02020093OF'CUPERTINO�
ILDING DIVISION
r.n•
BUILDING ADDRESSP '
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22047„CLEARCREEK
OW.NER,S NAME:,.. _ _
-` ,FAIRCHILD RONALD
ARCHITEC (ENGINEER:
” CONTRACTOR INFORMATION:
CUPERTINO PLUMBING -
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A ..._ ,N__ZA...B__._..__....
LV
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r1ND' PATRI I 10297,;;S DE
(408)253-0618
Z LICENSED CONTRACTOR'S DECLARATION
5,tnc I hereby affirm that: am licensed under provisions of Chapter 9 (commencing
;x4t- with SeciIDn7000)of Dlvision3onhc Busine/: ane Pmlessinm Code. and mY license -
Eirmmnr au ct. fX -16
Cnmrzctt� —�
I-
so y! ARCHrIECf'S UECI:A'RATIG
< .1 understand my plans shall W used as public mcmds
3 a O O Licensed Pr'
ofoxional
o LL OWNER -BUILDER DECLARATION
I hereby am. thatf am exempt from 0c Contractor's License Law for the
t• Z following mason. (Section 7031.5. Business and Professions Cade: Any city or county
F x o whreh rcqu a perms t on.t i Cm
L ,Mme, demolish re
or repair any structu
n 3_'Pnor t t' _ 1 m6rims de aapplicant for such permit file ignedsimman
m„ e ' t n., :. a .,,nn. r,..,.,,,•..
NO. .
,02020093
N SUB DATE '
5/2002.
BLDG ELECT PLUMB MECH
COPPER REPIPE
J_ob Description
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F
mommennn8;vitL Scmun;7000) of Division 3 of the Basins., and Profcssons Code)
(CCIN[1'320' (Y-f2Y UFiZ'r I AS: IO.3:
Valuation
HAZARD' S MATERIALS DISCLOSURE"`1,i':,'_
or that he is exempt therefrom and the basis for the allticil edempifuu. Any violation'
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Cupenn Municipal Cd Chapter912. ad he Health dSl,y'
nfSMiom703L5 hyanyapplumou tis
m a pemnt rnnjeetr ine applicant io a civil peneltY'
55321.P.,isOit Na + 1 I t 1. „
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ormtm manBen dedaolm' lS5007:
.
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FL OR PL
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,, .,Occupancy Type ._
BING
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all new materials for inspection, Applicant understands and will comply with
RTN
RCXTCH
if,,
_
d Ne'h zmd us mat , Is a-"nd Chapie fi.95 of the
hcnimslropu2nrents5533
ill d the �workand the'. wnu c s not intended'or offered for sal (sc 7814 '
Bus nd Profections Code no Co tract Licero,.Law does not apply to an
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_ ,
., .. __ _ .502 FINAL_ P&99TM FOPPRGY-.. = .: .._.__.... __ . ......
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ow.r, orpropenyWhot bu Ids or mpmvc 0 Jh due. h k himself
orin gnh-o employees provided that hoof - i i deE0,
507: FINAL PLUMBING
req re lsa h c t1f linsi be met pr or to ssu ce of Cen'fieem uff
fife d r sale IC however, the bbld n e I c i is w ifi n one year of
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completion,sefinthe owner W tdyr will hese the burden of proving that he did not Wild or
the
improve for purp,sc .1"ale.).
❑P as owner ofree Propeexclusivelycontracting contractors to
construct iM1 p Jeet (See. 70.6 B e so f ..ns CoM:)TheContractor's
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Litt La doe not apply t f p pony who )lids mas daemon,
LlEi®
_and whons.foesuch.pmJec¢ wiih.a.conwemrts) Lcensed.pucuni.to the
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Contractor'sLicnuL
olidect,emM nd,r.Sy .. ,. ,- .B&PCfonhis rtason
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MAR1 i5' 2002' ._.
_
Owner'. Data
" WORKER'S COMPENSATION DECLARATION
enaltafperjury .oncofthefollowing declarations:
"'• Ihiaffirmunder py
p1e
- " BUILDING
❑ 1 hav and will 'maintim'a Certificate of Consent to self -insure for Worker's
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s
Compensation, as provided for by -Sermon 37W of the Labor Code, for the
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perlin.1e of the work fm which this permit is issued.
❑ 1 have and wtl mrnw W ker i Comp, ratio 1 so more. as required by Seeuon
3700 of the Labor Cad f the performance of be work for which this permit is
� t....
issued. My Wot1s Comperration Insurance ca d Policy ti re,--
an
w.... _
Sf�4 f -u %13hlun
Yer
-0 Policy rdoo7
ii 'e ; CERTIFICATION OF EKEM ON
'e'4 F.
COMPENSATION
O ATION INSURANCE
'
t
sxuon ncetl of be core leicd dine dollars
p permn rs for one hundred dol
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� .1. �
';
IEI00)or less)
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n y mthpert common of slit work for which this permiis iss)d'I
<nif that n
'anall'not
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employ any pe in any manner. o r to become 'object m the Workers
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.:
compensation taws.! California.' Date.. ••_: .. ,:
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Applicant
'NOTICE
of Eae pi should
TO APPLICANT. Ifafter eking this ov si fns
a
z
z
become subject..111 the such Compensation provisions of Lon Cod you un'
of ,
fonhw i6 comply with such r or ih l hall W darned
Q
p revoked,
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t•,i'ti
'- 'CONSTRUCTION LENDING AGENCY nee
1 h rear (rim This there's on agency for the pcn'ortnentt
titin workfarwhich N' s,, sued (S 097ing
(Sec, Cn'C.)
y•Q
I,"rmt
-Lender Name1, %%7
Isnde Addresscorrect-
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1 ceniry drat I navy read this application and stem thin the abate inPormrlon g
I agree to
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CW
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comply on:and hereby all city and coumg aces and srte laws relining
io
reboil.
ntioned n:aert,Iwaerfiog
F., Gil
F.t S'
ennui
idannI-meng psenuiives orihis city mercer upon
the e)o(We) 69 toned smperry for inspersion proposes, harmle
-IW7l erose indemnifyane keep dthe
sector no against
VJ
V.Z
-
whiharnl
liabilities, J dpier, is, coats and poorer which y, n any ypec gainer mid
eny ay
City nc nse9 enaofthy8 - t gofthis pe t - - " •-
City
APy�c `�' NDFRS W Jn AND WILL COMPLY WITH ALL ON� I'
sot�fleF&Eo 1A a/r
Issued by:
Occup t
d O u
r : _ Ow.0 or a
Signature of Applicant Date
All roof coverings to be Class ` B" or better
OFFICE -_ __.
ate
,plicam/Comra �' ; Dore-
Re -roofs ,.
HAZARD' S MATERIALS DISCLOSURE"`1,i':,'_
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apidamn or future Wilding occupant store of handle ham,dous material'
_Type Of Roof...
Cupenn Municipal Cd Chapter912. ad he Health dSl,y'
55321.P.,isOit Na + 1 I t 1. „
r \
shall be inspected prior to any roofing.matenal being_ installed.appli
ich
Por deflood he
a equipment rye nage. an,
.in
a avant w i d fined ) the an ArcnA y - g
r r o rt einem,
_All -roofs _
If a roof is installed without first obtaining an ins ection; I agree to remove -
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all new materials for inspection, Applicant understands and will comply with
all non -point source regulations:
_
d Ne'h zmd us mat , Is a-"nd Chapie fi.95 of the
hcnimslropu2nrents5533
'_ "-' -^ +- • . _ -. .. _ ..
ti& heti ty Code. Seen,,.,
d 255341 understand that'
new not carently have a tenant. Na, it is any ruponsibiliry m hot FY tic'
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req re lsa h c t1f linsi be met pr or to ssu ce of Cen'fieem uff
, "1
Signature of Applicant Date
All roof coverings to be Class ` B" or better
OFFICE -_ __.