02060056 CITY
DING DPviSIiO NO CONTRACTOR INFORMATION:
PERMIT
Bpap�( d"a RODA DR CUPERTINO PLUMBING PERMIT No. 02060056
lU /"tf�RR 10297 S DE ANZA BLV 2
PHONE: (408) 253-0618 SANITARY NO. CONTROL NO.
IM00 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
"_3 II
y Z LICENSED CONTRACTOR'S DECLARATION 3
hcrcbyu�rmaailumlicensedunderpmvisionsofChapmr9lcommencing COPPER REP IPE/Wk+ft ch�f�'ER
,:t with Sen hereby
affirm
that Ion licensed
provisions
Professions Code. (co"m m"m
is Ism"
toll force end ellen.
o�"u Date lis� S DEC lot
0� ARCHITECT'S DECLARA ION
5 1 understand my plans shall he used as public records
7 O O Licensed Prolessional
R Oat I ma GILDER DECLARATION
-w 1 hereby affirm on 1 1. exempt tram be CommcsCo eLicense Ac taw for the
t?0 following mason.ISe if t ]o3L5.Business and Professions Cade:Any city or county $15-00
O wh,<h equ res a perm 1 t c n..1 r alter improve.demolish or repair any structure
m I t m t a ,el req trc the apple tr such mit m
Perfl sg ed otmm
eme
o. mar ha,isliter,scd Pars anu the pr mans ra Convmmt 1 Law lChepmr9 . 3C�3II.Q3rS�r fl)@a�ff pp 11ryn Valuation
(cmmci gwrh tattoo ))ofthe ba 3 the
e5 dion Any
Codel ��f�ih, - �'L.YI_ [': 5. :�lALiit.Eal hl ` ,
mom he d 31.5 b aeicfrom and ac haws far me alleged eaeaq,om Any l parson
-ofa.t ]031.5 vemyapplicant fora IA). subjcns he applicant roadull penalty
ofnarr�mremanBvenandr<ddouarsfsSooJ. 202APNbTltilNaPFLOOR PLUMBING— Occupancy Type
01,as owner of the properly,or my employees with wages as acir sole compensation, 301 - ROUGH PLUMBING
-will do the work,and the smicwrc'is not intended'or-offered far'sale SIC']044('
0
Bnsimas'nnd Professions Code:The Contractor's License Law does 1101 apply to an $
caner or property Who builds or improves thereon,and who does such work himself 5 0 7 - FINAL PL
or arough his own employees.provided that such improvements mems arc not intended or _
or sale, however,the m e t or improvement n sold within one year of t. -(K.,
'mapowrion,the owner-builder will have me burden of Proving that he did not build or '
improve for puryou of sale.).
col as "s,ofthe pmpeny,am exclusivelycomrofengwia1c rled)ThnCmdracs's t 'ill - fr.- `
anthem the prosect(sec.7044 Business and Professions Code)The Commcmr s -f
License Lew does not applyan owner th property who builds or improves thereon,
m
: .'.. ..andwho,comes.fonsuch.pmJecrs.wird.a.convunor(s)licensers
d.puuenr to.rhe_ .._._...._._._ _._, ._. . . _..__..__._..__..__._.___ ......___._..__.._.,
Contractor's License U.
❑I am exempt under Sec.'' - `,B&P C for this rescan
ower FINALE
WORKER'S COMPENSATION DECLARATION II11IY�1
I�haffi
ereby affirm under penalty of perjury one of the following declinations:
JUN 2 $ 2002
i Otl have and will Inaimain a-Cenificate of Consent to sett-insure for Worker's
Compensation, es provided for by Section 3700 of the labor Code, for rhe BUILDING
performance of the work for which this permit is issued. .
t ha and will ma ra W k- Crimpenwu n Insurance,as rcqu rctl by S E1ibn
0 3700 of the LuhoCCode,for rhe raro maws df 1116 work for wh ch flos permit is
issued,Cak 'M;ccJWorker's� C Compensation carrier erand Policy number
, N
C:u o1.. _. .7IVIT0 `!�NEPoll icy No..
CERTIFICATION %EMPN FROM WORKERS" „ I,,
Y.
COMPENSATION INSURANCE '-"tea^ s __
'(This aecr on need not he nimpleied if the permit iv for one hundred dollars
00)or less t
s . Itcharley, in the performanceim a work for whmh this permit s is ke 1
shall-nor employ any person m any mahnerso as to become subject io Jhe Workcii '
earn p..tno.llLaws of Celifomie:DAppli em"" '
NOTICE 70 APPLICANT
77 I( naktng ibis Cen Tema f Exemption, should
be 'wit Workers:Ccmpere t P o . u' Labor Cade,you most
00 forthwith comply with such previsions or this permit shall be deemedr ked.
.
`ICON SemUCfION LENDING AGENCY - ti
a-M T f(ithat - wonsr leading egencY fo the per(nnce v
ofo rkk ffar which
ch th s permli sued(See.3097 Ci C)
y.0 lenders Nome __. . -. __... ...
Le de Add e.s,
V D I Gen fy 1h 1 I ha a d a p,Ihafimm and auto that the above mfort teon is I /
lax F.. comer 1 ag t comply rh II r ry a d my rill erect a d r m la t ng
re
C.1 to burldmgc r ' i n a illi by a xe p t i s fmi nryl aa_pan /
�,�::ss ry the bo oro-edp pent fo peer p rya
L,l'Sy (W 7egrc t mdem rye ilk pharmlaeCry fCupenm against
CC4.44Can V] lieb 1 t )dg cora, 1 an expect rs h h may n any y cane against s td
U Cirym nee P1h g 1rg Pe u -
APPLIC UN :k$T AN( ILL COMP 4TH ALI NON:POINT'" I/ —O
' soU P < Cl .ATIO , . P• ,rq Issued by: 4i Date
li
Dmf Re-roofs
.HAZAR RIMS DISCLOSURE
"" Will the apPlip r f re b Id ng ac punt st r handl husk s mmenal „Type of Roof .. ._
atilt Wby theC perlino MuncpalCd Chepmr9l] and theH lin and Safety
bode sem a 25532ii 1 t r' �' r ,..; 1 a� '�:f p B ', i.I '> '
Duca ❑'rvo-' ri ( _AII roofs.;hail be inspected prior to any roofing.matenal-being installed,
Wll theapplicant or fm buildingoccupant use equipment ordevices which 1'
emlhezako smr comate errs as definedb the Be Alla air If a roof Is installed without first obtamm anins echoer I 9 recto remove
y y Qualuy Menagemcm g P g
Door., yes N " all new materials for inspection. Applicant understands and will.comply with
ti IIS r r„ � ', . , , q. ._ all non-point source regulations,
I havea ad zhe h z rdous nlomnels regwrcmcars under Chapter•6.95:of the
Califomua HealtK&Safe Cade. tell as 25505:25533 and 25534.1 understand that
if ilia building does a., rely due tenant that ii is mY responsibility to notify the
toecap n f th regal anu 'n be ren per r to' a of a Cmifica¢-of
Orap
:'- - Signature of Applicant Date _
. _ . . .. ..
o era' d ag r . ., - Date, All roof coverings to be Class "B"or better
_. _...
OFFICE ...._ . . __ _._... .. . ._. . .. _. .