02110127 CI'T'Y OF CUPEWI'INOBUILDING DIVISION PERMIT CONTRACTOR,INFORMATION•; '
BUu I - FsiEL PPADO WAY (A/B) AQUATEK PLUMBING INC PERMITN(02110127
oW drACN+MAN ERNA B TRUSTEE 1716 STONE AVE #E APPLICATITN1sVh2`Iry2002
[ONE: (408) 295-7767 SANITARY NO 7 CONTROL NO,
ARCI IITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
w00 LICENSIiD CONTRACTOR'S DECLARATION
m-ZP I hereby affirm that I am licensed under provisions of Chapter 9(commencing COPPER REPIPE Job Description
<W with Section TpBLlf Division lnfthe Business and Professions Cale and mylicrosei.s
< m 91N rRCC1.
ozLIZ F Lief FONALE�
— ,a _ cnnlraele,
RC 11 :CFS DEC RATION
dorola dmypla Inc pal i` .,it, NOV 2 7 2002
aG
F.
iO RB LDER DECLARATION ' 1 I�'
tin"0 fnllo reason
alarm fM1aflam pt from the Convacmrs Liccnu Law for the p' 1C�^'pt/± $9000
wing re sun,(Section 7131.5,Business and Professions Code:Any city or county B V LJ 7 V G
,,$� which requires a peonil to construct,alter,improve,demolih,of repair any structure
FZj- prior to its issuance,also requires the applicant for such Permit it)file a signed statement
r< that he is licensed pursuanttothepmvisionsof(beContractor'sLicense aw(Chapter 9 3AM.OTkb6At@A Valuation
ex (enmmenai ng with Section 7WXFOI Division J of the Badness and Pn lesions Code)nr
y
that he is exempt thetefrom and Ne basis for the alleged exemption.Any violation of
Section 7871.5 by any applicant for a pennitsubjects,the applicant m a civil penally of PN-N Occupancy Type
not more than eKhundred dollars(s5fn2 301 - ROUGH PLUMBI G p y YP
0 1,axowner of the property.or my employees wit wages as their sole compensation,
will do the work,and me shmemic is not intended or offered for sale(Sec.71aQ Business
and Professions Code The Contractor's License law dors not apply in an owner or507 - FINAL gt ections
progeny who builds or improves tcmon,and who does such work himself or trough his .
own cmp[oyecs,provided tat such improvements are not intended or offered for sale.If.
however,to building or improvement is sold within one year of completion,to owner
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
0 I,as owner of to progeny,am exclusively contracting wit licensed connanms m
nstrun the project(See.71WJ,Business and Professions Code:)The Contracrors LL-
cenuw Iy N
nnp to an owner of property who Wilds or improves emon,and
what,o uckomjds ah a comramons)hccnud pursuant o to Contractor a
License a1
lame w pd /(CA1s, ,Brit PC for this reason
O Date
N LARATION
el- under Pena ly of perjury one of flue following declarations:
1 have and will maintain a Ceniffcatc nfConunuo self-maum for Wuokeoh Comoro.
sation.as provided for by Section YOU of the Labor Code,for the performance of the
Pole litho which tis permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
JTp of to Labor Code,for the Pero marlce of UIe work for which this Permit is issued.
My Workerb Comrnsation Insurance carrier and Policy num her am:
Carver: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if me Permit is for one hundred dollars(Slip)
Or Ices j
1 certify the,in the perlinmancr of the work for Which'his prrmil is isvucd.1 shall not
employ any proven in any manner so aur become subject o the Workers'Compensation
Laws of Caloomin.Date
Applicant
NOTICE TO APPLICAT:11.after making his Ceni liana of Exemption,you should
Wcomc subject to the Workers Compensation provisions of the Labor Codc.you must
O O forthwith comply with such provisions or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that there is a construction lending agency for the Performance of
C$ Z he work for which this Permit is issued(Sec.3II97,Co.C.)
6. Q Lender's Name
7 ,z Lenders Address
U O 1 cenify tat l have read this application and state that the above information is
U, F^ correct.1 agree to comply with all city and county ordinances and sole laws to sting to
OU building conelmction,and hereby authnrirc moremmativcs of til city to enter uponthe
Le adogIsioQroboned property for insPecdon purposes.
H CL ( e)agree Or save,indemnify and keep harmless the City of Cupertino against
(q 'a idea J Out andespcnses which may in any say accrue against said City
U Z tarn gene rat X
Issued by. Date
A IT 1 EL COMPLY WITH ALL NON-POINT
OU C' ATI
Re-roofs
Si utrncof Ap I ruonuacmr umc
I iA'I.ARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicam or future building occupant stere or handle hararJous material
as defined by the Cupertino Municipal CmR,Chapter 9.12,and the Hexhh and Safely
Codc.Scmiun 25532(a)'!
❑Yrs ON. All roofs shall be inspected prior to any roofing material being installed.
Will to applicam or(more budding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haanrdous air contaminants as delincd by the Bay Area Air Quality Management all new materials for inspection.
Dimrict!
0 No
maottt dous materials requirements under Chapter 6.95 of the Califor- -
niallcal k`' Ct retim 2.S.NI5.255 and 2551J.lundcrsmnd Naif mc,building
does not s ba✓, tenant,that it ism rdarymaihihty m testify dr Occupant of the
or,ife twhi at to prism- a tent .enmeamofC,.p:mey. Signature of Applicant Date
Owner nr dagent Date All roof coverings to be Class "B" or better