01060147 CITY foFGUVISIIOON PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7895 BELKNAP DR CUPERTINO PLUMBING 01060147
OWNER'S NANIF: APPLICATION SOB DATE
-FORTUN JOHN R AND SYLVIA Q TRU 10297 S DE ANZA BLV 06/26/2001
HONE: (408) 283-0618 SANITARY NO, CONTROL NO.
O z ARCHITECT/ENGINEER'
BUILDING PERMIT INFO
u BLDG ELECT PLUMB NIECE
a er
v= LICENSED CONTRACTOR'S DECLARATION
= Job Description
Z I hereby aPoon fhm 1 unlicensed under Drovisions of Clup¢r 9(commencing
p„1z, w;m season 7000l rDf,i.ion3anne Ba.m.,,and rmre,.n,n.crare.a dmyhanse REPIPE .
s i,in fall fore.a 'fe, ”
i O ¢ Licence la., Lic.,l
w 3 es es I- Dam Cumranor u e'w
O ARCHITECT'S DECLARATI V
i�
Sy
1 undcrsfand my plan,shall be used as public records
i�p L¢en,ed I'rnfcsuowl
icor. OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contramor',License Law for me
t-?" following ream.(Section 7031.5,Biomass and Prn es,ions Cork:Any city or county
awfill require,a perms it,eonxlmet,11111,impro,e.dam°b,h,m mpan aby abaetnre $5000
ar G W t 1' -1 y .II "ppl f - 'I mitt I I,uuan,n _
'flat he iif d pm,runtt.he pouio...offibe i Boone.l'a . L (Chapter9 3 CAI�{�0 �1!•�LCa VaIUHIIOn
(m 6 ',h Sell 9(X10) f Uivi- )ofin,Business J P f ions Code) fJ Z$ V
°r that he s.acmpt therefrom and the bells for the alkgrd exemption.Any violmlon '
of Section 7131.5 by any upphcan,for n plimit,ubjecn the applicant on civil penalty
Or not mom than toe hundred dollar,135IX1). 202APN FLOOR PLUMBING
Occupancy Type
111.as owner moose property,or my employees with wages as their role compensation. _
will Jo the work,and the sommre is not intended or offered for sal,(Sec.7044,
politic"and Prefeleinn,Cha:The Cnmmcmr',Mena Law dnc.not apply m an 502 - FINAL PI 41411B0'141�4s}$gl$rR "Y
lA r of property Who builds or improves thereon,and who den,; uch work himself
or through his own employees,provided that such improvements am not intended or 507 - FINAL PLUMBING
offered for sale.If.However,the building or improvement is sold within one year of
completion.the owner-builder will have the burden of proving that he did not build or
....cove for"Opole of sale.).
Cl 1,as owner of the properfs um exclusively contracting with licensed contractor,to
lati the protea(Sec.7044.Business and Pmfc.aiOn,Code:)The Contra i
License Law d«s not apply to an owner of property who built,or improve.,thereon,
and who cnutmct, for such pmjols wilh a conuanor(s)hollows pur,ivat to the
Connot License Law.
111 am exempt under Sec. P C for This recon r—� r� rr n. r, D
Owner Dane - lll� IDf\\VII`/(^\+\X 141
WOR KIXS COMPENSATION DECLAR,ION
I hereby affrm under Penalty of perjury one of the following declarm ions JUL 0 5 2001
d0O 1 hove and will maintain a Cartilicte°f Cobwnl In selblbatm fill Worker's
Compensation, a, provided for by Section 3700 of th, _,1n Code, for t,,,
performille of the work for which fir,pemon is in,r,,. 6. ,V f�71 BUILDING
BI DING
❑1 have and will maintain Worker:,Compensation Insurance,to required by Section I�Om .
3704 of the Labor Code,for the performance of the work for which this permit is
tad y rk,r', pe.vafiVTbkra ill larrirand Policy Bremner ata.
C� CLRTIFICgTIONCOM OFEXEMPTIONAXONSINSURANCE
INSIIRANCF. '
QSteelion need not be completed if fM1e permit i.for one hundred dollars
IS IO(q nr leses s.f '
I certily that in the peticmwncc of the work for whirr this molt Is issued,I
sh:dl not employ any...ruin in any manner it,as to bourne.object ,,the Workers' it I
Compensauon Law,of California.Date
Applicant
NOTICE TO APPLICANT:It,after mnkmg fhw Cenificnte of lixemption,you shoals
z became subjecu°fhe Winker,Compen,;nion fall..ions of the Labor Code,yon const
ZC) forthwith comply wise such provision,or this permit shall h deemed reveled.
CONSTRUCTION LENDING AGENCY
1 hereby affirm thauhe,is a conamaion lending agency for the performance
oI the work Nor which this permit is hst¢d(See.30197,Civ,C.1
0. (] Lender's Name
= z Lander',Addrew
I certify thin I have read this application and ,are bemire aheve information i.
-F correct.I none, ,,comply with alk city and cmmy mdlo,nce,and Stam law,miming
V to building an"mction.and hereby uuthmim rcpt„.nada ofthi,lily to enter upon
} L:7 lia above-mentioned property for,pareai w ich may
,.
F.. G (W'c)agree mave.indemnify and keep harmless the City cf Cupertino against
Z linbilitie.,,pWom,ms,coon and expense.,which Ivey in any luny uceme against said
C.7 C' ine •of rte NDS AND
thisL COMPLY
OM
'P.ICA JTU OER'fANDS AVD WILL CONIPL\'WITH ALL 6pWr01NT J /_�-,
S nu,it
lgn,n, .Js. _ Issued by: �iDate �- -/.y_ x/10
sugb,me nr. ,pbaabffc °fm°nr Dam Re-roofs
Willthe applicnnn rl future building a mbane store or handle Luiallous material
u defined by the Cuperdno hmnicipal code.Chapter 9.C.module Health and Safe,
Of Roof
Cade,Section_25532DU
Ye, All roofs Shall be inspected prior to any roofing material being installed.
Will the applicant or furore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hazardous at,co anormann as defined by the Bay Arca Air Qualrtr Management m
°""i"o ye, all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the hatallous mmerials requirements under Chapter 695 of the
California Health R Sway CWC.Sections 3505,3533 and 35534.1 under,mnd door
iirjp
dingJm nen itl dy he,, corse,that it i,my responsibility o notify the -
, "panN th rcquir n t,ehmh must be amt prior m ,p en nl a Cenif ease of
o, y �y
�92 Signature of Applicant Date
owner "nor
ag,m \ D.rte All roof coverings to be Class "B" or better
OFFICE