01060146 CI saOF ISI
t DI I
G DIIVONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21618 FLINTSHIRE ST CUPERTINO PLUMBING 01060146
OWNER'S NAME: APPLICATION SUB DATE
MORRISON ROBERT A AND SYLVIA P 10297 S DE ANZA BLV 06/26/2001
IIONE: SANITARY NO. CONTROLNO.
(408) 283-0618
En O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
al — BLDG ELECT PLUMB MECH
L_] 171
y_ LICENSED CONTRACTOR'S DECLARATION Jab Description
z_ I hereby.Iiren that I am licensed under provisions of Chapter 9(commencing
with Secu.n]0(10)of Division 3 of ma Business and Professinm Cade,dad my license RE P I PE.
e Y
is.full force and Ifct, e J
a,z u Licrnse Class — Lic.Contp to b
3 a nm ARCHITECTS ac LA I (/
= g 1 understand my plans shall he used as public records
id O O Licensed Professional
a�R OWNER-BUILDER DECLARATION
I hereby afium that I am exempt from the Contractor's License Law for the
F z following mason.(Section]031.5.Business and Professions Code:Any city or county $5000
ccF G which ane ireper
a mm it construct.tutee commit,demolish.ar repair any marome
Lo-se
prior to 1so martilia,am millwant M1Permit t file i sighwal trumnical.
thathe r1licensed pi mrothpj u :of0 Coull,clarl'Le Law Chapter 3�®�}y.,,�tOOr�GCa,., - Valuation
(c m g sh Say ]tNN)) f Domain 3.nne Bashes,and r areaamna Cale) 5 6U l7l Ls. V_r t x 1 � i• s
or that he s exempt therefrom and,he basis for the alleged exempho 1.Any violation
of Section 70315 by any appleal for.permit subjects the militate to.cwil penalty
mf not more teas five hundred dollars(S50u). 202`1 bK6211ZFLOOR PL Occupancy Type BING '
❑1,as owner of die progeny,or my employees with wages vs their tele compensation,
will do the wars,and the structure is not intended or offered for sale(Sec.7011, �T�
'Business and Professions Cafe:The Contractor's License Law does not apply to an 5 02 — FINAL P np�
s N1RRGY,
owner of property Who builds or improves thereon,and who does such work himself
or through his awn employees.loo building
that such improvements meets vol nor amended m 507 - FINAL PLUMBING
completion,
she.owner however,me building or improvement is toed within one year of
completion,the ma,cr under will have the burden of proving that be did not build or •'
improve for purpose credit.),
construct
owner polite pmpenamexclusivelyY• exclusivelyco
y nvaaing with littnsed ma
mnorw
s
cm,<w - _
n the project IScc.]MS,Business and Professions Chi The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
who contracts for each projects with a canvanorlsl licensed pursCanr m me
Contractor,,cs
a License or s
❑I am exempt under Sec ',B&PC for this meson ..
ow r Dae JUL 1 6 2001
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under pewiry of perjury ane of she following declarations p 1
] I have and 'will maintain a Cenincme of Carl m eelf-imum far Worker's BUILDING
Compensation, vs provided for by Section 37W of the Labor Code, for the
performance of me work for which this permit is issusq
❑1 hive and will maintain Worker's Constellation Insurance.as required by S«tion
'- 3701)of bre Labor Code,far the Preferential of the work far which this pertni,is
iaued'�.�M��Yff,W,�or1kers Compensaliogqln ranee Cartier and Pofcy number am:
Cnrsied^"'3�I,L
CERTIFlCATION
_...— . ( .. COM1IPENSATION
(This senium need not Le complemd if me permit is for ane hundred dollars --' ` -- -
Sil or me,
.hull nm e n
minify
that in theperfrm c of the kTwhichttispe t Issuestl _
p y any poriaso in my l or us m became.abj 1,al he Workers
Compensation Laws at California.Date
..Apel' ora
NOTICE TO APPLICANT.IL after making this Cenilicmc of Exemptian.y.0 should
Q 0 became whjen to she Worker's Compensation provisions of the Labor Code,you must
foal comply with such provisions or this pe.is shall be deemed revokM.
Z . _. _ . _ .. .. _ _. _...
E " 'CONSTRUCTION LENDING AGENCY
T hereby affirm that then is v construction lending agency for the performznm
bf the work for which his permit is issued(Sec.309],Civ.C.)
a,•C Lender's Name. . .. _ . .
U Z
Leader's Address' - - , 'v,,,,
;a, 0 1 certify shoe 1 hove real this application and sol¢Dat the uhovo informmion is
�To F corncs,I agree m comply,w1m ail,lily and county ordinances lad nine In ix miming
= Q'V to building construction.and hereby umhorize epresersaives of his city to enter upon
:W he uhave-mentioned fairer,for inspenise purpoacs. .
.�.r 0. (We)agree m save; or Cad keep hatmlessme City of Colosimo.against
V1 liabilities,judgments;costs and expense..which may in any way accrue against said
U z City in conic uenc00'she graming,of this pertnir.
A. NO S] NDSANDWILLCOMPLYN'RH(/ALLNON�POhNT Issued by: ate
_ S+malli re afAp b err Cn ashw,' ` Dole Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
ova �4�, . . .. . . ._.. ..... .._ _
-Will rn pylic t formbalding W t t mh dl b Nousmaeeal Type of Roof
undersell m CuMonte Cera Chat.12, l theH hand Safety
Cal Section' 25532a)?
(al All roofs.shall be inspected prior.to any.roofing material being installed
carrWill the applicant or ferule bold, goc pant use c4 proem devices-which If a roof is installed without first obtaining an inspection, I'agree to remove
rya acrd anomunu as defined by the Bay Asha Air Quality Management
°saner all new materials for inspection. Applicant understands and will comply with
Dye all non-point source regulations. .
1 have read the hua,Sms materials requirements funder Chapter 6.95 of die
California Hea1m&Safety Cade,Sections 25505.25533 and 3531 1 undersand that
Write building does notcurrently have a tenant.thin is my responsibility to notify thepan of,1he q m t which must be met prior to issuancent a Certified¢of
xcc"uPY 1 / 7L "'{7
Signature of Applicant -,_ _ Da[e-. ., ..
ow r teamed erg , Dare All roof coverings to be Class "B" or,better'
"OFFICE - '