02080163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10746 LA RODA DR BAY AREA REPIPES 02080163
SUB GAT
o�y� cLNAGENI 1861 ORANGE GROVE DR APPLICATION 08/28/E2002
f PHONE: (408) 371-5763 SANITARY NO, CONTROL NO.
I
�o ARCHITECT/ENGINEER: I BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
E u =1 LJ
83�
Z' LICENSED CONTRACTOR'S DECLARATION Job Description
ZOZ4C the byeffiromtlamI colander provisions of Chapter 9(commencing REPIPE/WATER HEATER/FIRWALL
rr.L 1.1 with Secti 700D)ofDiivision 3 of the Business nusld Professions Cod-eadmylicense
g aiI is in fol rc<en if
3
Meta,
a< Licenu au Lic,x
O u Dem Commnor
3"-I-n ARCHITECT'S DEC I N
f�O g 1 mdem ind my plans shall be mad os pun m recons
OO Licensed Professional
e OWNER-BUILDER DECLARATION
I hereby affirm Nu 1 am exempt from the Conlrecmr's License law for Ne
?< following reason.(Section 7031.5,Business and Professions Code:Any city or county $5000
�F❑
CC wh h rlq.ircaa permit tricamicarawl,ober improve,demolish or rcpn r any swemm
n3w ..prior to its issuance,pur q thapplaaordhe Cchpemam Nese aw(Chtement
thmhgeit nactsds Sicht 7thep fDivinsoT WeCe Busines Creams law\napmr9 pill Valuation
ca Ron heir nh Saaefrom an fDi bsisor Ne Buvne xepion.My si Code) ) '1'3a6�1B�t0�eOf�ea.-ayl ,i'�-r(q.'
or Nvl he is exempt Ihcmfthm and the basis for the allege)eacmpci°n.Any nolauon� t'{� ` - - 1. -�- g1. 1.i.� s `h•
-of Section 7031;5 by any applicant fare permit subjects the applicant to a civil penalty
,of not more than five hundred dollam(s5W). 202APNlYf0p34EFLOOR PLUMBING`' Occupancy Type
01,as owner arms,property,ar my employees with wages as their sole compensation, 301 H
'-will do Ihe'sva:Th i9an,' s LimLfor snotappl.TB W,' 502 — FINAL PLR3RB1Bi1:aGnsW&Sb@YiL is D'IF
t will do sme v Prk.and rib Code The Conmaor s intended.1 offered Law does not apply to an
owner of property Who builds or improves thereon and who does such work himself 507 - FINAL PLUMBING '
ar through his own employees provided that such improvements not not intended or ..... _ ...........__.. ....._._.... _____.....- ._..___.._
-,6aereJ for able:If,however.the buildingim roJcmeni
'sold within ane - "
P Y of sv'i'!•, rrr:'rSnL 3.
cdmyletion,the owner Wilder will have the burden of proving that he did not build or' -
improve for purpose of sale.).
es owner of the pmpenY,am exclusively mmlvctmg with littnsed convncmrx m _._ ....
_ cnnshow the project(Sec.7044,Business and Professions Code:)no Commnor's y,l,r,; " i`,\rv, •,p-,.
License Wwdoes not apply man ownerof,smarty who builds orimproves Thereon,
:: ._and,who.contrans.far such prujecla.with.a conlmcmr(s).licersod.pursunnl to the -------
0 1
°1 amea In VI,,r S.6BkPCfar hi ..,an
Owe "Date
AUG 3 0 2002
1 t ' TVORKER'S.. ..pEN5AT10N DECLARATION
it _.I hereby olfim under,penally of perjury one of the following declamoons:
° 1 have'end willmiimaisi'd Cenifichtebf Consent to ulf.insum for Worker's BUILDING
ti Compensmiom, ts, prnvided-for hy-Scntim-.17(n'of the tabor Code, in,, me
performance or the work fo,.which this perms is issued .
°l have and will'mnimiin Wohcri Compeasmidn lnsurance;u required by Section
37M of the Labor Code,for the performance of the wmk'for which'chis'pennit is
4 CERTINICATION'01(EX ON FROM Policy number ere1. r
issued My Workers Com sat Ins ten curt)rand .,
. \ Z299n2 t.1Zdl-I-�h
WORKERS I- l:ia.t``i`d.q
" �s�
t - COMPENSATION INSURANCE' Y?
'r1 (Th s ienuin need'601 be almpined if the permit is for one hundred dollars `• ' '- \,rf c '� T"-I:
1 ......v». ..__
m,,.w..... .,. a. .__.
a' n an mnan[r SD a5 ho be<atllt SU6 eCl la Ille
` I enifYJhm n� pert tura �e f lh w rk(r wh¢h lbw perm ns' ed,1 � l 11- cs;(j,;;,•...
"shall not employanypecan y ) Woheti
App lician ion laws of Califoreid.'Dnm."'n"`
NOTICE TO APPLICAN r'If.alter m
ukmg lhsC rtitc to
FEhptCtheL a�you.h lJ
Qb ie bl ut the W6rk C rep t npro i snrt
forthwith0 ply with h previsions thisNmit shall he deemed resolved,
,
... ..... .._. .. ._ -t
CONSTRUCTION LENDING AGENCY -
a 1 he by Rrm th t 0 c we n I din8 6 ncY f th perfo c Is,
k: 'Imthe wmkfm whichdo,p6r.it . - d(S c 309] Ci C)
QLend sN ..s ..,.,+.,_ .. ... _ ..._ . .-_.... _.. ..._. -
Lender Addreis
r p•I I souify 1.c 1 h read this city
aid ionant and nute an es a above i laws mtkormiming g
to buil 1 agree m comply with all city end antory ordinances°ctrl cite laws miming
O' :the above-mentioned
boe-mensmu any ebyumhor pemutiv.'Ithi.city to enter upon
the b e t deeds pent t r inspection purposes..„
1We)agreeto costs
mdemmpeand keepha may
ath Qt yof Cupertinoregains
F.1 W liabilities.ludgmenn c sts and granting
of
itcherre may in any y came against said
V z Ccyy In co seq ence ftheg m gof this perms -' -
'Cg
NT UNDER Td\DS AND WILL 1 YWITH ALL NON:POIM1Ta
RC a' Issuedby, Date PTS
S, Itureof ApplmanUCom °ter.....; Dom Re-roofs
'� s HAZARDOUS MATERIALS DISCLOSURE '
W Il the nppbcant m future tsWding occupant store or hurdle hazardo.1 defined us mamnel
'cCudj °`Yenta C3 pal no Mu N.
....
oode ChaPt 912 and the Health ndSafety s e�PY +s �.,]I t Irl - Sz Ir s , 7 •`.3. .. •Y ',li
1 l5Y '^ f 1 i it I
All roofsashall be-tnspected.prior.to-any,roofing.matenal_betng installed. .._._
WIIme applicant ofuture Wilding occ po c uequipment de lam Inch If a roof is installed without firs ob ining an inspection I agree to rem ve
em c hoz rtlous o r comate IS a defined by Ih B y Arc A Q al ty Man gement
t obtaining o
D tit all new materials for inspection..,Applicant understands,and will comply with . .. .
,
all non=point sou"ce iegulaitons,,,
1 have rcnd'Ihrhazardous materials requbl rrc ss under Chapin 6.95 of the
y'
Warm. , :Cade. 25534,1 understand that
if the Wilding does not gumndy haSection,a tenant.that it
h titis my-responaibillhe
pcup.raif be retia rcmans which mut be mat error to ceoLaCcalficomof
- -
4 ` b" a°` Si nature of Applicant_-. _ . Date.
i �e�? -2 -d . .__g . PP - -
r N agentm All roof coverings to be Class B”or better
Ps
-. - ... . ;�...r. . . , .. .... ... 'OFFICE--
.._. . . _. __.. ..._.. . .__._.__ . -.._.