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02010001 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO, 10167 COLBY AV MICHAEL CHIkL 02010001 OWNER'S NAME: APPLICATION SUB DATE MICHAEL CHIN 01/02/2002 • PHONE: SANITARY NO. CONTROL NO. O re0 ZO ARCHITECT/ENGINEER: BUILDJUITPERMIT INFO z u- BLDG EL PLUMB MICH L1 ¢d z z Z- 1 hereby affirm Na LICENSED amONTRAd under provisions DECLARATION Y(commencing Job Description O N_' pr vino per g P-_u with fallfrpeandef Division3of she Business and Professions Code,an0 my license RE-CONNECT METER zY-< is in full force tnd effect. K O u Date Class Lic,p t - Doc ContSDECLAr w LL n ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records f3T n d p O Licensed Professional x o a OWNER-BUILDER DECLARATION st m 1 hereby affirm 1 bre exempt from the ContractorCI License Law for the F' < following mason,(Section an]01 L5.Haziness and ProfessionsonsCale:Any city m ccumy E a which requires a permit to report alar,improve,demolish,or repair any structure $1000 a 3 m -prior to its issuance,also requires the applicant for such permit to file a signed statement Nat he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9OOfValuation mornmencingwish Sccixxi_7 W) of Division J of the Business and Professions Code) lzA{eap l I � r,,; or that he is exempt therefrom and the basis for the alleged exerrpdon Any violation `4k V V of Section 7031.5 by any applicant for a permit subjects she applicant to a civilpsralry _ �.7�m�C of not mom than five hundred dr,frox S500), 304'? ELECTRI AL�f'• I Occupancy Type ❑1,as owner of the properly,m my employees with wages as their sole compensation, will do the work.and the structure'is nor intended nr offered for sale(Sec:7064, RINAT RIRCTRT AL ENERGY - - - - Businevs andTnifessions Cale:The Contractors License law does not apply to an 505 - FINAL ELR€9ito�_�Li%Epctions'' ." - twom,of properly Who builds or improves marten,and who docs such work himself or through his own employees,provided mm such improvements arc not intended or or szle:If,however,the building or im--'_ "'I is sold'wi'hi'n'd a __r_f - -"'-"'_.,___...._.".. . orepJ g provemen n yearn completion,the owner- ilder will have Ne burden approving that he did not build or improv ,mU o soled. owI',odmm property. exclusively contracting withf sed masers to c r a he p l n(S ]DLI B se dP f Cod.) e C tactors // License La doe. t pap[ per of p pent h Wildripp p tarpon,the C .and who cora acts f h framers.with t enor(sl 1 tt d p the _ G 1 1 License uan ' ❑1 m< rept Qd t 1` B&P Cfar enis..on ,iI Ousbar WORKER'S COMPENSATION DECLARATION I hereby affirm under pemalty of perjory one of she following declarations: . ❑ I have and will'mainp,in a Ceoificme of Carrier' m.olLinsme for Worker's Compensation, as:provided for by Section 3]00 of 'he Labor Cade:far the _ > performance of'he work for which'his permit is issued. . O 1 have mid will maintain Worker's'Compmmiioh loeuance,as required by Section 37O0'of the labor Code,for the performance of'he work for which this Penni'is issued.My Worker's Compensator Insurance carrier and Policy number arc: Came K t ie CERTIFICATION OF EXEMPTION RANO WORKERS'. _ I f t x ♦.'°.. `t{t j !s�'a la w - COhIPENSATION INSURANCE" J.') n need not be ample'eJ if the permit is for one hundred dollars - (5100)or or Icss.)ulo 1 certify n th p'f ' oter k h ha.mspe usissuer1 a " ih sp en employ any pe son n any manna so at to becamesubJecs to the Workers - Compemaion Law.c of California.Dam Appliceir •NOTICE TOct1.APPLICANT.IL after Compensation Certificate fExemption:def6.should mail 'become hwithc ropy the such Come,or is pr.it'ha of the deemed Cole:ymu must Q forthwith comply with such previsions or[his permit shall be deemed revoked. -^F I ` that in RUCf10N LENDING AGCNCY' 'pimps I hereby hickffirin do,pe re izs comuuamn Icndmg s. .) r the performaece , If she work for which mu pennn is issued(Sec JOY].Civ.C.1 � z Lc d AJJrezz r, 1 eagree ma[1 have reed this application any sate that the above information is corren.l ban,o comply with all city and county orduuncee and sale laws relating Q_fJ or bu.... .ema,uaionand hereby authorise'rcprmenmtivesbf this cirymemer upon th b f d apes p rpap [moi 1 eWju gree z �demofyandkeep haml the way f 1 peninarago ns' m liabilities,judgments, :'. J c pcnu which y,'n au Y'cc gainzl zaid U ,Z CnOT1or .ey f egmn Bolt pc 1. SAP I1.� J?UF rA�r A/y[/y L COMPLY WITH ALL\ON-POINT - ig Ulm OOS Issued b �- 1. y: Date gn art of Appl cHAC taco Dale Re-roofs / HAZARDOUSrMATERIALS DISCLOSURE Will Op ppl cant f' holding arae pans s[oa or haMl hazardous 'nal --Type of Roof m asdefcdbytheCpen M palC eChpt 912 and the Health dSafetyyP " "� "' """' """ ^�•" - -- 'Code 5 1 on 2551_0 °Y I. _ All roofs shall be Inspected prior to.any,roofing,material being installed _ 'e curl n ar m- e b '- e-t " If a roof is installed without first obtaining an inspection, I agree to remove m'hax tl m' '. df dbym Bay A qA QtItYM1I dgemm g P g °i m°' all new materials for inspection. Applicant understands and will comply with oY all non-point source regulations. " Ihv 4d'the himr l ' , q ' m nti d do Cb pt a 95 1 the California Health&Safety ode.Sections25505.25533 and 3553a I understand that f the building aces no'cumndy have 't tl mY .p 'tilty nno'fy me per. [arf them wheh u - Prom 9u rc n yu� p o is e f Cenifi to of " O have Signature of Applicant Date _ Owner or authorized agent Date All roof coverings to be Class "B" or better ' OFFICE