02100060 CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BuBli cgA1)q EsLA MAR DR LEONARD A VALENTI INC PERMIT NO 2100060
oaAS0 lSNlrLISA C ET AL 481 AUZERAIS AVE APPLICA`TrVUI0)8ff72002
HONE: (408) 848-9688 SANITARY NO. // CONTROL NO.
ARC141 FEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
foo LICENSED IUCONTRd under
DECLARATION
w P 1 ion Waybill
b ill thus I am licensed under previsions(if Chapter J(commencing oh Description
with Section vNNl) fDroishtn3of Nc Busincse and Pn+fca:inns code,rand my banse is REPAIR CHIMNEYI
I.full e Class
orad d1ym ��
License/��Ch�ess r�� 2 1 Lic.N L� `7
Date(I. /-. :cf Contract" ./�F��
/�� AIT I1T cCouuE A N "•�/
< 1 understand my plans shall he used as public rccaid.,
X�iU
'r-
'is ,, Licensed Prolessimum
g OWNER-BUILDER DECLARATION
fy,u`a<I 1 hereby affirm that I am exempt from me Contractor's License Law for the $1800
to
S00 following reason.Section 7031.5.Business and Promodans Cole:Any city or county
x which requires a permit to construct,alter,improve,Demolish,or repair any structure
H_i priorm its issuance.also requires the applicant for such Permit m file a signed statement
i< thalheislieensepursuant JpursuanotheProvisionsOftheContractor'sLicenselaw(Chapter9 3Sii19BtMdb1AIQfi1 Valuation
net-O (commencing with Section 70)(0)of Division 3 of the Business and Professions Coact(it
y
that he is commit,thent and Ne basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for Permit subjects the applicant to a civil Penalty or i JAPNN Occupancy Type
no,mom than five hundred dollara(S500). 312 - CHIMNEY REBA & STRAPS p y yp
❑I,as owner of the propeny,or my employees with wages u their sole compensation,
will Jo the work,and the structure is not intended or offered for sale(Sec.7D4J,Business
and Professions Code:The Conuacmr's License Law Jens not apply to an owner of egmre nspec[lons
property who builds or improves thereon,and who does such work himself or through his _
own employees,provided that such improvements are not intended or offered for sale.If,
builder,Nc building uimprovementissoldwithin one year ofcompletion,Ncowner-
howev will have the burden of improvement
iving that he did not build or improve for purthe rote r.
aaleJ.
co L ra t the project of the pmpenY ,B nidus and contracting with li Fireefa cant ctor's m /
sense La me esnt (Sec.o an Business and ny who Wilds
Cour;) pro Contractor's rad O/�
mom law does not apply a an owner of prapcny who builds or improves Conuac and
who contracts Lacu for such projects with a conuacmr(s)licemed pursuant m the Connector's
License Law.
❑1 am commit,undo Sec. .B&P C for this reason ✓� -
Owner Date
WORKER'S COMPENSATION DECLARATION •
1 hereby affirm under penalty of penury one of the following declarmiorno
I have and will maintain a Cenifcam of Con mnuo self insure for Worker a Compen-
sation, provided for by Section 3700 of be father Code,for the performance of the
w or which this pc.it is issued.
I have and will maintain Workces Compensation Insurance,as required by Section
371X1 of be Labor Code,for the Performance of the work for which this permit is issued.
My Woakcr's ConTeaml nn l omncc artier and Policy nnmhcram:
Cartier: Policy No.: TSL
CERTIFICATE.OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be compined if the permit is fornnc hundrcJ dollars(SItNR
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any perssm in any manner so as m become subject to the Workers'Compemmion
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:1[after making this Cenificale of Exemption,you should
become subject to Worker's Compcnvti in provisions of the IaMm Code,you most
Q Z fimthwi,h comply with such provisiam or his penia shall be deemed revoked.
'Zr'O CONSTRUCTION LEN DING AGENCY
[r I be mby affirm that there is a construction lending agency l or the Performance of
Ri t� me work for which this prem it is issued(Scat 3057,Civ.C.)
W 0lender's Name
0z Lcndcr's Address
J 0 1 certify dial 1 hove read this application and state,hal the shove infnmmfion is
ILP cored,lagme hn comply with all city and county ordinances andsmtc laws relatingm
O U building comrmo n,and herchy authorim representatives of Nis city to enter upon the
above mentioned property for inspection purposes.
(WcI egret I .aid cmmfy and keep harmless the City of Cupertino against
N Iiabilitics,judgm ,cos end expenses which meyi any way accme against said City
U z APPLIC amt U�NDc STANOSthisD WIL OMPLY WITH ALL NON-POINT Issued by: Date
SOUR REG . TIONS.
V Re-roofs
S' n sof Applicant/ mractnr Data
ZARD MATERIALS DISCLOSURE Type of Roof
Will Neap ream ser future building occupant stem or handle haraNuu material
m defined by th Culxninn Municipal Cute.Chapter 9.13,and the Ilcaltb and Safety
7Dishict?
sWm. 0Yeszss32(an ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building accuprm use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ade
mit hoom oils air comaminamu as defined by me Bay Area Air Quality Management all new materials for inspection.
❑Yes ❑No
I have re churaNuus mamrial.e ircmcnts nnJer Chuparfi9.a of Ne Cnlilinry
ixllc1th yCode Sccfiuns2 Sand 255W.1 undcrsmnd lost ifdic huilJing
oerally have a cera tat i my resrysnsihility m nntilil dtte occupant of the
ysnnn tewhmhmu:, ma miuuanccafaCcni Jteat 'cupanm Signature of Applicant Date
stern,mabinumi cont �(0/0 Dare All roof coverings to be Class "B" or better