01100030 CITY mESSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20833 STEVENS CREEK BLVD CRAIG ELECTRIC INC 01100030
OWNER'S NAME: APPLICATION SUB DATE
POWER TV 3070 SCOTT BLV 10/04/2001
PHONE: (408) 327-0550 SANITARY NO. CONTROL NO.
C G oz ARCHITECT/ENGINEER: BUIL-DING PERMIT INFO
w t{- BLDG ELECT PLUMB MF.CH
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LICENSED CONTRACTOR'S DECLARATION
'S✓=N+ 1 hereby ffirm In.,I am licensed undo f Chapter 9(commencingJob Description
with section]non)of Division 3oftheBusiness andProfessionsCan,and myrasTI , INSTALL RECEPTACLES .
f Y E is t full forte an!/ 'e7
¢O i Littnsc Class Lic.
Date Com War
u O a A CI TECT'S DF.CLAR
I understand my plans shall be used as public
Y
3 i pO Licensed Professional
o2 OWNER-BUILDER DECLARATION
= I hereby affirm thin 1 am anempt from the Comncmr's License Law for the
t_?< following reason.(Section 7031.5.Business and Professions Code:Any city or county $2500
mFG
CC Jut he is licensed pursuant the f the Contractor's License law(Chapter 9 , n
which requires n pemm id wren construct.shin,Improve,demolish,or apart any anucture
i3� porn tat its issuance.also requ'ves the epplicanr for such permit to Bleasigrod uamment. -
p proDivisi o p ,,�r,,�.,r gppn� L a�r. Valuation
or that
iswith Section]0001ofhebasis3of[be Rgedri sod Pwfeaivi Coda _ S,1 13Gtl17;2`O7 V-.. •i' �;V,.'1.l•tg9
or that tie is 31.5 b any applicant
p li and the basis for the allege)eplican an Any it Penalty of Section e th. v any hundred
o ll fora 50Tlit subjects the applicant to a evil penelry
of not inure man rw<hanatw donara(ssoo). 101PsRNYSIRAISDATION 1, � j � Occupancy Type
❑1,as owner of the property,or my employees with wages as their ante compensation, 109, - PIERS
will do the work,and the structure is not intended or offered for sale(Sec.](ar4.
Business and Professions Code:The Commrtor's License law does not apply to an 103 - UFER Required Inspections
owner of pmpeny Who builds es or improves therema and who dosuch work bimsau 104 — REBAR
Lithrough his own employeesprovided that such improvements am not intended or
offend for sale If.hoverer.the Wilding or improvement is sold within one year of 105 - ANCHOR BOLTS 1 a"
ompletithowner-Wilder will have the burden of proving thin he did not build or
improve far
r pe urpoacof sale). 106 - SEWER & WATER r
tri,as.wiles of the VOopeny: conclusively contracting with licensed coaanrmrsto 202 - UNDERFLOOR PLUMBING. - .-
nstrart dam p.j.,(Sec.7(K4.Business and Profession CWr:)The Connector's 203 - UNDERFLOOR MECHANICAL
License taw does not apply m an owner of property who builds or improves themon,
inW who contains for such projects with a contractor(s)licensed pursuant to Ne 204 - UNDERFLOOR FRAME -
Contractor'sLicenseLaw.
O tem nempt under Sec. B&PCfm Nis remon 205 - UNDERFLOOR ; INSULATION
Owner Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby alitm under penalty of perjury one of the fallowing i1miamaons: 303 _ ROUGH MECHANICAL
❑ I have and will maintain a Caaircate of Consent to calf-inose for Worker's 3 04 ROUGH ELECTRICAL
Cmmpcnmtion, as provided for by Section 3700 of the 1-mor Cade, for the
perfammnce of the woo fm which this perms i.issued. 305 - FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
Code.for the Performance Of the work for which this permit is 3 0 7 - INSULATION
u,a d.M pens n lnvunuce carrier and Policy number am:
!
3]00 of the labor
y orker's Com
CERTIFIC TI P Pmmy SHEETROCK
of FxeMerloN F•Qn w,�RTCFn ' - 309 EXTERIOR '•L'ATH".�
COMPENSATION INSURANCE ___._._......
310"'.: INTERIOR"LATH'-
(This s<nion'Med tot W completed if the Permit is for one hundred dollars _
(glo0)nneaa.) 311 SCRATCH COAT ,
I ced ly that in the arformance'or the wok for which tura Permit is issued,1 3 13 — ROOF NAIL •...
shall not employ any penon in any manna so as to biloma subject to the Workeri 501 - FINAL E LB CTR I CA'L' 'ENERGY
Compensationawsorcabfornia,Dine 502 - FINAL PLUMBING ENERGY.
NOTICE TO APPLICANT:If,after making this Cenincam of Eaemptiom,you should 503 - FINAL MECHANICAL ENERGY
buae subject to the Worker's Compensation provisions of the labor Code,you must
00 marine comply wids such proviaoms or his permit shall boile deemed!nt ed. 504 - FINAL BUILDING ENERGY, , _
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
> I hereby aRrm that these is a constmction lending agency fm the performance — - 1
of work for whish this permit is issued(See.309].Civ.C.) 506
GAS TEST _
a Q Unde1sNo 1. 507 - FINAL PLUMBING ,
�.Z Lendio s Address - t ,t
V'O Isenifythat Ihave read his ap,bra'ion and store that the above information is 508 - FINAL MECHANICAL
Lsi F correct.I agree to comply with all sty and county ordinances and sate laws relating 509 - FINAL GRADE
O..V to Wilding roninmcJmn,aadhembyaumnt;zerePrereotdivesOfthis atymeme,upon 510 - FINAL PLANNING
the above-mentioned property for inspection purposes.
y (We)agree tosave.indemnify and keep hamJess the City ofCupenintagainst 514 - FINAL UB C WORKS
V] liabilities,judgments,i,.wa and espemes whirls may in any way wrom against said
U z City in ronserp eine of the granting of this Permit. `
"a APPLICANT UNDERSTANDS AND WILL COMPLYWnNtALLNONPOINT Issuedb Date
SO'RCER LATONS. 'I' W y•
�Signawrc of APPh nJ omracmr Dam( Re-roofs
kRDOUS MATERIALS DISCLOSURE ( ti
Will theapplicantmfumm buildingoecupamsmtearhaMle barsrdous material Type of Roofas defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
cane.Section 25532(.)] , 1 17s •.• (a 9•. .. \4 fT,5.5 'ir.t _.' /
Duca ' "..o.NO` f. I. t All roofs shall.be.inspected prior to any.roofing material being installed.
Will the applicantcrfuture building cevariant use equipmentmdevices which If a roof is installed without first obtaining an inspection; I agree'to'remove
emit hanrdous air contaminants ss defined!by Ne Bay Area Air Quality Management
Distort all new materials for inspection. Applicant understands and will comply with _
❑Yes ON. all non-point source regulations: .. r
1 have rtod the haaallow materials requimmenm undo Chapmr 6.95 of the
California Hearth&Safety Code,Sections 25505.25533 and 25534.1 understand that
if the building does not currently have a anent,that it is my noponsibili y m notify the
occupient of the mr,wmir nu which most he met prior to issuance of a Canineare of
Or p'
"`y' Signature of Applicant Date
�. o aer fi,, a at, - .r All roof coverings to be Class"B"or better'
OFFICE '