02040160OFFICE
CITY unEONO
CONTRACTOR INFORMATION:
SSINPERMIT
BUILDING ADDRESS:
PERMIT NO.
1488 ROSEGARDEN LA
CUPERTINO PLUMBING
02040160
OWNER'S NAME:
APPLICATION SUB DATE
WU, K J
10297 S DE ANZA BLV
04/30/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)253-0618
ARCIi1TF.CVBNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job DCSC71ptlOn
or
1 berth (firm that 1 am licenced under f Chapter 9lmmmencin
y a provisions o p g
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Section ]looefect. n3nnneBuxme>+and rrataaan.Code .andmyhanxe
COPPER REPIPE AND WATER SERVICE
is in
infullforce and effect.
uLicense
CIyy��>> Lic. a
Date commas
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ARCHITCT'S EDECLARATIONATION
1 unJemmnJ my plana shrill n<used as public rtcordn
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$ p 2
Li¢nned Professional
car a
OWNER -BUILDER DECLARATION
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1 hereby affirm ma 11. exempt from the Contractor License for the
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Con Any r ly i
fallowing recon. (Si.it1 703 1.5, Business and Prnfeseions Cade: Any city oicoumy
$5000
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which requires n permit to wreathe, alar, nt prow, demolish, fi repair any stmnur<
.Pnor lea
CortrarmiuoicemeLzdstammem
the theapplicantfor
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F r a:..., i Valuation
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marble licensed pursuant to he (Chapter 9onsCde)
(corareermin withSetion7meofDimnsnr of theBaanesLiren.elyw
is Section or the and Professions Code?
that
(_'ON l'j3
Cher aWfi and the basin for the allege) cx<mpnoo Any violation
or be cxim and the basis t allied
of that be is
- of Section 1031.5 by any epplicani for o permit subjects the applicant to o civil penalty
31.5 b
of not mom than Eve hundred doRam(SSW).
202APN [M55 FLOOR PL MB,ING" Occupancy Type
❑ 1. as owner of the pmpcny, or my employees with wages as their sole compensation.
5 0 2 — FI NAL P1A9RIEIF$dbspE0iSRLGY '
will dome work, and the structure is not intended or offend for sale ISce. 70aa,-
Boone. and Pmfiesxiaos Code: The Contractor s License Law does m,t apply in an
owner of p,.,.y Who builds or impmvcs thcoun, and who does such work himself
of through h- . employees provided tht h improvements o t' intended or
PLUMBING
5 0 7 — FINAL PLUMB _ - - - ------
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d for Sale f, however the buJding r impro anent is sold w thin one year of
-offc I
-
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the owner -builder will have the burden of proving tbat he did not build or
Iariiplction,
mprove for pumosc of sale.).
_
'❑ i, as owner of jp(Secny, nm exclusively contracting with licensedcontractorsContracts to
'
the project(Sec. 7041. Business and Prty, hie Cade) The
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w. rhano n,
License Law das not apply to an owner of progeny, who bulice or impmvcs tlnrcan,
License due,
and who amnads such. projects with a.cammaor(s) licensed pursuam.to.the_
L
C m License Law;
I MApY Q 2002
0
❑lam exempt under sec. .B&PC for this rtason
1 axe
-•- •M/'L I'"'(.,
Owner Date '
WORKER'S COMPENSATION DECLARATION
'
BUILDINU
therebyalfirmunderPenaltyofperjuryoneofthefollowingdeclarations:
❑ 1 have and will maintain a Cenifii of Consent to self -insure for Worker's
\
Compensation; as provided for by Section 3700 of the Labor Code, for the
performance of me wod far which this permit is issued;.
MI have and will maintain worker's On Insurance, as required by Section
- -
37M of the']aboi Code, for the performance of the work for which this Permit is
.
issued. My Wodnumber a
er's Compensation Insurance carrier and Policy numbrc:
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Cam�r Sr/Cle li yfT.I
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CERTIFICATION OF EX 09 FRO M WIVORKERS*.
\el
COMPENSATION INSURANCE"� '
........
fl n O,oion neFJ'nm be ccon,land if the permit is for one hundred dollars
"' -" " '� ` "�'t,1 L' • r
(Sim) or les.)
1 npii that hep fnmtaime of the nor me this t serum 1
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on b c
shall not employ any person in any manner so a to become xubjm to the Workcri
e
'
Coitipcnmticn Lows of Califomia. Date' -
- -
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NOTICE TOAPPLICANT: If, after making this Cmi beam of Exemption, you should
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become'sdhjeel to m,i Warker'x Compensinno muvlsion.utf the Labor Code, you must
be deemed
fonbx ice comply with such provisions or this permit shall revoked.
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'" "•''" CONSTRUCTION LENDING AGENCY'
1 hereby affirm that mere is a mnstmction lending agency for the performance
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Of tfic work foris P
-Lender's Ne toe which his is issued (Sec:3(N
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LL_Ey
Lender's Address
1I upon that 1 have read this cityand on and state that the above information relati is
burred: 1 egrce tocontiflyt I have with all city and county ordinances and nm¢ lawn salmis
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to building construction, and hemby amhoriu repfesentatives of this city to curer upon
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the above-mcntioncd property for inspection purposes.
(We)agree to save. indemnify and keep hmmlcamc City of Cupenino ageism
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liabilities, ju and a panus which may m any way accme against said
City i an 9uni of this permit.
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'APPL D. D WILL COMPLY WITH'ALLNONTOINT
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Issued b Dale `-
Y:
Yllui o ApFl nUCdntae - Date
Re-roofs
HAZAVUUUS MATERIALS DISCLOSURE
he pplida t6, brute b Id'dg..Pon, t or bardle haiadous on.mml
Type of Roof _
as defined by me Cupertino Municipal, Code Chal m 9,12. and the Health and Safety
25532(e)P
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Code, s eon i _ et ,.
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All roofs shall_be-inspected prior to any.ropfing materia] being.installed.- -
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Will thapplicant or I more but lding occupant use equ ipt or devices w hich
_ —
If a roof is installed without first obtaining an inspectimi;'I'agree'to remove
curt ham dons air contaminants as defined by the Bay Arca Air Quality Management
District?
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all new materials for inspection. Applicant understands and will comply with _
- all non -point source regulations:
1 have read hthief I. egmrements under Costar, 6.95 of me
CalifomiS H' Ith & C.mons 25505,15533 and 25534. I understand that
-
ifthc� in doese 0mr.m. that it is my responsibility to mifyme
- ..
Occup t of ere muss he or to issuance of a Certificate of
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Osco cY . - N. 3G 02
Signature of Applicant _ Date.
All roof coverings to be Class "B" or better
aumnd, Date
OFFICE