02080156,CITY OF CUPERTINO
'..:41HLnlNG
CONTRACTOR INFORMATION: '
mvisION.. PERMIT
BUILDING ADDRESS:
PERMIT NO.
22126'LINDA VISTA PL
02080156
R'S NAE
'MARTIN AND AMY
APPLICATION SUB DATE
08/27/2002
PHONE:' f
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: -
i'
BUILDING PERMIT INFO
at, if
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereby amrm that 1 as, licensed Masser provisions of Chapter 9 (commencing
Job Descnp tion
wird Section 7000) of Division 3 of the Balm and Professions Code. and my license
S E V I CE UPGRADE TO 2 0 OAM P
o and IT
" in fu 1 for"''l
_�_/� Li .N 4
- -
Date
Damy mr ARCHITECT'S ,Af(AIiOW
1)II utidemvnJ my pi.ox shall be Mue,d m Public rtcords
L¢nud Professionvl .' - .
f .• t, OWNER -BUILDER DECLARATION
:1 recur .(item Mai I ore exempt from the Contracfmions Co e: Any c Law for the
following return. Professions Code: Any city
].ism Business
$1960
'(mutt sicounty
s a Penni, re mmwn, Slaa improve, demolish, are
which iequi Map... any twment
-. - - - -- --- ------ - -
a sig
priort d amwce,alro req the applicant for signed statement
s
,� F ] Irv, ts�pldlpr,p,�ea t,.,^
17pp�,yy 9[.f,'•,�
Valuation
Contrarmu is
thatheis ;lnaj with ScciinyoshepfoDi1isim3 ftonwnorsL n Low ones Cor9 ca)a
Prpfcsny
loom Gis tierof tnarroW0)ofard ib.,i,n,, heaBusmesand
of thin vi I.Ims,
iany...Iiromor basis for thect.thd runts. Any
v�l p.'1,5z't7lij�V 1S„+V ,.pk
Secthen31.5b I rally:
inn for v permit mhjecb the aPPlicunuo v civil pemlry-
p,
of Section 903 nI by any hundred
:ar oat mare thamhve_wnarad .arta. ($SBn)
304 p`pN'I�C7�'I ELECTRI
AL"`;.r." Occupancy Type
01. as owner of Me property, ur my employs with wages as sheir sole comp[nsvtioq
- 505 — FINAL ELREr'(IE HO.'�I3ectionsitr; sue o,,: r
will'doIhe'warK, and Me strucmne Is no,' intended or-offemd'fm ale (Sec. 90LL,
(Business�nd Praxes ions Code: The Contraemrs License Law does not apply to an
owner of property Who builds or impmves M<rton, and who does such work himulr'
_
or through his own employees. pmvidetl thn such,mp, ani mems art nm intended or
_
"'.(Bred idr ale” IL h e r the tioildin ' m i a sold w @none car of ,
kcomplenan build
—"__ .._ . _ ._..... .. ...._..__ .._.___. ___
)..��IS ., ." C v
the owner -builder will have the burden of proving that he did not or
improve for poems, of sale,).
_. -_coot.
orlicensede nnors w
ofahe pmpeny em exclusively
co l asci
� .. : T " %,_ IIT I :`(
ines d Profession, Connector's
Me r04<, Business and Professions Code:) The
jonsma.Dw
•, 1,, �_�,., )L}),q•. \P?';,
oes rat(5<n.
therso
License Law does rat M
puc:m an owner of property who builds or improves
'
r , so c
.-end-who-ronwns:for suN.projecu.with.a.cunuacta(s),Iicensed.Punuan[.m.Me.-_-
C , ae, r License V
❑lam empt,nder3 „JB&PCf this mosoo
IftVIIr� '
1-117
Owner } �,, .Y.,. Data .I 1+ -
ANA
- Y �uWAl6nl��
-''S COMPENSATION DECLARATION +
l:' "!I Hereby am. ander,pcnahy of perjury one of Me follawmg declaroti sm:--
SEP O 2002
L
❑.I have'and'will miimain"a''Cenificbie of Coneeni to ulf-insure for Worker's
,
Compemation; us provided for-bd-se1.alion 3]00 of W -Labor Code, far the
•perfarmSnce'of the workfor which his permit is issued.., ,
'
I I'1L ®Ipg/�
BUILDING
Iipeau n iA'Umac 'uz rcgadmd by Section
1 h nd will mm am Workers C ns
: ° 4e a
�J 1 V {.l
3]W of the Libor C de G The performance f the k f which this p m I' i
-
"i sued My Workers C mp.nsa[on Insurance umm or it P I y n mh arc
tC me <cfCESTIrCA ON �i
9't..
OF E%EMPTf O W RKERS
t s '
. f COMPENSATION INSU ANCE •-
....___.__._-___.. ..____._.___.`__--________
s.')1\I{ '
•�"':°'^''(Tluisittli'nn need not b'e completed if the permit is for one hundred dollars
"'Is: :W(t".
ISI00),or less.)
I cert fy (tint ache jxr(mia ce (thew kIo hchthis pernioisissued: l,
1
ash ll i employ any pc n ,n any mance vs m b'eco a subject to the Workers"
.�'I)'
Compensa ion Laws of Col tom a. Dam
r ,. o. .
�..._..-...
a'
.'Applicnt
' NfyrICETOAPPLICANT If, after making this Cem,riiV of Exemption;Code,
...
., -
becomesubjectiaMe Compemetion pmvisi you as[•,
theeanbor Coded. must;
shall
fnnAwiM domply'wilh iuch'-------- or this permiuhall he deemed revoked.
sucrvehps
. ----
.. _
.. !? , '• '. CONSTRUCTION LENDING AGENCY"' '
CONSTRUCTION
1 herc6y i Ih I Ih co I .' ag y f Ih perfo M
t6 ' 'J c 1'i ","• ''r C
„
30riding
h Ibl Permit is issued (S D Qv C)
i Sec
_
I
Lender'v Namore,wlilyd,h
_..: .: �::....•
-
.. ,.. coot ., I
.,.
yyict� Icmify Mat 1 have read this application and auto that he above information is
,,mmet,I agree tgcomply,with 11 city ii d roam, adularres and sum laws raising
no Wilding construction. and hereby andiron reprcscrontives or this city to enter upon
.ah bo e t nN p pend f . pen o p ,poses
against
IWe7agree is sa In errunify keeph Ico M City f nn
/]
ndexpenand
cue against
tub hu aidgmem sr' and expenses which y any y ago nst
s
'City 9 once hh gr in' N lh Lpermit. Id
gpl LT 4NY U,�'DER5 LUDSA� -WILL MPLY WITH ALC NON-polul''
[SSLLed b Dale v v
y
:501 REGDLATIr s„ -,z--
Si
,5 gvamrc fAppllcanVCo M ..i - . -';. -.
Re-rOOfS -
I HAZARDOUS MATERIALS DISCLOSURE "
d1the.appic Itsin.bsixdvusmntcnd
e.ofRoof
_.Type
adfn dbyM Cupcm M Ic pal Code Ch pt 912 end the HrolM and Safety
,Code Section {5532(91 ,
,t,# gan s s tdli'Il)5
( .r {`.' t h S 1' r r' Pr �: 1 •
t 1 p.I
'•
♦ .I. .,
... All,roofsshall be ms ected nor.to.an roofin g material bang installed. .. _..__.-
y,.
P'. p
v ,ai ac I M:e a imam or'cute' which
;;;•, Wllth_ pplc m rfmurtbul g pan q p w
•, a , ,
If a roof is installed" "without first obtains an inspectron •'I'agreelto•remove
ran haraMous err conummanu as Defined by the Bay Ansa Air Quality Management
Is Is
•g
all new materials, for inspection. Applicant understands and will comply_w_ ith
,_._ _..
all -non -point source regulations... ;
,
} 1 have iced Me haradous meaneb requirements under Cheprcr 6.95'of the
;:
Caldomie Health & Sefay Code S ctio s 25505, 55333 and 25574 J undersand that
_....�. .. .. .
iocMS Wilding Jops n ? came Dy have o certain Ihm a is my capons bJ Iy m hoary the
_.coot
.__.-_._... .. .....____.._ r
I,
cupem bf Me, regmiemenYe whsh' mt sI hub rpnor m s{xuvnce ofa CeniEeatc of
,;°pc
Signature of Applicant Date
t� 2
All roof coverings to be Class B or better'; ,
ois<r r uM axed ag nt -. t or,
... _.. ... OFFICE ... .. ..__. _ ._ ..... ._ _ ........._' _...... _
A,,