02090042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMff NO.
10711 RAE LA CUPERTINO PLUMBING 02090042
OWNER'S NAME: APPLICATION SpB DATE
JOHN GACHINA 10297 S DE ANZA BLV 09/ 06/2002
I�F
PHONE: SANITARY NO. CONTROL NO.
r (408) 253-0618
re0 ZOITECT/ENGINEF.R: a BUILDING PERMIT INFO
❑❑ BLDG ELECT PLUMB MECH
lz i 6 O I—.) L---1
LICENSED CONTRACTOR'S DECLARATION
ZO
Z,4I hereby infirm thm I am licensed uncleF provi:ions of Chapter 9(<emmereing Job Deseri On
p_[_u, eatian7ad,7D'virian3armeeasiryasandPrareaamnacea ndmylicense WATER SERVICE MAIN LI ����®
a I in full foreeam1 at?) ✓✓
Of ce a uecnas o __ Liaa.te@� L 2 y90
0 o � ARCHITECT'S UEQLARATIG� FEB 1 8 2003
N g 1 understand my,lam shat be used as public records
ea
E C Licensed Professional
�o OWNER-BUILDER DECLARATION BUILDING
1 hereby am.that I ons exempt fmm the Cmdracmr'a License law for the $2000
l:Z< following reason.(Section]03 1.5,Business and Professions Code:Any city or county
E F G which requires a Permit to construes,alter,improve,demolish,or repair any structure
ad Pnonoits issuance,elso requres thert"liamn for such pemnt m OleawgslN --
0tatp4islichiidpuisuanttotheProviaonso(ilio Conuacsoes Lcenw Law(Chepter9 ,af 3,C..rFe.rh....r-��a�s A 3 Valuation
(co mratfi wi(h Section 7000)of Division Sof she Business and Profissions Code) t,$,,,, x .__33_''99.0.
or but he r exempt therefiom and the bests for the alleged uemption.Any violation
of Section 703 Id by any applicant for. .it subject.tate applicant to a civil pcdalry
;of aofmaremanfive hundred dohars(S500). 202APNNNE)ERFLOOR PL BTNG".: Occupancy Type
❑I,ex owner ofthe property.or my employeeswith wage es thcirxole compensation. 301 ROUGH PLUMBING
LIL'�DG _
wi ulnasl do she wort:. stimr,and odstre:The Is nodinmr's Lio ene feredLaw does aleno,(Seply o,no
5 02 — FINAL NAL PIjU*H zy TQspZNr0ii.'Gym'i'
Bb.imas and Proles Code:The Commcmr's L¢ense Low does not° I mon '
uwner of pmPeny Wh 6 IJ. proves thereon,and who dxs such work bmaelf
507 - FINAL PLUMBING
or through In own employ.,.p ided that h p nt m tan intended or
infr ._..-_.. - ._... -... . .._. ...-__.
em do sal drewaver the Wilding improvement -_ Id withinantYea f - ?.I '.1 if
oprove m,the owner hu le).well have the burden of proving than he did not bu W or
Improve far puryoxe of stile).
.0 as as owncraf the
. _._ _.. _d dors .. ._. ..... .._._. .. ._. _ ._._.. . ... ._._.... _._. .__-- _-_ _ _...__..._-....
coL, property,am Business exclusively
wah licensedcontractorsT •I;Lctor's , f r. x. _
License the present(Sec.IDA),Business and property
who
Cade:)improves
ves started, T„ , _ i
o:. . o
t r License Law does not apply m mj owner of.a addo who builds or improves Merton, -
3' '0 _and.whones License
contmctortsj littmed.pursuant faiths.
Commcrors Liccnae Lvw..s
° f,r„
Iomist, under Ss:•
ec." ,BkPC(ar this reason � 1�' t:9S:Si ik;as
Owns Tal t ale'
!WORKER'S COMPENSATION DECLARATION
I hereb am.under _.
y penalty of perjury one o(Ne following declantiom.
?(S ° I heve'and will"maintain tr Ckficiu,of'CWxe.i td self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Cole, for the
'performance or tho'wak for which this pcmrit is issued. ¢
❑I h 5 and will ri15 t n Worker's Cot pensnt o Insume e t y."ad 6,Section
71X1 1 theL M Cal f th p rf rmance of therk f r wh ch this'permit is
ps d MY k C p s t n 1 . mn<e< ,t d Pot I y r -
SV
_..-
ti iij ".1
No
CEItTIFICATI NOF,.• PTION FRO WORKERS—' f.. .,y, a 3iJTa(_. At•s.� it LI.hid 11 `.N: �� f hz: V r'.i a,l l".I'.
�4 C MPENSATION INSURANCE ^
p permit is for �•n rt ... .__...____
i. , I 'I,. r . f . \'..
,_ (Th s secited need not be Com Completed if the hundred dollars �Ai s _
($H0 )orless.) , -
rsla 1 amplarn yyhtia the
a.,1 .na adn thwkforwhnscih 'per ms Workers'JII �s..,l_rt r q •
mall t employ any person in anY manner so td become mhjen t...the Warken '
r
Compensation Lawx of California:Date` -
(NOT a subject
1. he Wok:rs C.ar,making Nis,Cenmiii o of Labor is d ,you could `• L" v r 'r'
becomes b¢ett theta rkefs Com,ereat ispo nxof the deemed
Cale d. L
Q Q forth uh comply with ch provisions or this perm t hall be do meJ makM.
F7 t
FS > CONSTRUCTION LENDING AGENCY
r•I 'o........
r'I reb A131rm that the sI t ton lends'g 6e c f ;be
perompnce vU ,
\he
fh kfwhich this perms is¢sue)S. 7097
a' Civ C)Lendds Neme •. .—v _ .,._ u. !y... . _.....w.. .__. . ._.._......._ -____-- _ . _ __ ..,... __..... ...
Lanael't'Addritiv
U 0 �a1 1 certify but I have d this Imliesuitt.and state that the.1bova i.f.matumn is
kx F c rrect 1 agree,to comply nh all,city and county od'n .and mt ws relating T��/t�
O,V m buddng nsmuuchotund herehy'authonre represenarives afidi my lP enrarupan ai l
Phe above-mentioned.property. inspection. "poses. . I. ..
6ifor
Ey.Qs' a" g los aInd rectify and kee,harmlev ih y fCpeninditgatnd
rr V1 Cul hs 3 dgm ms, t and expense h ch m ny y <me against avid
U City q e ce of t ng of ilii du '
A P ICA UUUE T 1 D If P !W(T L YON P NT ,
Issued bye Date
Sign t rase(APPL anVComm to tc�
. r o Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
wiII the app)ca t o fwurc bwldmg ac Pani u re or handle haradou mete J Type Of ROOF - «... .. - —. - -
- mdcfnN by the Cupcn oMu cPd Code Chapter 912 end the Health eMSafy y Y 1 'f1 31,'aaLT11Q ' , '-.vqr
Cod
Section
25532(x) t - I . . s, (\`•• f 11"i t( is"
5 s
°P ` .I All roofs-shall-be.Inspected prior.to any roofing.material,being installed,____
�,; Wllltheappliwnto fut�dingo pant use equipmenta,Je ieci hr<h; If a roof is installe'd'withcut first obtaininganliiis ection;I a nee to remove
-� mRhezrdomauromominanis as refinedb sheI Area Air Quality Managemenu P g
Diatrietr Y all_new materials for inspection. Applicant understands and will comply with,_,_.
°Y«., P .
all non-point source regulations t,
1 h e:read the hoz o ren Is regwremmsaunder Chepte 6.95'mf the' \
Calif°mm Health h Softy Code,Sections 25505,25533 and 75341 understand the l _
'tithe bu ld ng docs a oily ha dtcn tthmu sso
'yr po Fll tyt my th
'ddopant of the, lui nm hl ha stit
, i n r u s oft C nifisate rf - t
7 Signature of Applicant Date
All roof coverings to be ClaB'or better
o uthonzcd ugem U« ss g
i:.„. .. .OFFICE • ... .-_ .._-...