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02030111 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 7738 HUNTRIDGE LA ROYAL SERVICES 02030111 OWNER'S NAME: APPLICgTION SYR DATE RICHARDS 4398 MICKER COURT 03/21/2002 HONE: (831) 462-0539 SANITARY NO. CONTROL NO. ' , Mai O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO U F BLDG ELECT PLUMB MECH <rL L7 r_U C_1 C_'J 5y= LICENSED CONTRACTOR'S DF-CLARATION y z_o I hereby affirm that 1 am licensed under provisions of chapter 9 mommeneit, Job Description mCty within 7W0)ofDivision3afthcRus inlandFout.,imsCafe.en mylicense REPAIR CHIMNEY, SHOULDER UP SY I 7 is in fu c angwff t ?' W06Lice )av C—�t'l.ic, On. pate Contractor ARCIi seDECLARATI �j 1 undcrsmnd my plans shallll hense used as public rernmx OO Licensed Professional OWNER-BUILDER DECLARATION 1 hereby strum that I am exempt from the Contractor's License Law for the t i a following reason.(Section 7031.5.Business and Professions Code:Any city m county $1800 I F G which requirespoorer to construct alter, mpm.c amos demolish,or repair any sa 3$ Prior to its' vane,also requires thpplicant for such Permit o file asgned statement - - . . ___ __ _ ... _.... _... _ that haslttnspd pars ml the p Iswns ofm<Conwnors License law(Chapler9 pp hI� lipp,,.. a ! - Valuation (co nnc'ng with Setionio J)of Division 3 ofthe Businewand Enficasnss Code) (�"'.;'r3'§9'�0 fi"Th,:17® a�h.B Sr�,_G{�. or that he Is exempt therefrom and the basis for the alleged eAempt bit Any violation " of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty- .of not monin..fivehundred dollars(aso0). 101APN t( JbATION - Occupancy Type ❑Lasmenter affairpropeny,mmy employaswith wages as emir sole compensation, _ CHIMNEY REBAR r,' STRAPS 'will'do the work,and the sumente is not intended Or'oRered far sale(See.-70i,L' - Busams andProfessions Cade:The Contractor's License Law docs net apply to an 514 - FINAL PTBgiaM IWgGXSns t"'' awns r of pm,dy Wbo builds or improves thereon,and who does such work himself or through bis own employees.provided or such im ent hscros are not intended le m -offe¢d far:ale�IL however,the nuildin--rim mens is sold-ithiii tier! ge prove w geld or oprovei for the owner-hil.).will nava the burden of Proving that he em not hila or ^'improve for purpose of sale.). . .._.-._...__.____-__.__.___ _._ .. ._.wi - T`s� _ _ ❑pas owner of the prapcny am exclusively contracting with licensedcontractorsContract to ■ A® o -` q{License const a the does project(Sec. too Business and Professions Codor The Contractor's d9 /sea �;,,,,. qf" License Low tract not apply to owner th property who builds or improves thereon, sena who commas for loch Prolens.wnM1 a convaaor(s)1 cemed purxuam to Ne. _. _ Col m exempt License Law, p k�py A. q .q OOey _ ❑lam exempt under Sec: � � ,B&P C for reamer � a s f 1� V 4, C L Owns Dat". . WORKERS COMPGNSATION DECLARATION BUILDING Ili rtby affirm under pc shyofp rjury ane of the follo gd Irriions:' A, ry ❑ I nuve'and wilFramnuim.Certificate of Cement to ndf-insure for Worker's Compensation, its provided for by Section 3700 of the lvbor Code. for the performance of the work far which this permit is issued. ❑I have and will'mainum Winter's Comrens iioii Insuruiice,ei requited by Section 37M FG f ih Trow Code,for the performance of the work.for which this pemiit is=' iseued.MyWorker's Compensmimlamrance,rrier and Policy;imaill no:�^ Cun� a. a. FICA XEMPI " CERTIPICATIONOEETIONINNFROM WORKERS" COMPENSATION INSURANCE..' (Th ct oiineed hoe becnmpined if he pernit is for one hundred dollars ... , . t- (5100)or less.) O Icarrifyffirm In h' Provisions f pihpI,of the workf which thspmit is,sel Y shall t enae Compc aro ay."'. yva bJetoh Wa k rs _ _ ._—_._..._ _. .. ...-._.. -_ ._._- IN OPPLCANT (ter making Certificate Exemption,. should z become uhl no theWok Ctionp hdonsof thL de you must forthwith mply with h P :inns or this permit nhailI fwd deemed revoked , _. - ' s ' pr arC at the Cf10N LENDING AGENCY 1 hertby'Rmi that the i a wet leading agency f the peOfonnana of thework for which this permit¢ismed(Sec3097'Civ.C) a,Q -'Lends shame �•... :.._..:. ... Jqi..._. •L. Ur Z Lenders Address ' ," '( 1 „ I .,t . • J. t.n :k ._ „y I cemfy that I have and this application and state ihm he above information is -[r correctrl egad to comply with all city and county ordinances and state laws relating to building conswction:end herby euthonad representatives of mit city to enter upon the above-memionem propm,fur inspersion pmrex..i po fr LS, (We)agru to saehdemnify and keep harmless the C'ry 6fCupenmo ePurs, Fn lin liabilities Judgments,costa d expenses which may n my y Beane egam s said V ,7� City r co eq of gmaing of Ihit pd h ” PPLICANT UNDE TNDS AND WILL COMPLY WIT ILL NON. OINT'!` �• /� �� OR cuL I S - r_ Issued by: Date Sigatilisilidf AppllctualCmunnew '--T—�';Data"i(,i Re-roofs ;' HAZARDOUS MATERIALS DISCLOSURE W , - '. Il the pplicam or fumrc building od.,sm store or handle harsrdou imamal _Type.of Roof- "Bred by.th C pert Municipal Cod Chapter 9.12.and me Health end Safety I' 1 '— odeS❑Y 2j532(i) ❑Nos,'. ly,.c f �. s E ''t°•, ! %' tp "lc('s i.�' 'i,1 .-i le m All roofs shall be spec[ed prior.[o,any_roofng.material being installed. _ Will die eppl a t or future buiId ng occupant use equipment ode des with If a roof is installed without first obtainin an ins echoer, I'a ree to`remove mit hexamouseu c numi ants u d fi by m Bay Arm A Quality M nage em g p g Dismn all new materials for inspection Applicant understands and will comply with rl t, , r - _ . — _. _ _. ._ 11 I I have read the hazomousmmenals regmremenls antler Chap¢r fig all non-point source regulations- '- Y \ understand the Ifahfomta building dos Safely Code;Sections 25505xt it and responsibility 1 understend that If Ow r Ili_-r esPom b I ty to n u(Y the or uta 4 ssuan c o a Ce fiats ( ' occu rat of the rt n rats hi h mu t be met dor rte p y q p 3�Z1 f G2 Signature of Applicant Dae . e Ing acs net rrcm y have tenant that t Is my r 10: g .Dona All roof coverings to be Class s`B"or better 1 OFFICE CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORIINFORMATIOi BUILDING ADDRESS: PERMIT NO. 7738 HUNTRIDGE LA ROYAL SERVICES 02030111 OWNER'S NAME: APPLIC TION S B DALE RICHARDS 4398 WICKER COURT 0321/2002 i� HONE: SANITARY NO. CONTROL NO. (831) 462-0539 rc z ARCHITECf/ENGINEER: GIll O BUB.DING PERMIT INFO lj BLDG ELECT' PLUMB MECH D o E,'I 1.._1 w i LICENSED CONTRACTOR'S DECLARATION Job Descri tion x z- I hereby effect that 1 oro licensed under provisions of Chapter 9(commencing p ,yt with Sectio 7000)ofDivision3ofthe BuUsi9cmand ProfeasiourCarl my license REPAIR CHIMNEY, SHOULDER UP y g y is in to a endwR I y r rc0 M Lice oss C- •1 e.tr Data Commmor ARCHITECT'S DECLARATI y 1 understand my pions shall be used as public rccoNs i I i p O Licensed Professional R t4i OWNER-BUILDER from DECLARATION 1 hereby affirm that 1 oro exempt from the Contractor's Co License Law for the t a following reason(Semon 7031.5.Business and Professions Cade:Any tiny or county $1800 18 0 0 �I It o which requires n permit re wmwcl,palter.pli,improve, permdemolish,or,pair any structure Y 3- anormi¢wenance.slaoonto me the VISirr wRustics pecmivo Bleaei-aw(g ,mem _. this(commend,aud who Seed.l to the ofDi Division Ofthmn3o COuhe Business Licenselaw(Chapter9 (rohathe IngwiNSasian70W)o the basis ar te.1a,cBcoonQont.Any Code) '13 J`)CY�Y"Y�-170:'i \' < I Valuation or Then he is exempt N y of li end the basis for the"s cA creation.Any violnion of Seniors 703 LS by any applicant for a pemdt suyens Ihceppliconuo a evil penally of not mom than five hundred dollars($500). 10 1A PN 4'M-keFDATION Occupancy Type ❑1,ax owner of the property,ur my employee¢with wages ex Their sole compensation. Vill'do the work,and the kuacmre is tat intended ne aBered fol'sole(Sec.704, Business and Professions Code:The Con recuu-s License law does not apply to an 514 - FINAL P1B3*JreI IItlQFMns ' own"of property%a builds or improves thereon,and who does such work himself or Nrouggh his own employees.provided that such improvements am not intended or offered or sale.If,however,the building or improvement is sold vithina.Cycv of "' - ----- '- - - -- - -- --- - completion,the owner-builder will have the burden of proving that he did not build or ` improve far purpose of sale.). " . :-. ❑Lesowne ofthe property,am exclusivelydProfeisi with dc;)'Me Contract no - [ construct the project(sec.7044,Busies end Professionsilds or The ver am on, License Lew docs not apply t pen owner of property who builds or Merton, .17 and who canines(or.suth projects with a commaor(a)licemed pursuant m The. ., Contmnori w License La . -. .... _ ❑I am exempt under Sec. B&P C for this reemn OwnerDim WORKER'S COMPENSATION DECLARATION T hereby affirm under Penalty o(perjury one of the following declarations: 1*3 ❑ T hive and will'maintein a Certificate of Consent m serf—insure far Worker's Compensation. a pmvidetl for by Section 3700 of the Labor Code, for the � p ribman ne,of the work for which Nis permit is issued. ❑1 have anti meiniaia Warkcr's Comp msutipn Inaurehce,as required by Scotian 3700 of the Libor Code,for the performance of the work for which this Permit is '� : : tied.My Worker s Compenution Insumna tertian end Policy number sae: ' .. .Int ......... ........._......... , .. adPal ._......... ..... 'Polity No.: I•' y', :. �:' lir s , Cunt c' CERTIFICATION OF EXEMPTION FROM WORKB . l .. l. Y ' '' "'COMPENSATION INSIIRAHCE;^ -; (This secnilin tibed not be'complded if the permit is for one hundred tlollen : .. t 100)or last - ' Itenily Nem Ne perfo sof Ne work for wbch thle perms is issued 1 shall nm employ any person In plyys�p'unncr�f ����to me subject m Ne'Workcn -• ' Cotppansanion U '¢ Cel forma,qts 1�Lj -Apphaln. �. _ .... _.. .._ _... NOTICETOa to the or Ir Compensation Ccmfnsofof Lathor on.youahoart - - 0 0. becomeh campy the each po Compensation pmvisionsofthelabor Code,you must 0 forthwith comply with such provisiam or this permit shall be deemed revoked. __..... _. - .. .. .. ... __.... ....- .__-.. .. ._ ._. . . _. .. I: 'CONSTRUCTION L ENDING AGENCY 1 hertbydTnmh t them isscommorion 1gerne,for Ne pnfonnensti of this work far whichlhrs pemnt is -sud(Su 3097,Cis.CJLenders me -' '" O Lander.sAii — _ .- _ . ... .. ... ..__... .. . s ...� .. . . .. I .. . .. ._. . J I certify Nat I have rad Thu application and state met the above information is ' fL!F,r cbBceL 1 agme as comply wish dl city and county ordinances and stele laws,hating 0 C.) 10 Wilding construction,and hereby industries,pmttntatives of this city to enter upon .* the abovcmentioned property for inspersion purposes., pt'j (Wepeirce to gave,Indemnify and keep ham:lem the City of Cupenin6 against DO liabilities,judgments,costs and eaPaMal which may in any way accrue agalmt mid U'Z Ciry in conmqucnce of rotting of Nis permit PLICANT UNDE NDS AND WILL COMPLY\ ALL NON OINT Gul S. f _ Issued by: Date t A $Igne to of Appbcan1/Comncmr - ' Data "' Re-r00fS HAZARDOUS MATERIALS DISCLOSURE''" Will ttie epplicanl m future buildini arnpml state m hurdle herudous materialI�Spe Of ROOF as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety - CodaSection25532(a)q;-i.' ... .(Ja✓,:. i s I -• .. -❑Yee ".,.t• I ':.: b I; s Ala roofs.shall �. nspected.priM.. o-any.roofing matenal.being installed... ."... ;adl the applicmt at(tiro,building oetupem u,equipment or devices which oaf is installed without firs[obtaining an ins eetiori,I agree to iemove 'I hamrdous air contaminants ser des d by the B6y,Ara Air Quality M...gemenl g p g istdcll �N/ oY e all new materials for inspection." Applicant understands and will comply with + �G `; °, all non-point source regulations. .'„ "'1 have read the tiaiudous'melniais requirements uedcr Chepmr 6.95V the Celifomis Health&Safety Code,Sections 25505:25533 end 25534.1 understand that is tha Wilding does non mmdy have a tenant,that it is my asponsibiliry to notify the - occapam of the mqu' nts which must be mat prior m issuance a e C ificete of ottapanty. Signature of Applicant Date y .. �3�1r�Gz - - OwndI .,banned agent' Data All roof coverings to be Class "B" or better „ , ' %:," . ). ..._., ...... , ....: .:C : ....:. .... . .. .OFFICE .. .. . _ .. ...... _ - _., r • APPROVED IN ACCORDANCE WITH THE CITY OF CUPERTINO CODES�N 6 ORDINANCES DATE��� ---�`— S This s Y (Z This set of p' . n "n'e3 1 LIm tions MUST be kept on t,e ;:: a a I es o and it is un lawful to mel e -1/ �""des or alterations on same wLh n P°amission from he but d,r; .• Cepe.tino. The starrm n' SPecifica[ions iHAll N01 o: p, mit or to b ar motovat f rh. v a „n i any provision' OFFICE COP _ _ - ((A, �c . MAR 2 1 2002 B x{42 Vie« IfL)o f- o9c L �