01110103 JCITY OF CUPERTINO - : '
nUn mNc nrvtsroN pERMIT CONTRACTOR.INFORMATION:,
UILDING ADDRESS: PERMITNO.
10774 S BLANEY AV LAM PETER R AND CONCEPC ON 01110103
WNER'S NAME: APPLICATION SUB DATE
LAM PETER R AND CONCEPCION 11/21/2001
f PHONE: SANITARY NO, CONTROL NO.
D ARCHITECTIENGINEER: BUILDING PERMIT INFO
W- BLDG ELECT PLUMB MECH
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5 y= LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 um IicemN under provisions of Chapmr 9 kom,tmncing
?mFed with Section700(fioffivision3oftheBusinessendPrefesainnCade,andmylicens, REPLACE WATER HEATER (40 GALLON)
f m I j is in full force end eHvm.
S z s a License Clnas Lam.N
Mi L' Dae Conwcmr
3 Oat ARCHITECT'S DECLARATION
]a I and....ad my plans shall be used as public records
e �Y
a O O
Licensed Pndessionvl
OWNER-BUILDER ATION
1 hereby.Snn that I air exempt from the Cono
License Law for the
Z< fallowing (Section Businessand Profession,Codd:Any city or county
which quiresapenttnemosmat h , p demolish, p" ny am lore
$270
ceprior to its1 q the pplt for suchpe a file a signedstureart
- that he ikl d n th� ... ..... ........ .... _... .. ...___
Station
p' ton fish the t ossa La (Chaps r9 _
(commencing with Sect 7")of Division 3of the Business dProfessions Code t. t �, i 1 :('ps :. Valuation
or that lien mempi,herefrotn,and the basis for the alleged ekemption.Any violaion 3- '�$�' �,et,kA Ci`",
of Section 9031.5 by any applieam far a permit mmects the applicant to it civil Penalty' P Y
of net.more had five hundred dollars($500). 50�pN"' L PLUMBI G ENERGf)ccu ant ,n'P e
I-wner of the property,or my employees with wages as their sole compensation.
will-do,he work:-and the structure'is not intended'or"offered for sale(Sec.']044,- -
'Business and Pmfessions Cade:The Candacmr's License Law does not apply,o an 507 - FINAL P$R AGPections!
owner of property Who builds or improves thereon,and who does such work himself
ath2fid his own employees.provided that h improvements t mad or
a
"-n- for sale:If.however,the bu ld'ng marapriwearcut.....IJ Within one Y<3e of ...._. - .-._._.._ _. ._._. ...._ .. _.__.__..._.. -. .. .._ - . .-_._ _ .. ._...._....
'completion the owner hu Ider will have the burden of proving that he did not build or
improve far purpose of sale J.
[]Las owner of the pr ny am exclusively ron me ng with hcenxd comrec,ors m
conswc,@e projen ec ]044 Buvnexs end Professions Code)The Comsat t
License Low does n apply to an owner of property who builds anmprovea,hc C �e
...end who conwas ar
such
rs with a convacmrts)_I¢PnsW purtuant,o the. . _ _r'.N A L�D .___ --------_,_ _
s" / .... ......... ... _ ... .._ rte .. ... . _-_
Cot t s L La
.. ❑1 mpt day B PC for thisrt son '•Jh , '. h;1.:41
aw r NOV 2 7 2001
RK R. NS TION DE LAR TION BUILDING
Ili by affirm tl penalty fp 1 rY fthefollowmgmaturations:
7
01 h6ve mie will'mnmuin a Can fieam of Ct nam,to xel(msure for Workv's B
Compensation, as provided for by Section 3700 of ,he Labor Code, for the
_ performance of the work for which this permit is issued. .
°I have and will'unumaln Worker a Compensaiion'lnsurance,ai iequireif by,Section
3700'of the Ube,Code,for the performance of the work for which this pentyl is
issued My W k Y C mpe . i n I ora nd Pot q umber re:
:.
..c Cdrnr kl'V 0 Pdl-y No ii• .. " -, r ? i1 �.';r S s .' •;!I..t.,.,.._. . . _
" CERTIFICATION OF EXEMPTION FROM WORKERS t' t a '" L k { •t t s s
COMPENSATION INSURANCE' r'
(Th s section need not be'cdm feted if m< unit is for one hundred dollen """'"_ __...._..
.: p is t
(S100)on los.)
1 n f th t tti rf O f th rk f which Ilii ,mins iss ed,
'sAell not cmpiny_a of n m any mnnncr so as m bcchme subject to to the Workers'
Chmpensation Laws of Califm than.,m,
.Applicant . . _ :. ..- _^_..:._. . _.. ...... _ _ . ._ . .. . .__... ...... _ .._ ..
NOTICE mj APPLICANT.Work IL after Compensation
making th s Certificateof of Labor Exemption, ,ymi mind s /I:
beth ubjmply the Worker's'C pensau provisionsa of the Lala Cod you must
'Q 0 forih nh comply with such Provisions orthis Perturb shell be deemed revoked,
E .. . __ _... __... ......... ... . ..._..,.__._. ._......._...._ .. . ._ ' .,., ._.._.. _
t I CONSTRUCTION LENDING AGENCY
.r
a
Ihreby ffmthat construction u t odoB agency fo ,heP perform> of thek f Which thisPermit .'
t
sued(S C J09]' v.C) _
Lend N _ ... . ...._._ .. .._. .....___
y-o __..
a(z Lend Add s";• 1
V.Q - -. �e.r... i.:: .
1 n fy"Out ha e d this Implication d state that b ve information is
fsir,E„ coma d g c to mPl with all city and countyordinances and state laws relating
. cif) to bolding conetmcfmn ad hereby aothonic representatives of,hscny to enter upon
(r] the above-memidned pr pony for
inspection purposes. ".
psi (we)agree io ve,indemnify ad keep harmlesiihe City'hf Cupe'riinoegains,
y liabilities,judgments costs and as nses which may in any way eccme against said
'U.� C,tyin .F,cqucnc fth g m of,his pe e
APPLICANT U' BRSTANDS' DWILL COMPLYWITH LLN -PONT "
RCE REG t '. / Issued by: Date
i6 awre f Ph an✓ m nm �` `Date" ""
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE i"' ' "t r��-'/L GJ
Y p got part,'tort ,handle haenrdo a sl Type of Roof
e t
_.
otl CM1 pter,912 and,he Health d5(cry dt
FF "'
Fire
Cod a
S ,mn 255�2(al stir y t � '. C4r'. } pk .bl ,w .,V,( " vf�t
11 Y" °N .All roofs shall be_inspected prior,to,any_roofing material-being installed.
tl pen M
las
- ._ _....
Wdons applicant oremure,b 6 trieding ottupantuse AaAequipment tydesums Management If aLOOf is ln$ta]10d'Wlt}IOUt(ILSs Obtffinm an"IDS QCt10nyla Lee.tO'remOVe
i'mi dous air 6nte mom as defined by'the Bay AreaA Quality Manage m inspection. pp g P g
rtJ� Dia nEl NO all non-poinall new rsourcerregulat ons; Applicant understands and will comply with
I h read t hoz bo marerial regmremens udder Chapte 6A*of of,he '
California Health afety Code,Sect as 25505,25533 and 25534.1 understand that
:If the buldmgd o, rred,ha (count,that it I,my new,mardildKity, notify the .. - -... .... '. - _. . .
nccupa t f,h ire is hi tis,b ,prior to issuancef e Ce (cant of
ct a CY
-' `�� ZJ�U _ Signature of Applicant Date
` o oo ]e eg nt Da,e All roof coverings to be Class B'or'betfelf
OFFICE
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