00100031 CITY OF CUPERTINO ..
BUILDING]DIVISION '. PERMIT ' CONTRACTOR INFORMATION:
.— BUILDING ADDRESS: PF.RMIT,NO.
OWNER'S NAME: APPLICATION SUB DATE
7.0792 W. ESTATES DR NOEHR MASONRY 00100031
PHONE: „ SANITARY NO. CONTROL NO.
CHIANG 17445 PLEASANT VIEW AVE 10/04/2000
O O ARCHITECTIENGINEER: - C L BUILDING PERMIT INFO
6,L 408334992? - BLDG ELECT PLUMB MECH
ao, 1=1 O CI CI
2 yLICENSED CONTRACTOR'S
DECLARATION-1 hereby affirm mal 1 ten licensed wader provisions of Chapter 9(ebmgteneing
Pit. withSection Talbot Division 3 ofthe Bananas and Professions Code,andmy license ,
�mS is in full force und9�erGytppp
License Chtss'_( I.ic.#—.L/ �_� .. .
Connector .
nEcF'SDHC A'fION - - ,.
r
�d y19hal'n °' d cres°rd' CHIMNEY REPAIR
wA po O Licem J vd�' oral It -
1%C OWNER-BUILDER DECLARATION
I h redly mfina then 1 an,enemy,historic Carleton',License Law for the ,
I"Z< following reason.(Section 7031.5,Business and Professions Coae:'Any city orcoumy .. '
F which requires a panni,to construct,alter,improve,dcinolish,or repair any struemrc
C
s, list he,filar ed no nimgo theprovisio ,.1 for Corm.nit lotileastgnpdsmnde,9
list wo Section
3 o Ce Business
Licenselxw(Chupter9 - 5'(I, I+st, FloorArea - Yallatlnn
or
a ingwOh Secrfon7000)ofliehavonor the
excimp Professions Code)
s„
or Shotio is 31 5 by
,borefmm am ,he basis for ubj alleged replicant to Any l Pennon
of Section e th n by uny applicant Tura permit subjects,he applicant m n civil penalty
or nm more man fee hundred aounm(ssnJ). DPN.Number - Occupancy,Type
❑1,as owner of property,or ertpmycei with wages av their soic catnpeasa,ion, $2000
will do the work,and,he s,melm,Is not intended or,offered far sale Ises.7044, Required Inspections
Business and Podowhms Code:The Command,',License Locs b,aw dnot apply in. CI "
ocaner of property Who builds or improves thereon,and who Lines such work himself
r though his own employees,provided mar.such imprayemems are not intended or 36907032. 00
mrered for.ale.If,however,the building or impmvemem to sold within one year art e '
iemple,ion,the owner-builder will have the burden of proving that he did no,build or y' '
ntpmoe rorpamona or-.ale). - •,1'01 — FOUNDATION
❑I,as owner othe nopery.ardexcin.ivelyenmmcar,wonderrendcontractors" 312 CHIMhIEY .REHAB R' STRAPS
,nstruct mf mm
e project(See 7044,Business and Prosomas Code.)The Coeme'a
construct Law Lines no,apply loan owner of publicity who builds or improves more'"' 514 — FINRL PUBLIC -WORKS
and who counters for such pr jects wbb a commentans) licensed pursuant In the
Contraaoth License Law.
❑I am exempt under Ser. ,B&P Cforthis al -
Owner t Dan, J "
W'ORKER'S COMPENSATION DECLARATION
I ncrebv mnrot under penalty orperjury one or ire r�nowing daaarmions: -
❑ 1n I umaintainren t 13 , , u'b rerewr he
Counts, .mi provided ( r by i Seen.,, Cmna 1 to -Labor Code, for the -
,promm.el the wank for hichdat, vornit is med.
❑I hove and w II rCode.n WrnAer a Onamformnce of t e workce,as requ red by SentoS
371%1 leave
the Labor nampl for the performance of the work for which this permit is
sued.My Work e Campensmion Insurance carrier and Policy n tier arc:/yp
Policy No.; BS �W
CRI IFICATIONOF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
(This section location be mmplmed if We permit is far one hundred dollars
($1 W)or less)
1 certify the Ia,he performance of the work for which this permit is issued.I
shall not employ any person In any manner so as in become subject to the Workers'
' Cmnpersatlon Laws of California.Dane
Applicant - -
NOTICE TO APPLICANT If,after making this Cerifea,e of EscrO dim.you should -
become subject[,,,he Worker's Pompensmioo provisions of the Lahar Code,you mus, _
zforthwith coreply with such provistons or permit sial t be deemed revoked. s
z0 1
FCONSTRUCTION LENDING AGENCY
a I hereby afBmt that them m
in a consumption lending agency for the perforance - - -
W of,he work to,which this pennn la,ssued(Sec 3097,Civ.C.) .«
A Lender's Name _
is z Lender's Add,,,,
V 0 1 certify that I have read this application and state that IN above infnrmmian is '
W F. carmen"1 agree,o comply with all city and county mdur ancea and eInto laws claim, - -
0 [) ,o building construction,and herehyautherim representative.s of this city to enter upon -
�„ W the h m tt pulproperty f .pea purposes.
ti LL (W) be to s d 'lyand k , .stheC'ry fCprinn against
h Cit I', j q a ts, n Li p ses h yin uny y ,aim,said �1..
U 'Z ata consequence or g t g nh p t
tti OUL AM1 UN A STSNDSAND W MP ALL NON POINT Issue by: Mateo
Signa fA iennocortmemr - D Re-r fs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hmallous material Type .
as detinet)by the Cupertino Municipal Code,Chapter 9.12,and the Head,and Safety
Code,Section 25532(,)?
0 V0,- El No All roofs shall be inspected prior to any roofing material being installed.,
Will the coliountorfuture,buudie,oceupantaw im,nion,oraeviatwhich If a roof is installed without first obtaining an inspection, I agree.to remove -
call,linimousaircound units as defined by the Bay Area Air Quelity Management
Di,tr t? oNn all new materials for inspection. Applicant understands and will comply, with
0 Yes all non-point source regulations.
1 baso read me'haedbdnuc mmedris requirements under Chapter 6.95 oldie -
Celiftend.Health&Safety Code Seu'on 25505 5593 and 25534,1 u d r ural that t .
J,1 b 'IJ'ngd c. nwrrently hevcoc S tl' mycw, 'Imhq :ffye, .
cep fm giren pks Mich an'tb prior ani. arc f C 'fcneof
or, uny. 1 - Signature of ApplicantDate
o_ . 617
' owner dagent Dme - All roof coverings lobe Class"B" or better'
OFFICE