01080125 . .CITY OFCUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR.INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10497 CHACE DR WATER HEATERS ONLY 01080125
OWNER'SNAME' APPLICATION SUB DATE
ROVEGNO BYRON P AND 'PATRICIA M 970 E . MAIN ST, SUITE 20008/27/2001
Ask
( PHONE: SANITARY NO. CONTROL NO.
(415) 566-2209
Mai ARCHITECTIENGINEER: - - BUILDING PERMIT INFO
O f - .. - BLDG ELECT PLUMB MECH
LJ LJ LJ
w LICENSED CONTRACTOR'S DECLARATION
z_p J ncrehy affirm iv d am after,ed underp and
Prens of Chapter, nd mmeneise Job DeSCrlptlonH
tnl-. ' with full
of Division3of the Business and Professions Code,and my license REPLACE 50G GAS WATER HEATER
;,:S9„e -In full force and effect.
z a License Class ,Lic.N
3 u H Dam - CanOaaor
Oa mnd ARCHITECT'SDECLARATION FIN ALC
1 undeamy plans Shull be 'S E public re �1cords G
iO Oa Licensed Professional ry
- OWNER-BUILDER DECLARATION SEP 17 200
X,- I hereby amrm that 1 am exempt from the.Contractor's License Low far the
C < �follawiag reason.(Section 7031.5.Business and Professions Cade:Any city or county $700
3'x❑
which q permit t stmet;aIle prodemolish,or repair any suu t
w_
>pnatIp t e apamltr t gtrph aaspaf tf ehperiod
ae dt file signed statapt
6
Ica nog with Seen 7000)oI Divi. n 3 of the Business and Prof ns Code) u~ '.,t;;'.{t +3ZIItJ G;7"]tr'sVtCl-{,.}r..:b;'sY i�u , i Valuadon
.,,he,he is ekeinpt Merefrom and the bass for the alleged exempimA Any violation '
-of Section 78313 by any applicant fore permit subjects the applicant to a civil petuhy-
�mfbotmore then five hundred dollars(5500). 502�PNIPPAXL PLUldi ',ENERGPCcupancy Type
❑I,ax owner of Mc property,or my employee wish wages as their sole compensmion. {
will do'the-work,'add'the structure is not intended-or offered for sale'(Sec:7814,• I
Nus rani rad Professions Code:The Contractors License Law does not apply to an 507 - FINAL PSY>IQR&Mpebtidns'r' ' "'
owner of property Who builds or improves thereon,and who does such work himself, k
or through h' awn empl y .p,.,Idcd that such tmproveme rt are cut intended or - ,
off df le If. r.the building - ent is sold within .- -. . .....-_.._ .. ... _. t ...._. _-._._. .
completion,rhe owner huildtt will have The burden of proving that he did not build or t •• a \T "„r
improve fm purpose of sale.L
F,, f the property.am exclusiveI)co i act g with licensed contractors to { ;v : •;
construct the project(S 704,1Business d Professions Cad ITh Contractor's { o l
License Law does not apply m an owner of property who builds or improves thereon t '
.' ..and.who contoom,fier snch.prejecls with,.cotureacls)licensed pvumomr w the.
, .....,... .. ....._ ....._.... ..__ ._..
� Cont u I License La . i \t . . __. _.._..... . .,..__.... ..-__ .._.___..
❑1 pt der5c -
.B&PCT this reason til;
.0 r ,.,I "''Date _.N..,..,i t t,
_WORKER'S COMPENSATION DECLARATION
1 hereby vffimi undo penvpy of perjuiyptie ori the following declarations:'
❑ 1 have ad witlTiandirtma.Certificate of C i m self ante for Worker's
Compe rrl na,-as provided for by'Sew on 3700 of the Labor Code, for the
_ 'perfonnanee ief Me wook far which Mis permll is issued.
O 1 h a d wi11'ma t W ker s Co p <r 11,unc required b'y Section
_ 37W of ducLaborCode,for the peifithrence of the work'fier•wh h this per, 'r is
-'
issued My Worker's Compensation I sti c r d Pol y bet rab .».,
ar y
C',
Policy No eERnPICd nCOMPENSATION
PENS TIONIIN Permit
I C ln, lad._,. L�I,._,.. ...�
I room atldollarsLtr,k tl, Wk q�,k a ^w to
p ,woxxER�s,
i r ION INSURANCE
w
M A
'stn's
i (EI W7 less) T i -
1Len fy that in me perform, f rhe work for his to r is ti d s` t
• -shaell not employ po m,ny maa n m to becomeo o
s bj tf to he Workers
.ApjAncrat nlawg,sofC if Dt8
i-NOTICE TO APPLICANT It, fuar unakinglh Cnt t fEe pi yush Id t e
Q Obee me vubjebtt the Worker's-C pe s r p ns of @ Lvb Cotl yo mast
, fonhw[h crraqlyis iff Inch pro,maxes Trills pemul shall be duarrial onsiked. t
ONSTRU ON„
LENDING AGENC
I hereb aRnnthat Cro nilnon ,enYra forth Pe.,xrr. i:m..t an_e� .._... _ ......._. ,-_... ..._ . •CJ ,,.Pt1 )"`
I ..
_ l I
ofhe o which this t ssued(See 3097 Civ C)
mhcr'�Name'
LItnidirr x Amkiovt
Uz Inify that I h d this tlr state r rhab a information
,
is
t' n 1 gree In comply with all c ry and my d' d same la s relating \
f, to buldngcn ,coon andh byauthoce p e1ive fdo uyt me upon _
the above ant d property fo ir,pitiefich pry I 1' I I / ,
try pt
(We)agre td et chindeyand keep h I the Qty Captain.Pagainst I//�/1V
,t"j V
rr V]
liabilities,judgments,costs and expe,cam,which,may.in any y accrue against said CC��
V.z City co sequence of the g n t g of this pcom '
APPLICANT,UNDERSTANDSANDWILLCOMPLVWITHALLNON.POiiiT"
SOURCE'REGIssued by: Date
[ICATIONS '{ J; (, ,
-•., �.
aSsigsemr udre1.lobYApplicaucon[acorDate RE-COOTS
ar ?6MN i
� pn , � ` ,useohah1`dosdateril Tpe of Roof-
he
C picehPD e xeaItna
Safety _. - ...
' Codes firm 25132(e) t p (ts.
❑vas ❑Nn „All roofs shall,be ms ected. rior.to,an .roofin material being installed. ........
� e rr t r P P Y $• $
-Will rhe appl'ca t buil ai g p ard useequipment or devices which If a roof is ins`talledlwithout first obtaining an inspeetiod;'IDagree'to'remove
mr
1e h rdcemented lant rant. de f d tride B y A m A Q I ty Management e
all new materials for inspection Applicant understands and will comply with
1 A ❑Ye ❑No; all non-point source ie ulattons.;.,,t, il, l ,.
�. < P
I have read the In a dour maierlals'requiremnents un=,der Ch,prer 6.95 bf the
Czhtomta Health ' her Cade.'Sections25505;25533 and 25534.1 understand that 1
iffheb ml in does not curtenrlYh amnem that it is mY respon'b 1'rymnotifgthe I,•
ocdupma of th require twhich'moil be met p'ar miss ante ofm Cenlfcere of 'r
i' Oc panty .l . . .. o t.
_ . - . . _'1 _._Sign&ure,of,Applican4. . _ .. . . _ __. .. . ..Date-- , --
ow r rn aegag nt q;te,,, All roof coverings to be Class B'of befter
OFFICE.. .. . ......._ ., t. .. _.