WCardous air Contaminants at defined by the Bay Area Air Quietly Management
all new materials for inspection.
District]
CYet N;6o
1 have mail the infamous materiels mquinawnts under Chapmr6.95 of the Califor.
nia Hcalth&Safety Codc, Sections 255(1525533 and25534. 1 understood lheirthe building
does nal cu aM a meant. her It R my responsibility m notify me occupant of mC
_ f
myuiromene whic mastlzmet rine aissuawe.fa C.mfmateof cepmcy.
Signature of Applicant Date
O B L/
All roof coverings to be Class "B" or better
Ow
monzeaes=sal Dem
$CITY OF
CUP I ERTINC)
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
APN # 'j r^
%Address:
' / U I L
`t
Date: 3 D
Building
Owner's Name:
Z LL
Phone #:
- 3S6 --
Contractor:
l2
Phone:
" GCl'✓d
l —Ohl?
License M.
2(LfS 8
Contact:
Phone: �p
Cupertino Business License #:
L/Z-
tA-2
62
Building Perm; Info:
Elect ❑
110
Job Description:
Residentiali
Commerci 1 ❑
Cost of Project:
_ w
U0
•
R
Qty if
Annl4d mh ,,) Fee M
Fee Descrintion
=Fee Groun
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
# z7-2,
, 16. 7