02040031CITYBUILDING DPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDP4G ADDRESS:
10887 NORTHRIDG
OWNER'S NAME:
ROBERT YAMAMOTO
PHONE:
ARCHITECT/ENGINEER:
a6'
z
H 2 LICENSED CONTRACTOR'S DECLARATION
i Z EI 1 hereby affirm that 1 am licensed under provisions of Chuptor 9leommencing
ret with Sceti.ol")of Division 3of,h, Buainessand Professions Code. and my license
ggis in full force and effect.
i z d License Class Li,. x
i 3 i
Date Cam.....
O ARCHITECT'S DECLARATION
oi 1 understand my plans shall be used as public records
Licensed Prafessionel
e'
OWNER -BUILDER m the
= 1 mu affirm that 1 1. exempt from the Com ars Co : Any c law for the
C ? < following amore. (Sutton 7031.5. Business and Professions Code: Any city or county
S a which requires a permit to construct, ober, improve, tlemolish, or... it any swttum
3 _prior t'is issuvncgalso ..arcquias the applicant fol such p loA1 EIeisignednetemcnt
M1a1 A"n'i8ltr.vdA n„k6enr m 1A3 A:nvianna n1 rAn fmm�rrnJa t irnn.n t nw I('hl a
at met he is exempt theiefmm and the basis for the alleged cdemptibn. Any violation
of Section 7031:5 by any applicant for a permit subjects the applicant to a civil penalty
:of not mom than five hundred dollars ($3001.
as owner of the pmpeny, m my employees with wages as their sole compensation.
111'do die Work. ad the stmnum is not intended or offered for sale (Sec: 7044:
Bhsimeo, and Professions Code: The Contmcmr's License Low does nor apply to an
owner of property Who builds or improves thereon, and who does such work himself
or througgh his own employees. provided that such improvement]; are not intended or
offered for sine. If, no a en be building or miprovenuctut is sold thin one year of
completion, the owner -Wilder will have the burden of proving that he did not build or
improve for purpose of sale.).
O 1. as owner of rhe property, em exclusively contracting w th Isensed conuarl t
a'omuuct the protect (Sec 7044, Business and Profess ams Code) The Comm t
License Law does not apply to an owner of property who builds or improves thereon,
.and who, omraos for such projects with conmacsods) licensed pursuant to Ne.
Convectors License Law. .. ..
❑I am
ez eg:PChm this reason
Owner Dme
TUWTWnF6V1PENSAT[ON DECLARATION
I hereby of inn under Maly of pe jury one of the following declarations:
❑ 1 have and will'mainthin a Certificate of Consent to self -insure for Worker's
Compensation, as -provided -for by Section 3701 of the Labor Code, for the
_
Performance of the work for which this Permit is issued.
Ell have and will maintain Wor u'S Coinpensaiion'Insurence. ori required by Section
— - 3700 of the Inbar Cade, for the performance of the work for which this Permit is
- issued. My Worker, Compensation Insurance carder and Policy number
Comer n '.':' I t it v't Policy No
CERTIFICATION OFEXEMPT16NFROM WORKERS';,
COMPENSATION INSURANCE
(This scmm. aced not he completed if the permit is for one hundred dollars
(S 100) or less.)
ERMIT NO.
02040031
.PPLICATION SUB DATE
04/05/2002
ANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I I CJ L I I
Job Description
REPLACE WATER HEATER
$200
t_t"13'IS@3Fbt'OFdiYtr i''''.-a:'r(J.'. Valuation
502APN �4A!i, PLUMBIN ENERGYOccupancy Type
506 - r_n�TEST
507 - FINAL p1Ry l*1Ct4spectioT�S''
`... jt.n
.. . .. _ nmea.
d certify that iii req o i nrmanae: n r s work for which shit permit a issued, l •s b
'stiell'not employ any person in any manner so ss to become subject to she Workers 's `
Cmitpenseunn Laws of California. Data
. Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
,ZQ 0become Subject to the Workers Compensation provisions of the Labor Cade, you must
forthwith comply with such provisions or this permit shall W deemed revoked.
^.V� +' ”" il" ^"'"I CONSTRUCTION' LENDING AGENCY . '.
"I hadeby.fthandittflainem.cmismandim lendidjaped,fo,flat performvu:e
ore
intheo,mliforahteh th s pemm is issued (S 3097 Cs C )
WLendwa Name ...._. r.f... .u.. .•. ...>. sr_a .. _._. ....
y.0 Lenders Address
U ,' 1 ccnify thm 1 hove orad this applicvsion and area shat the above infmmasion is
W corm agree m comply,wiih all city and county, ordinances and stem laws relating
0� to Wilding constmctimnand hereby amhories ornesenatives aftMscity to enter upon
W
U 7.�
y of Cupertino against
ay acme against said
ALCNON.POMT''
$1®gefQ t PPm INNh(aLmM1M,.. Uam t .
. AZARDOUSATERIALS DISCLOSURE ..
I the app rc
W Imm m famine Wilding occupant store br handle hamidou i mucid
m defined by he Cupemm Muntcipal Code Chapmr 9.13, and the Health and leery
Code Section 25532(0
Will the applicant or future WdiJir,'pmu use equipment mr devices which
cat hazardous air contaminants as definedby the Bay Area Air Quality Management
1 Dismct? •r
�—Phive read the herado6a mamdils regmremems under Chipter 6.95 of Ne
y.
owns a ori rl age
:L
a
Issued by: _,;L, it e Date
Re -roofs
-.Type of Roof
A1Lroofs,shall be inspected prior.to any.roofing.material.being installed.-_.. ......
If a roof is installed without first obtaining an inspection;'I agree to remove
all new materials_ for inspection. Applicant understands and will -comply with
all non -point source regulations;, tit
" I Signature of Applicant Date
Date All roof coverings to be Class'B" or, better
. _ ...:..—. .. _- OFFICE -