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02120038 CITY OF CUPERTINO BUILDING DIVISION PERMIT fir-CONTRACTOR INFORMATION f BUILDINGADDRFSS: WATER QUALITY PLUMBING PERMIT NO. 870 BETTE AV OWNER'S NAME: 1860 ALMADEN RD APPLICATION SUB DATE STEVE GOLDSTEIN 12/10/2002 ONE: (408) 267-9330 SANITARY NO. CONTROL NO. ARCHTTECI'IENGINEEIL j BUILDING PERMIT INPO BLDG ELECT PLUMB MECII O O O O exOp LIm Mat IDCONIIt ACTOR'S DECLARATION m-F IM1emb0(1)ol mallamfceeBusiunder pmvt[innanfChapter .undmmmensiis Job Description with Scninn]IXgBnf DiviainnJnf the Business and Pnttcaium Code.and my license is t_oz rnDIBbrre. er COPPER REPIPE ZO'gZ Umen7 Class Lie./ 6 ��� ^ n �© ua wj sMal[ useT'S DECIA D K< 1 understand my plain shall be used as public rccorJs m 3 a F Licensed Profess ion] DEC 2 7 2002 =0< OWNER-BUILDER DECLARATION y55�Taos a S 1 hereby affirm that I am exempt from(be Comment's License taw for the w,^'T aZMO following reason.(Section 7031.5,Business and Professions Code:Any city or county ����D�1tlM m which marines a permmWswl,e it le erller.improa,demolish,or repair any svucWrc N prior to its issuance,also rogues the applicant for such perms to file aligned stawmenl ivn 1 < that W is licensed prrspant m ftprovisions of the Cunlsmwn r's licese Law(Chapter 9 Sq. Ft. Floor Area 4?Noition (commencing withScetion]IXp)of Division Sof lW lLuinessand Professions Caklsv i $ mat he is exempt therefrom and the bases for Ilse alleged exemption.Any violation of Salon 7031.5 by any applicant for If permit subjects Ihe applicant in a civil penalty of 3 6.NPN R Occupancy Type nm more man rive hundred dollars($501). I,asowmrofthepmp,ny,ormyempluyaswimwagaasmeirsolecompensafion, willdohework.aadthe tumisoolimmnd oroffemdforsale(Se.7( .BU never and Professions Code:The Comrsomrs License Law does not apply to an owner of 301 - ROUGH U{v) ec Ions psopertywhoil WMMurperves ft...and wrt hodoessuch wohimselfor through his own cmphryas.provided mat such improvement[arcnol intended uruffered Tor sola If. 502 — FINAL PLUMBING ENERGY however,the building or improvement is sold within ore year of comp)„on,the owner- builder will have the burden of proving mal W did not Wild or improve for purpose of 507 - FINAL PLUMBING ale I. ❑I.as owner of he property,can exclusively contracting wise liatscd commichm in construct the project(Sec.7B44,Business and Professions Code:)The Convacmr's Li- wasse,law does not apply to an owner of pmpeny who Wilds or improves mercer,and who convects for such pmkcs with a ennuactor(s)licensed pursuant o the Comracmr's License Law. 14M exempt under Sec. ,B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION Ihcrcbyelfirm under penalty of perjury one of hr following declarations: ❑I have and will maintain a C,nificate M Consent oself-insumfor Worker's Cumpcn- union,is,provided for by Section 3700 of 1W LM,o Code.for he performance of the work for which this permit is issued. ❑I hats and will maintain Workers Compensation Insimm ce,as required by Section 3700m he IaMr Cate,for he performance oflW work for which this permit is issued. My Work is Compcaauon Insmncc emocr anJ Pulicy'nyp, Mr�ar�c: Carrier, r oRPulicyNn.MWOR&E,�/v 30 CERTIFICATECOMPENSATION I N FROM W R ER ' COMPENSATION INSURANCE Qhis section need not W completed if'be permit is intone hundred dollar(S IIgB or leas.) I certify that in the Kofammucc of the work for which this Permit is issued,I shall not employ any prison in any manner se as m become subjecuo the WorkersCompensation Laws of California.Date Applicant NOTICE.TO APPLICANT:If,after making this Certificate of Exemption,you.should become subject to the Worker's Compensation provisions of the labor Cock,you most 0z forthwith comply with such provoioaor this proud loll W dermcd revoked. z CONSTRUCTION LENDING AGENCY [-+ I hereby ahem mat mer,is a construction lending agency for Be performan¢of fY > the wink for which his From,is issued See.31n7,Cr,C) QLender's Name 7 z Unite's Address V 0 1 certify mat 1 have read this application and start W thin he ave information is IL F correct.I agree to comply with all city and county ordinances and stale laws relating m OU building construction.and hereby andufi2¢presemIIives of his city to calm uPon the rW above tmentioned property est fang expenses purpowhich may (-'k1a (We)agree to save,indemnify and kap Wtmless the City of Cupenino against UN incoioandredgmcns,moslsandof this swhich may in any way accede egainv said City Z A APPLICANT U DERSTAN nr thisrc WILL Issued by. Date n-r APPLICANT UNDERSTANDS AND.WILL COMPLY WITH ALL NON-POINT SOURCE REGULATI NS. /I tL-IQ Re-roofs a�c PPI vcnmmrrm /�� Dam UAZARDOUSM IiRIAIS DISCLOSURE Type of Roof Will he applicanl or future buil mg meupanl stoic or handle hvadoa material a defined by he Cupertino Municipal Calc.Chapter 9.12,and the Health and Safety ,We,Section 25532nd? DYe., 0N All roofs shall be inspected prior to any roofing material being installed. Will the applicam or future buildingm'cupant um cquipmentordcvices which If a roof is installed without first obtaining an inspection, I agree to remove emh baallous air contaminants as defined by Ihe Bay Arca Air Ouality Management all new materials for inspection, D"o-7 ❑Ya ON. I hoe real the bman ous materials mumm orchis under Chapter 695 of he Cahoot- .in Ilcmd,&Safety Cask,Section 15N15,25533 aa1 )a.Iuakrsmnd Whit,Wilding de nol cunenlly hale a tenant Main c my resgr. hilily to nn,ly the acupanl or he finioneracruniwho'thughrac c,mfieaenra,apanry. SignatureofApplicant Date h'iO _O-L_ norm 9th)r. •cn Date All roof coverings to be Class"B” or better