03080178CITY OF CUPERTINO
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CONTRACTORINFORMATION�:,
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO03080178
NER'S NAME:
PERMITISSUE DATE
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACaORS ON
lob Description
lt, ravCLARAT
I hcroby affirm Net 1 em licensed under provisions of Chapter Y (commencing
hap
P
with S Iia Olen) of Division 7 of 0. Bus'neuofssmas Code, end my license is
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ELECTRIC UPGRADE
CONTRACTOR: WOLF ELECTRIC (#02440)
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Aac I crs`oe��laN
in n s f y p n he used as public records
All
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Licensed tonal
OWNER-BUILDER DECLARATION
1 hereby reaso affirm on 1 em exempt from the Contractor'ionss Ct{pI/� I rtvr f�'-
reason. Section sites and a
into Ca°r.R air
?004
whichkilleaing
which an
w, de signed structure
consu r. alley, impose, demolish, structure
u peril re ores
am iirea
fie a
prior o its issuance, also requires the applicant for such permit m file a signed sraa
toc,
that he is licensed pursuant the provisions of the Comment's Li cc a
(commencing with Section 7") of Division 3 of the Business and
G Sq. Ft. Floor Area Valu$`i9f 000
Nat he u eampr Ihcmfrom and the basis for the ellcgcd uemption. Any violation o
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
�o�n�n�a,p
3MN01 Mber0.O__.
Occupancy Type
not more than Ovid hundred dollars ($500). —
----
- P Y yP
❑ I, as owner of the property, or my employers with wages as their sole compensation,
will do the work. and the s W[lum is not Intended or offered for sale (Sec. 7W. Business
and Professions Code: The Convectors Limrtse Law docs not apply to an owner of
Required Inspections
property who builds or improves ouncon, and who does uch work himsel(ortbrough his
304 - ROUGH ELECTRICAL
own employca, provided that such improvements arc not intended or offered (or sale. If.
however, the building or improvement Is sold within one year of completion, the owner-
SOI — FINAL ELECTRICAL ENERGY
builderwillhawdo, burden of proving that he did not Wild or improve for purpose of
_
505 - FINAL ELECTRICAL
sale.).
❑ 1. u owrear of du propert, am exclusively contacting with licensed mnoactor; to
comtruct the praiser (Sec. 7014, Business and Professions Chm:)The Contrutor's Li•
moue law dms not apply to in owner of property who Wilds or improw s theron, and
who contracts for such projects with a comreclor(U licensed pumuanuo On, Contractor's
License law.
C31 em exam or under Sec. . B ,k P C for this mason
r Data
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under pantry of perjury one of the following declarnions:
0'r
..
ave and will mainuin a Certificate of Consent m sal f-insum for Worker's Compere;
az provided for by Section 7]00 of the IaWr Code, for the performance of the
work for which this permit is issued.
r_l1 have and will mainuin Workcl's Compensation Insurance, as required by Section
,
7700 of the labor Code. for the Performance of Ne work for which this permit is issued.
My Work �is, Compensation Insurance carni-e�rfq�Ild Policy numhe q
Ca 'et �gww � M n v�PolRy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
frhu uOil. need not he completed if be Manor is formic hundred dollars DIOd)
or lass.)
1 certify that in the performance of are work for which this permit is is ucd, I shall net
employ any person in any machmsn as to Wmme mbjmun the Workers Compensation
Laws of California. Data
..
Applicant
NOTICE TO APPLICANT: IL ofur making this CCNficau of Exemption, you should
become subject to the Worker a Cam r a isation provisions of the Labor Code, you must
forthwith comply with such provisions or This perm;tshall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I handy affirm Nn there its construction lending agency for the perfomare, of
the work for which this permit is issued (Sec. 3M, Civ. C.)
Lender's Name
Lenders AJJmss
1 cloy Nat 1 have read this application and sum that the shove information is
building 1 agree to comply with all miry and county ordinances and shat lent relating m
Wilding hereby authonpempreunmivcsmf Niscity to enter upon Ne
ahovo red
anoneproperty for impaction purposes.
(We)
(hoc) agree t ve, indemnify and keep harmless the City of Cupertino ad
tiv ve
anti cxpcnusph mey in any way eccmc against uiO City
City
liabilitWeeg
in coning of is.APPLAN
A WILLCOMPLY WIT ALL N-P INT
SOUR
Issued by: Date
Re-roofs
Type of Roof
3
Aigionlard,mfApplicaH Zale
ARDOUSMATERIALSDISCLOSURE
Will the applicant or future building occupant sore calls cha/hrdous material
u defined by the Cupertino Municipal, Co is, Chapter 9,13, and the Health anti Safety
tion 35573(a)]
cmtl r, SioNNu
Yn
All roofs shall be inspected prior to any roofing material being installed.
Will future bpilefng
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or Occupant use equipment or devices welch
it'lavhrdous air contaminants as dermal by the Bay Area Air Quality Management
all new materials for inspection.
lrlCll
❑Yes Nu
-
Ihav 0 ardrms ser' s menu under Chapurr 6.95 of the Califor.
nia Health S tY ,Smdoa2 5 7 and35574.1 undeuour d that if Oat Wilding
Jmcs nidi nil mnam I' y rcspensihilily o nilly IW ¢cup of c
rcgwrc ts I�y:<-W 'r i„uanaOra cerdfim ler en
Signature of Applicant Date
All roof coverings to be Class "BI' or better
o ammmri.ed/,gent
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