02050004 CITY GON UOPERT
IPERMIT NFCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20109 CHAVOYA DR BELL PLUMBING INC 02050004
OWNER'S NAME qq
BOLECH PHYLLIS L 2420 PRUNE AVE A05cj01/2002
111,01NE: (510) 438-9000 SANITARY NO. CONTROL NO.
WG O O WILDING ILDING PERMIT INFO
Q U u BLDG ELECT PLUMB MECH
y i LICENSED CONTRACTOR'S DECLARATION Job Description
i Z v_,0 1 hereby affirm that I am licensed under provisions of Can,,,, escrp
r 9(commencing
„tw .vhnsadnn]000)nrui�ixinn3nnneBn.me,xagLProreaxinn:c"ae.anamyucena WATER SERVICE
iYEJisiaful_I fja can �C
:Wn< L�i'c/y,1 I Lica
i u N Ly. lOr
R ARCHITECT S ATION
01 I undcunderstandmy plans shall be used
DEC DECLd as public records
osi
]Mac aLicensed professional
o that I a-BUILDER DECLARATION
1 hereby.affirm abut 1 1 exempt from the feumas Co License Law for the
t 3 a fallowing reason.(Section]031.5.Buzinas and Professi,m Coda Any city or county
$2200
ex c which e. Permit t to common.aII p demolish.or re - any summ
a.3= poo c its n < eq rrc mapplicantfor such pe itt fl sig ed t t t
that he-s licensed p a n the Provisions of the Contractor's License La (Chap) 9
(commend 6 anSci 000
] ) fD' s 3 fthe 6 a and professionsValuation
Cod) t-}:"j ' �3�8'L 3'( tl'4'r'1Y`\VI}ia( ,•u it ;k
or Nal he n excmpi therefrom and the basis for the alleged esereptmo.Any violation -' - - "
of Session 7031.5 by any applicant for a Pemba subjects the applicant on a civil Penalty
or not mart than ave hundred donan($50o). 2024PN1t)J FLOOR PL BING Oecupaney Type
13 1.as..her fine proper,or th,employees hit wages as their i.lb umperimmu. 301 — ROUGH PLUSMBZI�N1, �+�]o
will do the work.and the amcturc is not'imcnded'er eRLaw for salt(See: to ca•- 5 0 2 - FINAL NAL PIRTtl��RQsp NiBRQY"
owner o and!Professions Code:The Conmmoro License law does nota 1 to an ,.
orruhhisowWho w�ds,rimproves atsuch.and who deca notintendedh work n .mself507 — FINAL PLUMBING
cmd for his own th.phowever,
t provided that mpr vementemems art not yez or
offered rm sale.If,howeba,the building a improvement Prov n Bold he did one build of
,prove font the owned W e.).will have the burden,f proving mea he dad not build or
improve purpose o
❑1,as owner of the (Sec.
7 am Buss nivel)'convecting with licensede Contrave to .-
onsvuct the project(See.]04a,Business and Professions he ills or The improves
themor.
Liccnu Law dos not apply man owner of a comm who Wilds or dmp ome thereon.
❑1 moend o`,micens for such projau wish a.eommnogs)licensed pursunm m me .._ ....___-_.. _ .. ..__..- C tipp pp o
" C nvactors License law.
exempt under Sm. ,B&PCfor this reason
IED
Dwnei Date - MAY 0 2 2002
WORKER'S COMPENSATION DECLARATION
I hereby off—under penalty of perjury one of the following declarations
• nsa1 hive and will maintain a Cenlfeam,f Consent to self insure for Worker's
CoBUILDING
mpetion, as provided for by Section 3]00 or the labor Code. for the
pr:dommuce blithe wnrk for which this permit is issued.
❑1 have d will mai ti Worker's Compensation I uratic s required by Section
3]00 of the"her Cod for the pttf rm e f thework f M1 h'hi .it
esu MyW is rope s t I ran<e d Pol y be
Pnl
" ERTIFCA ' KE'R'S'3 R
COMPENSATION INSURANCE
(This seRnn need it.,be completed'Rhe � � �- -- � ' --
(SRN))or less.)
Oermit is for one hundred dollars -
- - ......
I certify that;n the pc in a,na of rot work for which this ct mdt a issued.1
,hallcohn'nti employ any person in any manner c,es m become subject m the Workers' t' '
Cmnpenmtion Lows of California.Date
NOTICE If _-
NOTICETOAPPLICANrker's ompensmg thin Cisions of of Exemption youshould
st - - '
' ,� becomesubject1--P to the Worker's Compensation provisions of the Labor Code,you must
0 Q forthwith comply.with ouch p.,vis„ns or This permit shell be deemed revuketl.
F-h
CONSTRUCTION emisacLENDING AGENCY - - - -'
1 hrk fee affirm that theta iss issued Sec.
lending agency for the performance
W Le Jae work for which this permit is issued(Scc.309].Civ.C,)
r.t
P. z Lcndcr's Name -
o'z Lcbdc,'�Address
U F" 1`agree that 1 have mad this application and state that the above information is V
is E. corrcn.1 acme to comply with all city and county,matinees and scam laws relating
0 C.2 to building construction,and hereby authorize representatives of chis city to enter upon
the vwvememioned pmpcny for inspection purposes.
es,judgments,agree to save,indemnify and kccp hamay irmit. in the City of con,a ai against
W liabilities,in echecob and expenses which may in any way accrue against said
nce of the
U APPLICANT UNDER TAShooting
n'�AND WILof this LCOMPLYWITH ALL NON-POINT O v
URC�i<E,7j .,TIO Issued by: Dale
��l ��QZ
engsyrc of wppucant/Comtacmr me
// HAZARDOUS MATERIALS DISCLOSURE Re-roofs
Will the applicant or future building occupant store or handle houcamons material
as - Type of Roof.
def d by the Cupertino Municipal CM Chapter 9 1 d the Health and Safety " -
Cade,S.imr 25532(0
0 Yes
1 .
All roofs shall,be'inspected,prior to any.roofing,material being.installed.
Will 1 appl ant future nmild led b e Bant n. equipment a gement which If a roof is Installed without first obtaining an inspection, I'agiee to remove
emM1 b "tit - 1 ssda6 tlb)m Bey ArcaA Quality M agement
District?13Yc' all new materials for inspection. Applicant understands and will comply with
1 ' all hon-point source regulations: - - - p Y.._..
1 have read the hazardous materials mquiremcros under Chapter 6.95 of the
California Health&Safety Code:Sections 25505,25533 and 25534.1 understand mat
if the building does top currently have lenam.that it is my mspmoibilityto notify the - - -
receptor of thc ne,remens which st be mea prior m issuance of a Ceruficam'of
Occupancy
Signature of Applicant Date
" res, od=wage".t' All roof coverings to be Class "B"or better
OFFICE