02050136 OF
CI BUILDING DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
llnlN011DLD101$ t. CLELLAN RD CUPERTINO PLUMBING PERMIT NO. 02050136
O 'ft5PIE:lC IH.EN 10297 S DE ANZA BLV A6
1J/ L 77'02
PHONE: (408) 253-0618 SANITARY NO. CONTROL NO.
=O ZZ ARCHITECTIENGINEER: BUILDING PERMIT INFO
z m BLDG ELECT PLUMB SUCH
G<a L U IUI C_J I__3
y E LICENSED CONTRACTOR DECLARATION
,Z u, 1 hereby affirm that I am licensed under provision•of Chapter 9lmmmcnem, INSTALL GASL I NEIO�'Be"ftEN
mom, with Sectem7M)of Division 3 of the Bon.,srini Professions Code.and my license
x I_ is In full force and effect.
:s w a iocex Class Lic.a
LL LL N Date Contractor
ARCHITECT'S DECLARATION
°, 1 understand Soy plans shall be used as public records
i c Licensed Professional
that I a -BUILDER DECLARATION
1 hcrchv.lien that 1 1, aunt from the Contractor's License Law for the $1500
t z< following rcoua(Seniors]0315,Easiness and improve,
de ie li h.or Any city or county
E G prior t requires a permit re c°enrvm,ober.improve,demolish,or repair any swmure
a. 2S pnonoits issuance.also W the aision of the
uchpc is signed(Cha mem - - a ion
thmh rear,licensed seetion. Iti provisions fm Contractor s and Law(Chapter9 r• Valuation
Iced g rn Sect ]mil) rhe ice 3 fm Business )Prof Any
Code) t I ••.r1k L.Y: '_r,.,,,Y ll tr,�'
."bar he is 31.5 b Therefrom and the hams for She allege)t,lica on.Any violation -
of Section e in.. v any hundred
-am fora 500). subjects Ire applicam m a civil perepy
of non more then five hunJrcJ dollars(5500). ELECTRICAL:.
" Occupancy Type
❑I...c°tobe,nfine prnpanr.or my empl°yes with w.,as To thdrsme camperm.d r. 501 — FINAL ELECTRI ALENERGY
will do he work.and the structure is nor intended or oRered for sale sed.90¢4,
Sminess'anJ Professions Code:Tho Contractor's License Law docs non apply to as tlon5
owner of property Who builds or improves thereon,std who docs such work himself
or through his own employees.provided Thal such improvements are not intended or
offered for.sale.If,however,the It ldin -' t i.,sold within one f
gar iman of pro yeldo
completion,far the owner-builJer will have the harden of proving m.T he did not build or
improve for purpox of
. _...,_ ,,. -_ _
onstruownerprje FINALE — — - —
prnpenY,am exclusively con with It commcmrs m •
_ License
The project(See.]to a Business and property
who
cMe:)The cnmhereons .I,
License Low docs not apply man owner th propene woe builds or improves thereon,
_ .nd,who.co cls for teach projceTs.wim.a comnctw(s)licensed pursuant m the -._ _. -... ._ ..
Cannan a _en ,w. . JU.N 0 3 2002,
❑1
'I
and &P C fynhis rtason
n, e Spy oY ' BUILDING
W R( R'S COMPENSATION DCC ARA ION
1 hereby af.under penalty of perjury one of The following declarations:
r• ❑ 1 have and will maintain a C'mrcaie of Concent m ulf.i....e for Worker's
Compensation, as provided for by Section 3700 of The Labor Code, for the
performance of the work for which this pealed is issued.
❑1 bave and will maintain Worker's Cope... on Insurance,as required by Section
3700 of The Lobar Code,for the performance of the work for which this pertain is
T: issued.My Wakes Compensation hournace carrier and Policy number are:
Carr er•• ' • ' t: Pride,N.': T'
` CERTIFICATION OF EXEMPTION FROM WORKER55
COMPENSATION INSURANCE
''(This union nccJ nye be completed if the permit is for one hundred dollars '
(51007 or lcz,.7
r - .. .. ... . .. .,_..
I eemnppnfty}mal Tb pe f V yf thet p,a k fpe�xbhr n rho pe l a d,I
,bha yf{yi tf`('p Q_ YIV Y) 16 he WoAri - - ' •• r< ' _. _ ...
oro sal 2gfp
N CE f0 a0 kSng m' C n f S I Lx pt you eh W
z esub)e T theta kcr s Compensation Provisions of The Labor Cale you must
O0 foMw'on comply with such provisions or This permdeemed
it shall be revoked.
F .. .-..
C4n •' -_- -
,1 . . , CONSTRUCT ION LENDING AGENCY i -
a, - Ihercby af0rin Sha Share is a<onswctinn lending'.grncy fur the performance
� r of The work for which This permit is issued(sco.3099,Co.C.)
QLand ._. ..:1er's Name .y _.. :_. _.....:.._t. ..... --
�.Z Lender's AJJrtsz . 11 .., .. p /)
V0
.I cenify that 1 hove rend this application and state that the above information is
fiF•t <dmet,I agree to comply with all city and county,ordinances and sale laws relining
O V to building construction:and hereby WBKRIzereproscntativcs ofthii city to enter upon
} The above e)agree 1.propene for merify and keep
purposes.
�.Zt
(We) t.ave,Cost and a ptoses keep nam may
in the way acme
against
nt Snst
aid
rn liabilities,judgments,casts end expenses which may in any way ac<rve against sail y /
C.7 z City or con qtr nceof The gaming of this permit.
'•' APPLI 'DERSTANDSANDWILLCOMPLYWTHALLNON-POET Issued by: r Date
50 RC. L )NS. " .��I Q� Y'
awre f ppbcem acne '. Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE •
,. .alum pplimi future balding necapaint store or handle baz,rdeasnormal Type of Roof ..
as defired lay.the Cupeorm Municipal Cod Chapter 9.12.and the Health and Safety .
CPJe soon 25512(.) . i'rt 1 ! � ,Y l�i', •.lv ' ' dI '
�}' )" - All roofs shall be.mspected.pnor_tgany roofing material being installed.
Will the;ppBFann rr mmre bujlafng occupant use rouiptnentor de.ia:which If a roof is installed without first obtaining an inspections I'agree'to remove
coil hazardous air contaminants m Jefned by the Bay Area•Alr Quality Managemaot
Db6ide? all new materials for inspection. Applicant understands and will comply with
(I 0Yci .04 all non-point source regulations. . -
`�✓ 1 have read the hazardous materials requiremems'under'Chapter 6.95 of the
California Health&Safety Code,Sections 25505:25533 and 25534.1 understand that
ifthebuilding does not current havcumnnnglM1m it is my respansibilitymnotify the -_ _ . . _. -.. _ - ...
occupant ofy nh qhcT!dts whicIt nim,na be met prior to issuance� of n Centric of
Occupanc .. ry• O
Signature of Applicant Date
4DOe,orteal N eJagenT Dae. All roof coverings to be Class "B"or,better
y
.._ . ..-._...;(_. . ... ... .. . ... _.. �. .,- .•-.. OFFICE - --"