02070106 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOKINFORMATION:
BUILDING ADDRESS:
21353 VAI AVE R & Z DEVELOPMENT PERMIT N62070106
ok ff9`iiS /ZANGER/FAYLOR 21771 STEVENS CRK BL #100 J W
APPLICAT)VOMS�/ `I2002
(408) 252-1101
PRONE: SANITARYNO/. OCONTROL NO.
OO ARCHITER/EI:GINT.ER: BUILDING PERMIT INFO
Q U BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
;� o IM1ertbyaf0rnthulamliccnudundcrprorisiamofChapmr9lcammcncing TEMP POWER Job Description
vs t; with Sation]O1t0 rvi1bm3ofim Business ylRenu
� is in full tome an ct. 1
aLicense Class Lir.a
O i O Dam Con n
2 RCHITECT'3 UE A o
I undemm�d my plans shall be uutl as pub"rtcar
I-p o Licensed Professional
oOWNER-BUILDER DECLARATION
I hateby afBi 1 am rxcxrpl from he Ci m amr.License law forme $10 0
FiQ following rtason.(Section 7031.5 Business and Professions Code:Any city or county
F O which requires a permit to construct,alter,improve,demolish,or repair any stracture
3m prior to its issuance,also requires the applicant forsuch permit o file a signed statement. - __ _ _..............._..
mai he is licensed pursuant to the perovlslons of the Contramrs License Lis.(Chapter 9 t „.36g''�6.�'Ib3r.f44k•,- r . r- '. , Valuation
'eommeneing with Section 7000)of Division 3 of the B mess and Professions Cade) r " s' 1
or tom he ii asempsthchfrnm'ond the basis for the alleged examPtion.Any violation k. A\' '\ .. -\ 4.•.1 t-�i• '••:.\r g
of Senion 7031.5 byany applicant for o permit subjects the applicant o a civil penalty
'afaamorethanfivehundreddollars(s5W). 10APNPL'JiPttER " Occupancy Type
❑l.as owner of the pmamy.or my employees with wages as their sole compensatmn. 304 — ROUGH ELECTRI AL `
will Eo'tm'work.-add the strvnure is not'imenddl or offered for sale'(Sec:7111x, b r
'Business and Professions Code:The Contractor's License law does not apply to an Required Inspections'
owner of property Who builds or improves theuon,and who does such work himself
or through his own employees.provided that such improvements art not intended ar
_
completion,
ule.If,however,the Wildingor urden emcntnsold within one ilei of
'cnmplmi for purpose of sale.).will have the burden of proving that he did not build or ss
improve for purpose o(sale.).
O1 fthe pmpany, exclusivelyc tracing with I sedcontractorsto - - - _. _. _g�--t` .. t : t i .'I1 F ..
nn t the d0
)a 1S 014 Business and Professions CWc:)The C t ier's Y a Will L P 1�
L'san Ll d t app t er of property no builds or p m neon, �`YJ 'f s t t
w o son for. h-p ) -with esu oactor(s)
tots L
"S
K MP NSA 0. ON UlLDlM�
r .. p IvtVl
' Ih af0rm undo pemlty of perjury on<af.the following dedvationa:- v
❑ 1 have and will mairai.is
a CeniOcam'o('Conxcn(to Lilt-insurt for Worker's '
`v Compensation. as provided-for by Section 3700 of the Labor Cade, for me
performance of the work for which this permit is issued. .
- - 0 have and'will m mihi Worl:<r'i Compel 6i'Insurance.as required by,Senion
e_ 37M of the Labor Code;for the performance of the work far which This pemdt is
issued.M_ eLyWorker's Compensation.-• , , _. Insurance carier end Policy number are:
Comer° CERTIFIG TION OF EXEMPTION FROM W
WORKERSL
. :... ._ a .t •COMPENSATION INSURANCE':•_• • ' -
`'•''I"':'fibi:ifElida'mka'n6leeaen;pi sin pem,bisrmaaenanartamn.rs ;..I \ pel;'_ _.l�,ee:
moo)M-1
acne eonn any aortas f c m s e Wwkcrsam iNbo en aiip provisionsof the labor Code,yau'muxt
O O funhwim comp 's h provisions or this permit shall be deemed revoked.
. _._ . ... _. ..... .. ._ __ -_ -._... -- --
[y-�-.�.r '"' t" "ICONSTRUCTION,LENDING AGENCY "', 'I t'
1 hertby alrmi m t mcrt s a censtrun a Imding agency for the perfoimence L:s' vl-(
�nAof the workfe nI bthspermit's sued lS, 3WIT CV CJ
Londe N me _ ._ - -
Leader's Add
�. 1 c n fy mat 1 have read th ppl'eat on and state bar thno fotmata.is
tz f^ cern I gree to comply with all it and ry or d encu and State News misting
Or to building construction.and hertby authori repreu fins of this city to enter upon
fsl Ili4tdmi
nedp rinspect) parr . .
psi io ave, de ify§nd eph it the City or Cupertino against
rn' too ,cos end apTe hick m in any way ears agai saidCit df tH` ng of mia " - _ /AP "eTITI" Issued by: Date OIL/
a R n c Re-roofs
H R OUS ATE SCLOSURE
Ithe'ep to of Wildiny'occmpant share m
eo.handle hvaNau uuial Type Roof -- -::-v--. - --
a ser br m e x t a a coo Chapter 912d the Health d Safety YP
Code Scto 35531P \ t '• lC f,�' !4J!
Y" All roofs shall.be ms acted rior.to,an roofin material being installed..--
i
stalled.._
P P Y g g
t:• IB max liceni or Lire buildia occupam use aqui t ar dcviccs,which installed` ... ..
vp $ ?min If a roof is �wrthou[ Ins[obtaining an�inspection;h'agiee to(remove
it M1 doss Lir coma t 'e0ne b3 me Bay Area A Quality Manegem<nt ,
trap. all new materials for ins ec on. Ap icant understands and will comply with
n ❑Ys n a oli=oinf so .. a egu] ons.
1 I'O th a d'mc ba materials q rtrhams under Clip 695 of he
feel to H lm b.Safety C lis en ons ,di 3353)and S3J4 1 emend that
is e c ply h e to m that it
my pomsdi i to notify the
scup t q' •m n t horn moi -at pa u nee C mficete of _ - ----- -
a g- ture o.nA
D t
in t lgpt roof coverings to be Class"B"or atterq
I
...:-' •.... OFFICE .-. . . .. _ __ ._ . . .. . . _.