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03020100 CITY OF CUPERTINO % .. BUILDING DIVISION " PERMIT � ��\'ARl�.�TOR� �pRM+� �4 . ..rats BUILDING ADDRESS: WATER QUALITY PLUMBING PERMIT NO. 21721 SANTA BELLA PL 03020100 WNER'S NAME: _ 1860 ALMADEN RD PERMIT ISSUE DATE ROBERT SHINAGAWA 02/24/2003 NE: - SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO OO PLUMB 0 o oLICENSED COWMACIOR'S DECLARATION Job Description 8 1 hereby alarm that 1 am licensed under p Isiana of Cheerer 9(commenting p ' withSecilon7 )o(Division3oftM BupnW PIZZO.CoM.and my license le 0 mmumroe u OSOt B GAS LINE TO COOK TOP �`•�� i 1q0-.Z License CI Lk.M_ 9�'�� Ja De (understand my plane ARshoCHITECTS be DECL•as AtATION � ,W FEB 2 8 2003 Su.�a Licensed Poor..wool �a OWNER-BUILDER DECLARATION <2 1 hcmhy eRrm that 1 am exempt Boum the Contra fm's License law for the maxim.O 0 fallowing rcnn.(Section 71213.Business and Professions Code:Any city or county $ which requires a permit to construct,Alar,Improve,demolish.or repair any atruclurp - t- < prior in its issuance,also mquires the applicant for uch permit to na a signed statement ggg gay that he is licensed pursuant to the pmvisiom of the Contractor's Lucie Low(Chapter 9 Sq.Ft.Floor Area 3MI010ion to (commencing with Section 7000)of Division 3 of the Business and Profwlans Court or B fur he Is exempt therefrom and wa basis for do alleged exemption.Any Noladon of Section 7031.5 by any applicant for a permit subjects the Applicant o a civil penalty of 3 DR not Mort than Rim hundred dollars(S500). f Occupancy Type C3 1.as owner of the property,or my employees with wages As their sole compensation, I _per p�q��p@yam w111 do the work,and wesmumurtls notinkdd oraffertA forsaa(Sec.70u,Buunw 202 - UNED")" L@�Y1Q IS;I 011VG and Professions Code:The ConuacmYs License law does mol apply m an Owner of propenywhobuflds 0rlmproves lamon,and who doessneh work himselforwrough his ownemployees.provided Nal such Improvements art not Intended wortared porsak.It. 301_-_'- ROUGH PLUMBING'- ------- - however,the building or Improvement is sold within one year ofcomplawn,we owner- 302 - TUB & OR SHOWER builder will have we burden of proving Nu he did rot build or improve for purpose of , ask')' 502 - FINAL PLUMBING ENERGY ❑1.as owner of the properly,am exclusively contracting with licensed contractors to 506 GAS TEST - eomwct the project(Sec.70th,Business and Profusions Cade)The ComrumA U. roma Law does not pply to on owner of property who holds or Improves thereon,and 507 - FINAL PLUMBING who contracts for Arch pmjecu with a eonvacmr(s)licensed pursuant to the Contractor's .. License Law. - ❑IamexemptunderSm. ,B A P C for this rwm net Dow WORKER'S COMPENSATION DECLARATION I hereby Afloat under penalty of perjury one of du following declarations: I have and will midmain aCeMncs a of Con cnito self-hndm for WorkelsCompen- satian.As provided for by Section 37M of the labor Code.for the performance of the ' work for which this permit is issued. ❑1 hoe and will maintain Workers Compensation lmtmnce,u worried by Section 3700 of the[.her CdA.far the perfarmaneo of the wpprrk for which this permit is food. My orkefs Compensation lnaunnce taniu andPElicy fnumber Art: p Me 3l' •N jf�q Poi in,No.: CERTIFICATE OF EKE ON FROM WORKERS' COMPFNSAD NINSURANCE (This semen used not he complekd if Ilia pump is for one hundred dullan(S I W) or leu) ' 1 certify war In the performance of the work for which this Permit k immod,l shell not employ any portion In my manner an As m become aubjecl to fee Worken'Compernsatlon Laws of Callfofnis,Dare Applicant NOTICE TO APPLICANT:If.eller making this Comftan of Exemption,you Mould become subject In the Worker's Compensation provisions of the labor Codes you moat �O forthwith comply wife such provisions or this Ferrell shall W deemed revoked. - Z.y. CONSTRUCTION LENDING AGENCY I-n I hereby Affirm that were Is a comuoction lending agency for the performance of - a> dre work for which this permit Is Issued(Sec.3097.Civ,C.) W 0 Lender's Nauru a z Iander's Address U Q 1 comfy that I hove read this application and sum that the show Information Is n.E conal.I agree m comply with all city and county on inmcu and sera laws mhling On 0 building comwctlan,and hereby suthocire reprommetiims offeb city to enter upon we Eahove-mcnlloncd progeny for inepedon Purposes (We)Agree to sew.Indemnify and keep harrmlw the City of Cupertino against ,.v VisIlabilidu,judgment.costs and expiums which may in any way acerae against old City („)Z in cansegnence of the granMg of this Permit. APPLICANT UNDERSTANDS AND WILL OMPLY WITH A NON-POINT Issued by: Date . SOURCE REGULA770 . Lt'03 Re-roofs ignAlumo A ices mrn ' Dam ARDOUS MATERIA DISCLOSURE Type of Roof Will we applicant u fulum boiling Occupant amen or handle hasadom material - o MOncd by we Cupertino Municipal Code,Charter 9.12.and the Health end Safety All roofs shall be inspected prior to any roofing material being installed. Yes �Nu Will the APPlhcanl ter future Wilding occupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It h vandors air contaminants a dennd by the Bay Area Air Quality Management DuMct7 all new materials for inspection. - 1 ❑Yes `4RNy I have mad the hwNrwsmalerhb requimmonts under Chapar6.95 of the CAlifor. - .. -is Hemlth@SAINYCode,Sections 23505.25533 and 25534.1 on wulde building dace not currently haw a knen4 wet it u my rasa athlllly to Imo the necupant of the requlremenu which muse be normissrance aCcnincaaor n. Signature of Applicant Date ' wnet araat a naA DateAll roof coverings to be Class"B"or better