01120050 CIBUDTII G NO
DIVISSION
BUILDING CONTRACTOR INFORMATION:
Bu1tv9'TftERTY CT CUPERTINO PLUMBING PERMIT NO, 01120050
O"T1i Wn?ff2 STEVEN C 10297 S DE ANZA BLV APPJJ2AT�ON, J215F01
(•PHON[:
(408) 253-0618 SANITARY NO.
L V CONTROL NO
Z ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
v,Q6
z u i LICENSED CONTRACTOR'S DECLARATION J
;z=0 ction7").fD,I hereby affirm ii.O3.forB.,I am licensed nderpmdPmIs,i.m.Qdc.rnommencmg COPPER REPIPE, AAA tip RVICE
C� with tall
]UW)o[Dlvision 3aflhe Basinessxnd Profnsionx te.and myllemse
m 3-c D t full Ince and y
be or u License cross Lic.x
3 on N Date CDECLA
ARCHITECT'S DECLAR I
j O S undemand my Alam shall be used as public ret s
`r
i n iez Licensed Professional
OWNER-BUILDER DECLARATION
u�•'-'to 1 hereby of rm that I am exempt from the Contractor's License Law for the 5 O O O
F Z_< following reason.(Section]031.5.Business and Professions Codi Any city or county
Y F O ,h¢h requires a permit to construct,aIter,improve demolish or repair any structure
ad
dopimwas also q ' N apphinart for,.eh penman.fl g d t t mendc. - - --
��y'Ic2 [�.n .. . _...
Ihathe slit dp ka to they ons of the Contractors License Ln (CM1 pter9 Icdyap A`:.Vil, - .. Valuation
(commencing w th Section TW )of D'vli on 3 of the Businessx td Profesvm¢Code) 3 p 3?'
nr min he is exempt thetcfrnm and the harts for the alleged ezenm,4u.Any violation
-M Section 7031.5 by any applicant fur a permit subjems the applicant too civil penalty'
of not more than eve hundred dollars($500). 2 0 APN NghTWRFLOOR PLUMBING Occupancy Type
°I,as owner of the property,or my employees%ith wages as their sole compensation. 301 - ROUGH PLUMBING
wiB dothework,and the structure is no,intended or offered for sale ISec.7614,
Business and Professions Code:The Convactnr's License Law does not apply to anp
owner of property Who builds or improves thereon,and who does sum work himself 507 - FINAL P NG
or his ply provided Nat such improvct intended oroffered for sale,If however,the buiddugow iffiRoventient
is old within one year of
completion,the owner-build II have the thundrin of proving th t he did nor build or
imp
'
for purpose (sale.).
E3 i, n ffl prpry I :' ty"nlecink with lattowdferpho"pir,
..
al
PJ 15 7044 B O Profession, d ) Ih Compact.,ts
License does not apply to an owner of propern,who
buld p i es thereon.
ad ha.cm toeis for.such.prol nx.wilM1-a remonstrant)lcense)
_... ., . . ..
puratrad.t .the
pC nt net License L
t u
l
pt under Sec .B&PCfor his
Owner Dale U J
'WORKER'S COMPENSATION DECLARATION !`
I hereby affirm under penalty of perjury eine of the following declarations: -
d•❑ I have sand will ar intni,i a Cenifri Of Consent to sel6imu.e for Worker's
rBxF. .Compensation;as provided lar by Section 3700 of the Labor Code, for the
performance of the work for which this permirts issued,
°1 have and will maimain Wm ker's Compensation Insurance,as required by Section
77W of the Labor Code,for the Performance of the work for which this peimit is
is -M Worker'sCorypeevaiaan�Insumncec dProb1rynumberere. I,
Can-r MD,a PO'to'
EIO
RTI KATN OF EKEMP FROM N'ORKF.RS' J -
COMPENSATIONINSURANCE"
(This section need hal be completed if rhe permit is for one hundred dollars -
1$Ifphmhss) .
i 1 nfythat e I f cc i,, workwhichth. p m he Workers'
Coneoro employ any ire m any Innen xs to become mbyn io the Workers' "
Comisnsmitn Laws of Colifurnia;Data
Applicant -'
NOTICE TO ct to me ANIWork rf,Compect nlon,sation
this Cenifeme of Exabortio de.you truld
st
bechmesubjecty it such p'ssi,i x omion provisionsll the Labor Code,you muss
O (onhwith romply with such provisions or this Re it shall M deemed resoled. t
CONSTRUCTION LENDING AGENCY
," 1 hereby affirm that there t a construction leading agency for the performance
n�a of the work for which this permit is issued(Sec.309].Civ.C)
Lenders Name.-_.. . . , : .. ..
V O Lend der
ANfelhat
a Zsa
"W'f" torten.I agree to comply.with all city and county ordinances and state laws relating
V to building construction,and hereby nuthoriu representatives of this city to enter upon
the above-mentioned property for inspection purposes. n
p. 6r (We)slime msa enndemnify and keep harmless the City of Cupertino agvnst
y liabilities,jud en¢cos¢and expenses which may in any way accrue against said
-V Z City in .eque m of t e gmneng of this permit.
A ' CANT L' ER.' \NDSA\'D WILL COMPLY WITH ALL NON.['OIPT' !
1
E N 12—( Issued by: Dale
3gnamre n.A,p ucm r .. - Date Re-roofs
as def ncd by the C HAZARDOUS MATERIALS DISCLOSURE'
Will the applicu t future building �c pa tsr m or handlchan Nous penal Type,of Roof
Cupertino Municipal CM Chapter 9.12,and the Health and Safety -
Code Section 2553210.
-' All roofs shall be,inspected pnor_to_any,roofing,material being Installed. .
worn Pplcam
future b Icing Occupant seequp I devices which If a roof is installed without first obtaining an inspection,•I agree to remove
mit 1;121 us ter onmm a s• a{dvfned by the Bay Aran Air Quality Management Dict _ all new materials for inspection Applicant understands and will comply.with
1 °Y all nori-point source regulations
�.
Lheve read the animations materials 2 505,2 533 a d 25,1 Chapter 695 0(the
'Core N5ia Hced Safetye d Sections 75505,25533and23934 ityto 0tend that
if the building dce tcuncntly hmxatenant.Nat it is my rcspnnsihilitymnotify
b: 3m lif the qu ants which mus he met Prior to dnancc of a Cenifeme of
Signature of Applicant Date ,
0 ono Date All roof coverings to be Class"B"or better
OFFICE