02090125 CITY UD DING DIVISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS'. PERMIT NO.
6033 SHADYGROVE DR 02090125
W qM APPLICATION UB DATE
r9'6sJ� 14AMID NAVID 09/19/2002
PHONE: SANITARY NO. CONTROL NO.
WOO ARCHITECTIENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
t
Z m i - LICENSED CONTRACTOR'S DECLARATION Job Description
OZ_p ebony )ofDtion h.lo3mf.1 Btoiunder prnPinneW...of ode. ad
INSTAL SEWER CLEAN OUT
p lE I w with full force and e f effect. on J of the Business and Professions Code.and my tic<nse
6 Y 0< as in full(lace end effect. FB
0 gg U Lice's Class Lic.tr
a. t C u Daae S DECLARATION `s�®
L:El u.t; ARCHITECT'S DECLARATION
E n O S I underhand my plans mall h used as public record,
SEP 2 3 2002
u.u°'I i p p Licensed Professional
OWNER-BUILDER DECLARATION
vi 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
F Z Q following remain.(Section 70315.Business and Professions Cole:Any city or county BUILDING $200
I Z G wh h 9 permit t construct. re
alter improve,demolish,or repair any structu
ad
ser proorto itsIsom,, theap,bincent forsuch pmommfilea signedztatemem - __ _._...._...... ...._... .
that h; klicensed Irrs 'nmtne pao'nh m of lite ContmcwraLanse Law(Chapter v .f ��'Ub 9oearnn tSS' ,`` Valuation
(cb mnwng with Sw 7000)of Divion 3 of the Business and Professions Code) l �r°lil Lcs,�.klxl,lr'Sr4��F.•i:
or that be is ciinlpl thenfmm'and the basis for the alleged cserapuon.Any nolaoon
-of Section 7031-.5 by any applicant far a,drit,uhimus the a,licanr w a civil penalty
of not more than five hundred doll (s5m), 106 APNjtWTj§q & WATER Occupancy Type
❑Lasnwnernrn,epanpeny.armveanploree.wdnwageaaztneiranlecnmpenaaltnn. 202 — UNDERFLOQR PLUMBING
'-will do the work:'and the structure is not intended or offered for sale(Sec."(1TI, - -- '- --'-
Busih8s mal Professions Caade The Contract.,,License Law docs not apply to an 301 — ROUGH PLUMPE&Inspections
owner of property Who Wilds orimproves meaeon.and who does such work himself 302 — TUB & OR SHOWER 1
or through his own employees.provided that such improvements am not intended or
-:oB<ii'd'foP sale:If,however,tfie buildin"-or-im:6vemem is sold wiinin one <hr of "_..___.._... .- _ -_—.�-
' nt Inion.the wsme,builder will have he barren or Y 502'- FINAL-PLUMBING'-'ENERGY3. m-
cofir
p proving that he did not build or
Improve for Purpose.r,ale.). 506 — GAS TEST
- '----- --- ----- ..__.__-._....._... _...._. ....-5.07_ .._._:FINAli-PLUMBING------'- '— - -- ;::..---- - -
I;.s owner N the propcnY.am caclusivcly contracting with licamsed conametrus to
met th<pmjmt(Sm.7 ,Business and Professions Cwe:)The Conuacrnr's
\ .Lic L J not pply t er f p pent who bu Id pmv Herron
and who commcts.fo such.p icts_with tracturtsl l d p u t c. __ _._ _._. .__ ............_ ..... . ... ............
.1 sc Lars. ,.
mpt under Scc i this 7011 l:,'CI L" �D
c,' i W OMP see ION CLARATION . .
the by d a IlY of pert TY of the foll g declarations
❑ I h a d II m a n C nificm f Consent to self for Worker's
Compensation. as provided for by Set 37M of the Labor Code, for the
performance of the work fouwhich this perm)¢issued..
« ❑Ih 'nd will{o.i ti W k xCurnc t iIsumrFe i it by Section
37M of the'Ldbor Cod f the perfomu f the work'for which this'peor"is
i.ssiod My WorkereC p 'i Ia<mmneecam<rand'oI y - Ireri ,u y
,a..�,...._.. ..�.
,Gait , a i ,,,t Pol.yN .` ..e f r 'f tir* 'or:d1 .t.111 V.f1,.I ol,
1 CERTIFICATIONOFF EMPr10NFRONI,WORKEERS •. S1,s 1 s� ,, 2 < + : s+ - ,•
v COMPENSATION INSURANCE s
.A....r.°'.;-....._._;i....,...a-.sir-.._, ., .__.�....__:-.--.,_,.-, .....-"'--'_........_-__-'__.__-...._...__.-.___.
fThry se2i{do neer itoi M nrmplcieJ it the permit is for one M1unJrtJ dollars
151001 ser les.)
I itY lkt nth f is Id kf h hd ct t s edl k 1': - - � A ItsJll. Use .
ih II t y Y It n oyy'banner t be me subject t t- W rk _ r
C, t La f JDate
pf ___. _ .. .. ... ._ _._. -, _ _ ._
' t If tt nuknglnl C<tf t'ol Esenpi you Mold - -- - - •il\ Nd
c t
CET
c rte object o ahs. V k! C npsns t p n.i d the Labor Code,you muir
0
Q' faith th Comply'"with..h p ,icons..this pc.it shall be craned revoker.
\'CONSTRUCTION LENDING AGENCY B.II' r t
1 h' by ifflirmilut them isacianstmetion m1 ny Jgen y f th pxdcroiu m
ohM1 rkf h'M1th pc 1L toed lS �T97C C) .,,:a �
�.A Led N _ ,.... .... _. __.. ....._--_ _
�"' Lendcr Ada
U O m //v'/p///��•
Imodify th,I have readth PPI t J.t.cdouffic abovenf Simn is
ks is cern t 1 tgr w .ply with II city and county N'n aces, ¢d t la reul g
-'OU .to WJdtng conhrtinton and hcrehyhmhonte represcmm' e\nfthisa ty mcmcrupon
'-I.Wth b t rni neo p p ty f peel p apo
., F S (N ) gree to see indent fy and A p harm).3 the City of Cupertino agonst
R1 liabilities y dgmentx t J expense,which y n any y e gpin.t sat d /
UZ City c quacefiheggr gofihs perrtut. -,' V(�
ApFLfG TAtJDERSV AND WILL 0001-Y'WIT IALLN N` IIT Issued by; Date
SOURC FOUL, IONSut
1
nm (APP.. to I 5 Date Re-roofs
HAZA DOUS MATE LS DIS LOSU '
W II the�Cod Sect .2353l c(aml r t I, bu ly
occupant.t r handle hamr.J.o material i Type ofrtRso,ro, f_
xeyteCupemon p. oe ape, hy _ p ql .! n I ,7•sf 1� ,','
.Ili ]7
oY Imo" 1+ All roofs.shall be inspected pnor_to.any roofing.material being installed .,
want ..peri t f
am bar
g n tn,eeq pd a nm If a roof is installed without firs[obtaining an ihspec[Ion;4'agree'to remove
mit do irc0 m 't. defin yah B yAreaA Quality M rog t
District, � all new materials for inspection. Applicant understands and will comply with
Yes'.. 4 all non point source regulations.., „q
1 h,c rcadihe ba rd s maieriali regmrements under Chapter h.95 of the
.CaliforniaIHeal S 'I Sm....
n'tio 2550515513"'125534nI 'Jere.J that' _._
p espo bray to noufY the . . _._ ... .. . _ .._ .. .. ,
ftheb Id ngd n t<urrcntly ha sten t lh t t my
"occuant of th< bre cis he .tL<metp rmi nc<ofa Ccnif't 'r
Oe °""`y Q Signature of Applicant_ _ _ Date- - -
All roof coverings to be Class B' or better
<. r thorired agent g
-..,,_..,.:. , ---- OFFICE— .. .. _. __... .. ._.._ _ . .. ....
t.