02070167Chi
CITY OF CUPERTINO
BUILDING DIVISION
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CONTRAGTOWINFORMATION:',:
PERMIT
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BUILDING ADDRESS:
10394 GLENVIEW AV
WATER HEATERS ONLY
PERMIT
N82070167
°1A RICHARD J AND URSULA
K970 E. MAIN ST, SUITE 200
APPLICATH3l35p&DATf2OO2
/LD
VNO.
PHONE:
(415)566-2209
SANITARY CONTROL NO,
ARCHITECGENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u C-1 L."7 L J
LICENSED CONTRACTOR'S DECLARATION
flOn
I hereby aRnn that l am licensed under provisions of Chapter 9(commencing
REPLACE' WATER
ith Smion 700010! Division ] of the Business end Professions Code, orad my license
is ce full (arca an rch / �1
J fs
License CJpas
Date Cmor N!
5 ULC
ARCHITECrS DECLARATION
I undersmrrd my plans shall be used ex public mcoNs
Licensed Professional
OWNER -BUILDER
mDECLARATION Contractor's License Law for the
1 hereby affirm on 11. exempt from rbc Cessions
following rrm0n. (Section ]031.5, Business Professions Code:
$700
and oc Any city or county
which construct. vltee improve. demolish. or repair any structure
ogorn
licemod
orequiresiwtS
.. cheap from firrousch
oat lme
I`w s 36q JfC wNWG.,M(��
lH03tY
Valuation
ocdatetemmt
Shatr
that is [Lased pursuam m C.a.rmiuoiense Low
die piasonsof rhe ConwnnesLcense Lewons (Chapter e
and Code)
(commencingthe, ,nrpt,epc'.anOfDivision
(. 1.,'.tt),�,z o.,a s 1\.�'Y'1``4r
" ` 1
li and the basis for the alleges
ordaealegedcsino Any
Any viPlnaon
Shot he a exempi rany
of plicanon.
of Section applicantfor o500) subjects the vpplicvm toacivil Penalty
p
C]ive
not mo903
'ar sur mala Inert rue nanarca dollars (ssom.
hudredoll
Pad
ccupancy Type
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01. as Owner of me propeny.o my employees with as their sole compensation.
506 — GAS TEST
,
'will 'do rhe"work: and the structure is -not intended or offered for sale(Sec: T044,'"but
_ , . - .,
spectlong -
'Business and Professions Code: The Convector's License Law does not apply to an
owter of primeny Who builds or improves rbercon, and who does such work himself
or thmu h his own employees. provided that such improvements an not intended or
is within one year of
offered or tile. If however. the building or imen
... ... .... ..._. _. ._ _. _..-._ _._ _. ._ ..__. _._. ._._,.___.._.._._.
;.t_ <. '-
of prat toldhe
completion, the owner -builder will have the burden of proving thin he did cwt build or
improve for Purpose of sa1eJ.
OIrte Owner o(Ncp(Sec.
lam BusinrvclydtmcungwNlicensedc Contractor's
ontrato—to
License me project (Sec ]044, Business and Professions Cotle) The to
License Law dos not apply to an owner of property, who builds or improves thereon,
thereon,
'
seimprove
Prolttss with e.contmnor(s)licen¢d pursuant SosM__.___._
_and_wha's
..___.___-____.___.—_�
Conwnols License law. -
License Law. -h
❑Iemexemptunder Sec"' �� �:s ;B�RPCfonhis reason
_.... ...... _._'_..--.
i?`:�1 c'Oi•
Owner
C
FINALED
" WORKERS COMPENSATION DECLARATION
\ ` I hereby aRnn under peneltyi f perjury one of the following declantiom:
AUG 0e' 2002
❑ 1 hula and will'mainmin a &rdiRed, of Canute to self4sure for Worker's
,
Compensation:. provided -far by S.d.. TJ00 of the Labor Code, for the
parfarmence of tAe'work for which suis permit is issued.
1.
BUILDING
B U I LDI N G
�37011 have orad will meinuin.Wofkei s'Compcnsaiion Inaumnce, ai required by Section
.w
3'.f he Labour of f du work f which this pcmut is
pis,_MyW lief mrnf s�t one lira s em rand mbcr
.Policy
'Policy Z/n
r__ -
Carrier Nn t�0✓7
t CER FIC TIONOF EMPT[ON FROM.WOR_RS J—
5°,711.1. ,rV
- -1',' tti r •dr'' , f1.4 \. t ii !w`]
_.., r;__, COMPENSATION INSURANCE'•;"""' -,.,
L3J(,fe - .r .., .. ,. in
ITbiisenibn ntied not be mmpined if the permit is for one bond rM do[lats
•'
15100)0 less.) .,,,
_] that the ed, l
any'eoflhe o kf r which Njecttois
_
shell oat employ ony; pc e.tau
pat in any minner so as m become subject to Ne
1sf41 ❑.r, ,, ,I t,ds1
dal
SWorkcn
.Ii .
Comicant an Lewes of COifamia!Date '
Applicant.::, .0 ..
..
If. makingthis of
NOTICE TO APP LICANT.r's aftCo
lode.
..._.._ ._ ._.
,t:'.=."- :• ':'+.-•-'• .
the pensiti nPrCisionso Labor Code. you man
you
bedhrtsiti pr Compensation permit onil
comply
forth rah comply with such provisions or
such this permit shell be deemed revoked.
PY P be deemed
^tr CONSTRUCTION AGENCY' """
" _C .,r
ormstrLENDING
1 hereb Rnn'that dome s canswctr dlendmg agency far the pcAomunce'
. • .1 ,
of the work f which this perms is issued ISec 3099, Civ, C) - ' "
..tenders Neme.:._.•. •.
_. _. .__ _..._._.__. ... ..... ....__.
- .- _._. _._.... .._...... .
Lend sAddress --• r
1. ...1 .n .., ..,
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1 cemfy that 1 have ad this application d state that She above information is
'
coved. ( agree to comply with all city end county ordinances and nate laws relating
mbuilding convection! ad heabyauthoAu reprtunutivnofthiscitytointerupon
the a scvcmemioned property for inspccdoo purposes.,
r M'0 agree m mmlindemni(y ind keep hatndcss the City of Cupenino egainn
liabilities, jud$gmems, costs and expenses whmh may in any way aecmeregainn said
CiSYmconmqucnu she
of grei gof Nis permit
APPLICANT UNDERSTANDS A a WILL [OhfP\'17H ALL NON' Of '
souRCERErnrLAno - Z
Issued by: Dat
SignbNlc pf Applinn✓Cenwaor """""""' "Det �
Re -roofs
..' HAZ4RDOUS A9ERIALS DISCLOSUREI I'
-
Will Ne applicant or fumrc bu Id rap acupenl sort .handle hezardoua net rad
�d
,Type of Roof .. ..... ..
as,:
B N by We Cupen w M n 4paltCode Ch pt r 9 I? end die HnIN end Sarni
',-
- v" ..
�..11..
S;'�,.
Code S❑ecYs 35532(0 \➢�� �` %I 3 ). d1rt r _
S , i.6•' :I•
All roofs.shall.be inspected prior.to any roofing.matenal.being.installed_..__-_.
Wall the epplrcent or futurcb ddmg ac p.nt sae quipmenl rar devmeiabvh
__
If a roof is installed' without first obtaining an inspection,hagree to•remove
ever hazardous nr aonmmments ei defined b) the Bay Arca Mr Quehly Manegemem
D.:met^
,�, �� /�
.'; ❑Y �IEpr Fry t ;•
a new materials for inspection. c to th
p _t untie, s, and will_comply _..._...
non-pointrsourceregulations.:A Applicant understands
all
1 he a read the hmmdouamaterials req herecins under Chnpm, 69]'of ilia
Celif mit Health g Safny Code. Sections 25505Q5533 and 25534 1 understand that
' -
tribe hulloing does not ormody that it is mynspansibllity to ramify the
have atst
.C,— -
w he
oceupam of S e'rcquire si .which 'si'be'mei pnor;mrissuance of ¢ C i0cete of
Occup
S '� �
Signature of Applicant Date
All roof coverings to be Class ' B ' or better
own udron g p tr.: `
I.
...OFFICE- _....,_.._...._ ._. .,. _....._.._ .____.....-...._......_._._ _.-_,
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...OFFICE- _....,_.._...._ ._. .,. _....._.._ .____.....-...._......_._._ _.-_,