02070109CITY OF CUPERTINO
.i '
BUILDING DIVISION PERMIT
.CONTRACTOR INrORMATION:
BUILDING ADDRESS:
19717 AMHERST DR
CUPERTINO PLUMBING
PERMITN .
82070109
'MMG JAMES L AND ANNE E
10297 S DE ANZA BLV
APPLICATV}SjlDA$ 2002
PHONE:
(408)253-0618
SANITARY NO. CONTROLNO.
ARCHITECLjENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u C-1 L.'7 u
LICENSED CONTRACTOR'S DECLARATION
Ihereby a)of thmIn. Banxaunderprosmmof
Section ]000) Division J
COPPER REPIPE�gKl1RKc�A°I'ER�WATER SERVICE
with of of the Business and Professions Code. and my license
'kimsCChapter and
ceran orasenae ec`
Liansa Clvs Lic. a
_ Wm for
-
S DEC
ARCHITEDECLARA ON
1 understand my plans shall bee u,e
3 usctl as public recoNs
5 Licensed Professional
_ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or coumy
$5000
which requires a permit to construct. °Iter. improve demolish, or rtpam any sumaum
o - prior to its issuame, also maim the applicant for such permino filea¢igaedsurtmem
—
_
that he.izliaimedmrsuamtothe Pa.,War, or theContractorsLicenseUw(Chapter9
(v ing Division
.•..,,,'„ .,,t3$(„- '���.-'�.�" I Valuation--- -- ---
with Saiiop7000) of 3 of the Business end Professions Code)
s � � :
_ f.._.� .: e- y
' "' ' '
rnij he
or N¢i he ii exempt theiefiom acid the basis for the alleged exempion. Any violation
"'
-of Senion ]OJIb by anY apPllram for a pemdt subjttts the applicam to a civil penalry-
�ofnot more thin ryehundred dollars ($500).
108iPNI5>bri &R & WATE Occupancy Type
OLas Owner of she Pmpeoy, of my employ tax with wages as their sole compensation.
202 - UNDERFLOOR PL BING
WiB-do the woik: End me s morns is ear intendedor'blTc¢d'far -sale (Sec 7044: -
064;`'Businesxand
'Business 'andProfessions Code: The Contractor's License Law does not apply to an
ections`�' '• -'' `�'
o wner of progeny Who builds or imptno. themar. and who does such work himself
302 - TUB & O
- or through his Own employees. provided that such improvements am not intended or
offered forule If, however. the building or impmvement is sold within one year of
"' "- 502 -----FINAL PLUMBING -ENERGY--'-----------'-------
miompletion. the owner builder will have the burden of proving that he did not build or"•-'
prova mrpurpomof¢am.).
'- •,J!':..
506 - GAS TEST
co L as owner of the n
pmpe y. vat exclusively contracting with licensed contractors
-.... ... .507- ---FINAL-PLUMBING ---.... --.............._ _._ _.....
construct the (Sec. IDM, Business mM Pmfohob Code:)
Contractor iLicense
iThemproves
does no
Law dos.fapply mmjowner of Property who buildsnrimprovesthereon,
and.wh j\ a.conuanor(si licensed pursuam.m.Nv
and.wcuses
Contractor pl case la -R IIN
Tamm .-I,
❑lame pt untlersc Bd:PCf his reason
- t
Owes - "
j� �B
11— 8 B YkB Adis F,
Data
WORKER'S COMPENSATION DECLARATION1.
hereby affirm undo Penaltyo{phrv�1'one or, the following declaration:
U 2 2 2002
AUGl
❑ 1 have end will maintain a Carnevale of Comm to self-insum for Worker's
-
Compensation. as -provided for by Section 3700 of he Labor Code, for-im
performance of the work for which this permis is issued
S U I LDI IV G
131 have eridlvill mtlimam Worl:a's Compcmmion Insurdvice, as mauled by Section
00 of th Labor Code f0 the iforma -f the work for which thisrecruit is
rs M s Co pc rs.
'sob
Mi .TVfk� 1 PoI icy No L/(>/J %CO
CERTIFlnA
(TION
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�} \ rr• - 'a
-
oO�PENS
4 Si It. ..
; t'
.OM_WORKERS"-
INSURANCE_
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senionnaAnoi be completed if the permit is for one hundred dollen
` - ivii `..' r ++ - +r i}L
Slllfl0 less.)
- 1 nph th t sat er perfu an f th rk f h h th' peoh t sued, l
+ehSll
......_--._..,„._.-....,_-._...
i art mploy any person many manner so m u beroma subject to the Workers
t.. t!,; .. ). 1 •e +I _ j i' +T-
COnTiamilm Laws of California. Data ”
'
A 1 ant '
PP . t - . _ .. ._
- -
APPLICANTI' flat gthsCnfat fEse pion should
._...
.-. ... ... .. .... - -. ._ ----
f It
become m
beco statical Workers Compcnsationpro.rsionsofthe Lebo Coeyou-must
_, ',
innhwNt comply with such provisions 01 this permit ana11 be domed invoked.
-'r t CONSTRUCTION LENDING AGENCY
1 hereby Rmi that Ne s conswa o I' d g agency for the performance
/'.
of the wo k for- hlcfi N s pernu s ss ed (Sec J09] C C) ' '
I` tl' ' -
Livderr Atldress -
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. 1 cenify that I neve metl this application end stem that the above information is
-
cmieci. l agree m gomplY!vith all city and rounty ordinance seed scam hews relating
to W ilding ronstrvnion, antl heiebj auNorize rcprcsemadves of this city to corer upon
the eb a nt oned p perry ( -nspe tion p ryo es
(We) .gra to vet iris {y d k ep hamdess the City of Cuperim0 .grana
habil Des Jud n , cm end a h h may n y w y attry ms. said
(�1
CIIY In CO Of gMlm Of In' rat 1 - -
AP7LIC - ER 1�5 p L COMp.LY NTTH A L N NPO
souRCE 1 . s.'
Issued by: 6
,�
Date
.Sign re Applrtan d we r'." :" ,... ...•+.•'. •. '...
.
Re -roofs
HAZA S A RIAL$ DISCLOSURE
"� t I the ippl t or four
gam ¢tort or'has he herallous mnJ
as defined by the C penin Momnpal Cats Chapin 9.12. ria me H lin. d sarety
Type of Roof _ . _
- �.• -
code.
ode Section 25532(.) V
,.- ❑Yes s tNNo' a,P nj 1 t
...1
+
- .. l f t -- •`4
ar..s t
roofs shallbe inspected to
. i Wdl th eppl re t o future bit lamg pat q air o devices wh
_All prior any roofing, material being,installed.-
ch'
a., haurawsu contam..is tod fined by Nc B yArca Atr Qt al tyManag mens
If a roof is iiistalled-without first obtaining an inspection 'I agree [o-i'emove
° "'ct
all new materials for inspection. Applicant understands and will comply with
'aa
all non -point source regulations.
I h sae Shc: h waw¢ ienali