01090082 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1050 CRANBERRY DR CUPERTINO PLUMBING 01090082
OWNER'S NAME: APPLICATION SUB DATE
AdkkHAR THOMAS C AND CAROLY 10297 S DE ANZA BLV 09/20/2001
•HONE: (408) 253-0618 SANITARY NO. CONTROL NO.
G Zo ARCHITEC"D`ENGINEER: BUILDING PERMIT INFO
ec BLDG ELECT PLUMB MECH
"5 h I hereby affirm that IDam ICONTRACTOR'S
icer al underr provisions of Chapter 9(commencing Job Description
with Section 7")or Division 3 or the Business and Professions Cod.and m license REPIPE.
' reran forte a�a�(eet. /
License Class ` Lic.X !O 6
n
are Commaor
3 3 LL v ARCHITECT'S DECLAto TI
I understand my plans shall Ce oud as public racmd,
t i
'2 Licensed Professional
n 5 OWNER-BUILDER DECLARATION
I hereby athat 1 am exempt Prom the Contactnr'e license Law for the
t z< lTtm following reason.(Section]031.5.Business and Professions Cade:Any city or county 4 O O O
I F C which requires a permit to construct,alter,improve,demolish,or repair wy structure
ad
In 3 m ono m is •.,,.• Borry' de Folk if cn P< 1m Rhaasid.....meno- _ .. - _ __ _____ ___
thpttt,sl sedpmu a d;ip fth C tact Ucmv Uw(Chaprcr9
(continuing with Section]%0)of Division 3 of the Bq ;and Prof¢;sops Code) 13. -Y4:Ag8r'.4 6aaj sYl.
Valuation
or that he is exempt therefrom and the bass for the allege8 exem;nort Any violation
of Section 70315 by any applicant for a permit subjects me applicant to a dvil penalty
or not mom than fin hundred dollar,(axon). 2024PN rRFLOOR PL BI'NG" Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation, i
will do the work,and the structure is not intended or oReted for sale(Sec.7044, 'Y4aa ( iY
Business and Professions Cadtra
Cade:The Coneor's License Low does not apply in as 502 - FINAL P $&3s
owner of property Who builds or improves thereon,and-1W does such work himself 507 - FINAL PLUMBING I _
or th gh his ply p thio art provided such iniqua dorms not intended or
oRcieE(or sale If however,theWilding or improvement is sold within one year of
completion,th nellbuilde,will ban the burden of provmg that he did nor Wild or
improve for portrait f salej,
_
❑I of the Property exclusively contracting with licensed contractors to -
truct the prgat(Sec ]OVI Business and Professions Code)The Comranor s '
� /1
License Ww does not apply t of pmpeny who W Ids or impmvxs thereon, I \- "11
and who comru¢for ch p 3e t with a contrector(s)licensed Function or the j
Conbactors Lrcenu W - --- -_
❑lam tumor senders c' B&PC for this reason !'(
-• WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perxhy of perjury one of the following decimations:
❑ 1 have`and will'mainuin a Ccdificate a(Comms to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade, for the
par(oremnce of the work for which this permit is issued.
❑1 have and will maintain.W.iker i Compensation Insurance,as required by Section
1, 37M of the Came Labor Cod f the ple fomnzrne of thework(or which this pemdt,s
s° a C pe i 1 umrance w e aM Polity bet arc: '
o
rsw d '. \ rk i 9 PolicyN "/ / J O IVq a(D .-7,(
Y
PU ICATIC OF EXEMPTION FROM,WORKERS1 (- 1 , „sem t"!_3 't tyca aC. _(�s .,`l.
`COMPENSATIONINSURANCE_
($ (This union need ttd be iromplei a if the permir is for ore hundred dellen n t' ----
ISIOD)orleu.), '
I c d fy that in the m moron,m f thework far which this j pemdt rs issued.I �• •' "" " " " ' '
shall notation y ny Perm y nu so az t become subject to dr Workcn .. '
Contpenseoan Wws of Cabm
fone Date
. Applicant '•,,.. .� ._ ..... .. ...
r
I ET'OAPIf.afterranking his fen fcmeuf Exmpon,yau should
� zbecome subjectotheWor ' Co pe .ton provisions ofthe laborCade youa=
Q forthwidi ply with xth provisions
or thispe t shall be deemed rtvaked
CONSTRUCTION LENDING AGENCY
1 heteby,hRrm that theme is is construction lending agency for the performance
of .,
4L_ti the's Nim h'ch ih pc i s issued(S i09],Civ.C) "" t "
U 1 certify the I hove read this application vad start that the above information is
ga F camecL,I agree to comply with all city and county ordinances and state laws re ming
C.,(, to Wilding consuu2tion:and hembii auttiorize representatives of this city to enter upon
}_w the above-mentioned property for inspection purposes.
,r..0.� Dc)
agree to save.Indtrmify and keep harmless the City of Cupenlno against
R] liabilities,judgments,costs and expenses which may in any way name against said
-U zCi - n acne f the giaminS of Nis permit.
'A LIC' WD STAN AND WILL COMPLY WITH ALL NON-POINT" I
- = S 1 N -r. 'r,. � Issued by: Date
' Signammof AppliwoUCo nor "' " ' •' - Data
HAZA MATERIAL$DISCLOSURE - Re-roofs
Will the PPbcrrm mttna Wilding odc.,.t store or handl ha eraats maemd.. .'Type of-Roof ,. . ......-
as defined by,the Cupen Municipal Code,Chapter 9.12,and the Health end Safety - ' ' - "' ^-
Cade Secdo 255321a1 +. sJ,+
oys oNa riIs _ All roofs shall.be.inspected poor to any roofing matenal.bemg.Tnstalled.. _
r
Will dthapplicant i Tut holding occupant a equipment devices em rb If a roof Is installed without first obtaining ars inspection;I'agiee'toi'eirlove
mit h rdo contaminants e defined by theBey A A Q al ry Management
°"r 'oY ON all new materials for inspection..Applicant understands and willcomply with
all non-point source regulations.
u I have read the hazardous matenalx regmremcnn under Chapter 6.95 of Ne
Calif Baia Health&Safety Cone;Sections 25505.25533 end 25534.1 understand that
if the building does not currently ha%e a tenant,that it is my responsibility to notify the - -'
occopSnt of the requi cots which mast be met poor m issuance or a Ceniftcata of '
Panty'
,. - .,
Signature of Applicant i Date
tmhom age t s Dane. Al] roof coverings to be Class "B"or better
ICE-
OFF ,. . . ..