03020006 CI'T'Y OF CUPER'fINO 1"
BUILDING DIVISION PERMIT ,.CONTRACTOR INr ORMATION °:.
BUILDINGADURESS: DIJOSEPHS PLUMBING PERMIT NO.
20598 SCOFIELD DR 01020006
OWNER'S NAME: 205 WYANDOTTE DR APPLICATION SUB DATE
WADE FRANK A 02/04/2003
IONEI (408) 365-2058 SANITARY NO. CONTROL NO,
ARCIIIIECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC11
o o
00 LICENSEDCONTRACTORSa R'SDECLARif cloth
zF I�olEnm Thal I am licensed under mvtsirns of Chxpbu 9(commencing Job DCSCrIpl100
y<2 with Scnt 7 ))ser Division 3nr the Basin JPmfcxsions Calc,anJ my liana is
< it mu torte err .(' REPIPE (DOMESTIC HOT, &: COLD WATER)
I mop Lncnse :: I'm 11
OZF^ D c
Co
to I
ARCf=CPS A ION FINAL®
Cii-I understand my plans shall M used as public records
xo�u
w 3 a Licensed Professional x
FLL05 OWNER-BUILDER DECLARATION 'rr EB O b 2003
I I herchy affirm Nat 1 am cacmpl from the Contomoa's License Law for the
to 00 following moon.(Sdcuun 7031.5.Business and professions Gme:Any city or county
e ce$ which requires a permit set convict,alter,improve,demolish,or repair any structure
f-Z>• pnortt its issuance,also requires the applicant mrsuch permiuo file a signed statement
< that he is licensed pursuooftofar pnovisionsofthe Contraeuv'sLicense Law(Chapter 9 S r res $5C,&(blption
y (commcoci ng with Section 7(XXB of Division 3 of the B mins and Professing Code)or
y 3 that M is exempt therefrom and the basis for the alleged aemption.Any violating of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than Five hundred dollar($501L 6 Occupancy Type
0 1,m owner of the pmperv,,or my employees with wages sw their sole compensation,
will do the work,and the structure is not intended or offered for sale(See,EW,Business - eeQQpp ING
and Professions Code:The Contractor's License Law does not apply to an owner of 301 - ROUGH LU R ffiec Ions
property who builds or improves thereon,and who does such work himalf or through his 1V l7
own employees,provided that such improvements aro not Intended or offered for safe.If. 502 - FINAL PLUMBING ENERGY
however,the building or improvement is sold within one year of completion.to owner.
builder will have the burden of proving but he did not build gr improve for purpoa of 507 - FINAL PLUMBING
sa)e).
❑1,a owner of the proper,am exclmivelY conmcung with licensed connections to
coats,the project(Sec.70,1,1,Bat.and Professing Cog.:)The Contractors Li-
cense Law docs not apply to an owner of proper who builds or improve demon,and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law.
Cl 1 am exempt under Sec. 6&P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury on of the following declarations:
I have and will maintain a Certificate of Consent to selhimm.for Worker's Compete
sailor,a provided for by Section 37(111 of tM Labor Code,for the performance of the
work for which Nis From it is ismcd.
❑I have and will maintain Worker's Compensation Insurance,m required by Section
3700 Of the Labor Calc,for the performance of the work for which this pemtil is issued.
My Worker's C,rn�mpe,/nsalinn in sennet ca rand . .nnot rare:
G en_5/a/P �r7o�PnRayY� '_"?29-oy—
CERTIFICATE OF EXEMPTION)ROM WORKERS'
COMPENSATION INSURANCE
('Ibis section need not M completed Rthe permit is furnace hundred drift.($100)
less.)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject o the Workers'Compensation
Laws at California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to he Worker's Compensation provisions of the LoMa Code,you must
OO forthwith comply with such provisions or this Permit shall he deemed revoked.
z tZ, CONSTRUCTION LENDING AGENCY
[-. I hereby onirm that here is a emmimctlon lending agency for the performance of
�. > the work I'(ir which this Permit is issued(Sec.397,Civ.C.)
fill Q Lender's Name
CL tinder's Address
Z
U Q 1 certify that 1 have read this application and sole teal Ne shove information is
0 U builder 1 agree to comply wth all city and county ordinances vesof and salt laws relating c
Q V alpswangcoawmiomand hcmhy euNomdrepsean.tivds of this city to enterupm he
abtvomcnlioncee to moy for demnify an keep ca.
0. (We)agree m save.indemnify and keep harmless IM City of Cupenst against
h inconses,judgmenh,staining if the staining oftenusmit. may in any way acerae against mid City
V z APPL CANTeUNDERSTANDS AIND WILL COMPLY WITH ALL NON POINT Issued by: Date
rb,
EG .ATIONS, I n
Re-roofs
f Applicant/Cumracror x Date
HAZARDOUS MATE )ALS DISCLOSURE Type of Roof
Will the applicant of future Wilding occupant store or handle hanuNous material
y Ibe Cupeninn Municipal Code,Chapter 9.12,and the Ilcaldi and Safety
eaa 25532(a)'/ NAll roofs shall be inspected prior to any roofing material being installed.
the applicant ser future building occupant usecquipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
ous air cmnaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yea 4No
I have mad dm hamorms mamrialsrequi.mcnts under Chapter 6.95 aide Califor.
nig iicaiN h Sgety Ci J.Smuog25505,2 533 and MSM,l unt cnwd Nm if tM Wilding
does ant eormally hast a tenant,that His my tespoaibility to notify the occupant of he
mquimmcnts wloc must Mmet nyissuancc ora CertificatefOsmapancy. Signature of Applicant Date
�j3 %rid
sono or tuthon.d agent Dale 7 All roof coverings t0 be Class "B" Or better