02070147 OF
TINO
CI BUILDING DIVIISSIIONPERMITCONTRACTOR INFORMATION:
BUILDINGADDRESS: — PERMIT
10556 MANZANITA CT 2070147
QV16VgA'CETAVERAPU APPLICATYIVAT72002
PHONE: SANITARYNO. CONTROL NO.
I
c s0 0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E w F BLDG ELECT PLUMB MECH
u 7 L"1 U
LICENSED CONTRACTOR'S DECLARATION
Z EI z 1 hemb f(mn that I am licensed ander provisions ofCAi t 9(commencing b Description
i_o pndPr e INSTALL GAS PIA
m t_� wain Senioneand effect. on3of the Business and Prvfcssions Code.and my license
is in full lass and cRcm. or ����
0 s a License Clan Lic.a LE®
:�a U Date S DECLARATION
3 G ARCHITECT'S DECLARATION
0� 1 undmund my plans shall be used as public rtcoNs JUL
�} (/�a q
p O Licensed Professional �"U` 2 6 LOO2
K P, OWNER-BUILDER DECLARATION
w—,r, 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
Gfollowing reason.section 7031.5.Business and Professions Cale:Any city or countyUiLD1�j15 0 0
which ax, permit to a perto construct,almr,improve.demolish.or.,au cry structure B
w3$ priorwits ix.waAalwreq.uA.heappli<am fasuchperrou.file asi,nedstnemem" -------
a. Valuation
i
tleih6ii licensed pumu4nsto Bac pforidons ofthe Cenraele(s License Law(Chaprer9 ,,,;.,,13�.6#2.Q-BO�C'.® err-:• ivy�� aUahOn
(commencing with Section 7M)of Division 3 ofthe Business and Professions Code) L j';•,
or that he ie MOM
eany o,pm`and the basis for the alleged cienytion.Any violation Ij 1A
"of Senion a he. v any applicant for a pemdnubjec.the applisanno a civil pemlry
.ornmmo.eNanRwhundred dollars ISsom. 1064PNL'41EkTi68 & WATER Occupancy Type
°LasewnermftheProperty.Armyemployeeswith..,a,.,theirsalecompsmssdon, 202 - UNDERFLOOR PL JM13ING
-Will do dm work:end the structure is not intended orbRcad'for"sale(Sec:704P _
Bmirim And Professions Code:The Contmotor's License Low does not apply eo en eCIlOnS
0
weer of property Who bails or improves 1haremn,and who does such work himself 302 - TUB & O
FM
or through his own howevemployees.provided that such improvimprovement
mans within
not neyeintended or
c6medfor sale.If, the Wilding the imeoof proving atom wimN one build or 502 '- FINAL PLUMBING—ENERGY ---- --- --- '
ioprove for theowner-Wilder will have the burden of proving that he did not build or .•.. •'f°
mproa<rorpamnxnrsme.). 506 - GAS TEST
-- - .__ .. _ ... -` - -- ---507- - -FINAL-...PLUMBING... --- - - - ..-
°1,os owner of enc pro'n'am ea'hw ively contracting with licensed cow.Aws to ---i:eL '.«)V J"nK 1 s"(
construct the project(Sec.7044,Business and Professions Code:)The Contractor's P;
License Law does not apply to an owner or property who builds or improves thereon,
_andwho coovaa,for such projec..with a.conuactor(s).licenxd-pursuant-tome_
tarn x m t a a�w -.
_C tarn xrs pic<n
p c $• ,B RPCtm this reason
0c ... tjite .. ...n, •..
Vc R ;SCOA ETNVSAi1��DECLARATION
,,ll 1 hereby AM.under pcnahy of perjury marc of Ne following declarations:
° I have and will maintain a Certificate or Coram to self-insure for Worker's
16-V Compensation, as Provided for by Section 3700 of the Labor Code, for the
performance of use work for which this permii is issued.
°1 how indwill mminuin Worker i Compensation Iniurenu,as required by,scction
3700'6!the Labor Code,for the performance of Ne work for which this permit is
issued.My Workers Compensation Insurance carrier end Policy nom her sm:
" Cam". � FICATIx •iXEM IO
CLRTIFl.'.COM OF ATION INSURANCN MOME WORKERS" '
"COMPENSATION NSURANCE
.. is union meta n,... • .. •• .. • ':..t •' ._. ._ .... _...__...._.__._
' `•'(TT' gibe completed if the permit is far out hunartd dollars '�3'' i � ' " iJCf}:il;j:i:V fY]'•:
.IS100)A,lmsJ
Y a pe
In f thein the durmance a e woh fo h h m i mut.issued,l
shall a( 01 Y y pcnon m any jeer to the Workers
Comp t
NQT TO 1 WANT IL a r m g fiche of Exemption.you should '" " < -
0 Q bis as bjec to the Workers Compensation provull ns of the Labor Code you must
forthwidh comply with such provisions or this Permit shall he deemed revoked.
__.
r3 `" c •CONSTRUCTION LENDING AGENCY " 's
I hereby afTrm th t th s Aberms ct on lending Agency for ilm performance I' ,
s.,
of thA worl,f which this Perms is issued(S' 30S71 C)
a
�.Z Lindar, ran, . . d. ,'r et-.
I cmily that I have mad this application and state that the above information is
[iG t..t wrier.I agreencm to comply with all city and county ordinaand sum laws relating
C)_U to building construction.and hemby Authoria representatives of this city to enter upon
>,5W the above-mentioned property for inspection pumou.
.9L. We)Agree waeveNhdemnify and keep Wimlcu the Cuy'OfCupeninoapaime
sr:Vj liabilities,judgmcnss,cos.am expenses which may in any way eccma against said
UM City in'cosequence of the granting of thisyermt •50•(7"/)
APPI�rA\T�U�NDERSTAN 5'AA'F WILLCOMPLY WIT A}�L'FON Olh Issued by: Date
se6e !/o Gns�i_L /7^' �X CE
4 y
Signatu.. ApliC.AoCo vactorTA. 1 DafeT Re-roofs
' !HAZARDOUS MATERIA DISCLOSURE
.'•: r Rill& ,ream tf n budding occupant share or handl lice uddusunwerod Type of Roof,
as defined by use Cupertino M Cade Chaps 913 orad Ne Health am Safety s ,',� - : '• '
Code Scn 255R(a) 'i' -
°YC5 1 "0':n),;,,,' _ All roofs,shall.be,inspected.prior.to.any roofing material being installed. _-__
Will out pp6m t Oro..bu Idi.toccupant usewinpro em wdevices which If a roof is installed without first obtaining an inspection;Q agree tolfemove
emit h taido air contain na t m a coca by the Bay Afea AIr Qaallly Management
Distrn all new materials for inspection..Applicant understands and will comply_with.,. .
e oY{, e t all non-point source regulations.,.., -
L' 1 h "d int In'zardous m'lerialsaqui. men.underChapter6.95 of the '
Califomia Hcallli&Safely Code,Senion,35505:25533 end 25534:1 understand that
ifineagilaitil am oat currently us p
nenetlum is my mibility to notify Ne
oLsvppm dh e'rtquiremcnti whicub h us i be,mei ooranie'of a Ceni ate¢ f
t: Ocu
cpancy.' j �i ,: -. .. ..
_ '* It. Signature_of_Applicant _
?• O. _
All roof coverings to be Class'B"Iortbetter
or onac agent .. 1 ".. m A g ...
„ v
FICE. _. _. .. . _ . ... . .