02040138 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, PERMIT NO.
22654 OAKCREST CT FALCONE AND SNYDER CO I 02040138
OWNER'S NAME: APPLICATION SUB DATE
TENOLD STANLEY E AND MARGO L 650 LINCOLN AVE 04/24/2002
PHONE: SANITARY NO. CONTROL NO.
` (408) 292-9705
O.Op ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
vU
LICENSED CONTRACTOR S DECLARATION
'z lSz I hereby abort int 1 licensed J p of Chapter 9(commencing Job Description
'h � with Section 7000)).fD" 'on 3 ofthe Business dpr,lc,oxmx Cweandun,Teense SEWER LINE REPLIR
I,in fol Me anL 1`&C Loc.« J" s 3 .,� 11®4 `s�
in-< Li<enseC �' ALe®
!0B" Dat L `�aa� Coamc f ma
1 3 c. �-_!I"k 1 ARCHITECT'S OEC TON
1 O 1 understood my plain shall be used as public records MAY 0
} 2 2002
i d p C Licensed Professional
OWNER.BUE.DER DECLARATION
w F-' 1 hereby affirm that 1 am exempt from the Commnnr's License Law far the 11,,
G $1922
FZN following reaxom(Section 703L5,Business and Profeaaions Code:Any city or county B{./'L®'�/'�
x F O
which q: perand,t construct,et It ,improve.demolish, repo any tmemrt
a.3 pooh 6 ss < 1 rtq to scions t, cn perms l is on - - -'hat he<Ib scrip pursuant o s ,tneC s an li W (Chapter n,Ced9' ^ $$ �ij(,� ppr(�p� T ; Valuation
(rose ing w lb Sccll romend the boson l of the flintiness nd P p[ ns Cede)
or that he 7 exempt thcrcfrom end the basin ,s Inc alleged he exemption.Any violation
of Section]031.5 by any applicam for a permit subjects the applicam to it civil penalty
of not more than five hundred d„ll,rs ISsin) 10 6APN NS"ffR & WATER t" Occupancy Type
❑I,as owner or the property,or my employees with rages as their sole compensation,
will do nese an Professions
the strachiode:T e is not intended a offered Law does (Sec. to ai' 3 01 - ROUGH PEupk 1 jMp
Business and Professions Code:The C"noanoro License Low docs nota 1 men ec[iohs "
owner of his o'Who builds or improves rt such
tend who,ca does such a work himself
oeredfrhisownentPloymx. Wildedmatmpriemientmsolarenotmmnaednr 507 - FINAL PLUMBING
comple for vleC If.however,the ll ave the
burden
of icni n sold w rh n doe Year of - - -- -- - - ---- - -completion,the owner-Wilder will have the huNen of proving that he did not build or '
Improve li,r purpose of sale J.
❑1,as owner of the progeny am exclusively con...in,with licensed toot...I—to
instruct the project(Sec.7044.Busincs,and P...eeso ns Code)The Cnntmeow.,
License law Jas not apply to an owner of Nopmy who Wilds or improves thereon,
-and who.comra,a f"r.such projects with a commn"r(s),Ileeraand punmin.to the
Catnmct"r's Limine Law. . - - _
❑I am eaempt under Sec. ' .B&P C for reason
Owner Date .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I ❑ 1 have and will mainiain a Certificate of Consent to self-insure for worker's
Compensaion. as-provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑1 have and will maintain Worker's Compensation I"mrance,as reyuireJ by Section
37th of th<LaWr Cade,for the performance of the work for which this permit is
issued.MyCt�r //W rkers Co J,e1�tion LIns'f�'uurraa�nc�( '- raand Policy numbcrare
I ,CERTIFICATION OF F.% ON FROM 'ORK� ERS"- 4 x. _ i l�, t t.1 k v',, I.-"
COMPENSATION INSURANCE'"_, ...'.. _..___.._...._....._-..____.__._.._. .-_.__.._-_. _ _. ._..
�
'
ISIsection need nm lie cnmplaeJ i(tne permit is for one hundred Dollars ' " '" �'
m)or rn Rle,s.l .,
1 c employ
Person
the work for which bj perm tis issueJ,1 0 ;(li ''t
Ccur.mempldy airy pedon in any manner�o as m become svn)en to the Workers'
And etisatian Lawx of California.Data'
NOTICE TO APPLICANT.IL after making this C visions m of Exemption,you should.
Q Obecome subject to the Worker's Compervotion provisionsll the Laborerred Cade,you must
forthwith comply wise iuch pmvisinns or this permit shall be deemed revoked. '
r/) N a "• CONSTRUCTION LENDING AGENCY
^' '' I hereby arfimt that there i.a construction lending agency for the Performance
•of the work for which this permit is issued(Sec.309],Cie C.)-'
QLender's Name._ . • .. - _. .... ...�__ .. -. .... _
�'.z Under s Address
V 0 1 certify that 1 have read this ap city
and.on and orae that the above information Wring is
0. correct.1 agree m comply,with all oily anJ county ordinances and state laws miming
�,V to Wilding conxirunion:and hereby' thdnzc representatives of ihi'scitymenmr upon
js'W the Wnr nY m� soto uryosesy ( y iei ec harmless the City of Cupeni no against iq/x u w ich may in any way accrue of�isi sat ((('''��� — IV Z Coy in a ting f li vim t. �� / ,/•' �lSA 'D\' LCOMPLYWITHALLQtG,y4'{tlKitp A Issued b : r Date v VVV-tt ��� Y
. .. si am a ornpplmatwcontracmr .',. •...., •� ate' Re-roofs
,HAZARDOUS MATERIAL$DISCI OSURE ' '
( W'I th ,pllcant or future Wilding occurcum am,or handle hazardo6s maedal Type of Roofas defirsed by the Cupertino M ' 'pal Code.CWpl 9.12.and he Health oad Safety -
Code,OVcs 25532(al 1 ! .+. ,
" rve t ll to shall be inspected priorto_any+roofing.material being-installed...
Willtheapplicant r Wilding occupant e eq�Pment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit h...odous a rcnntemin to as defined by the Bay Area Air Quality Management
Di,in 0 all new materials for inspection. Applicant-understands and will comply with
Y " all non-point'source regulations.
1 h d thed96 m
' /i e vial. qu cmenks order Chapter 6,95 of the
Calf h&Se Col S tions 505 25533 and 25534 1 understand that _
iifihebu' JoeIno ncntyh earn nc that it is my responsiW ty io not fy rhe - - - - -
niccbpan t e hi m is wh h mus 'issuance of a cera,site of
°•"opo"`y' - \ �y`f , ignature of Applicant _ Date
(,pr anthon:ee agem eft„e All roof coverings to be Class`•B" or better
OFFICE