Loading...
01110091- OFFICE CUE CITY � Ut DI c DP VISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 20669 SHELLY DR WATER QUALITY PLUMBING 01110091 OWNER'S NAME: APPLICATION SUB DATE. LUU KENNETH K ET AL 1860 ALMADEN RD 11/20/2001 PHONE: SANITARY NO. CONTROL NO. (408)267-9330 JIM ARCHITECT/ENGINEER: BUILDING PERMIT INFO �m BLDG ELECT PLUMB MUCH Sim aan i„? LICENSED CONTRACTOR'S DECLARATION Job Description P I hereby a1Rrm that 1 am licensed under pmvisiom of Chapter Y (commencing °wmnsemm�-r«xunrDi.;ainn3nnneeyNmc. nndPrnfe>.in n.anamyfcenae REPIPE & MAIN LINE. in full force' t. //Tf c 6 ,aD u ' i- Licenu I s 7 Lic. N Dae F — nm-@QVALED ITECrS DECLAR0 j '1 ;C4 I h de d used os punlm retool, ccna ” a NOV% o ZOO(f ca oLL OWNER-BI➢LDER DECLARATION "0• ^ a/ I hereby effort Thai 1 am e,empt from the Contractor Licenu Law for she following maven. (Section 703 1.5. Business and Professions Code: Any city or county O Q 0 i D which requires a permit to am,mc ,cher, improve, demolish or repair any structure .priorto it. lin_ q theppl'cant forsuch permit ofileastsncd smtimat - I'pT t Valuation thitha.Imemed ant the rol dulawntoCalr9 pti p nsmfthftheB.cim,, tread) rD kronor ad ooh es,msn„0mrn the cipptima. nyvi m and the basis for the alleged exaes.,1 . Any violation or thatbeis exempt tray ii, nl Sttfinm]Ol I5 by ray vpplinm for a permit xubjtt¢ the upplicant fo a Civil penalty 'of not mom than Five hundred dollan(5500) Occupancy Type 2024PN'�"ffRFLOOR PLBINE ❑ 1, as owfmr ml the properly, or my employees with wages ns their sole annpenutimn, intended a ser mrtnw for snot (set. ]our rs Licenu law docs not Bus dm me work, and the structure is Contractor m an Bunts and ons endo The C.s, 502 — FINAL PEUN4SSNQ4PEP00 RGY” " re property W the work hi owner ofhiso Who Nims or improves thereon, and who eocs such work need ernwf his imp 5 0_7.. - FINAL PLUMBING or own employees. provided that such roveI, sal art mlf armnde r or a, r or for sale: IL however, the building or improvement n sold within one compile build the owner -(milder will have the Horden of proving thin he did not build or Icompletion, mprove I'm purlwu of sale.). O Las nwn.r odea property, am nnmm to withlicensedThe .. v II :4; .1,; . (, I' i', i , Bmrmively d Pr m,sima C onsfroct the project (Sec. ]06.1. Business dna Professions Cada) The Comnaor's r, r License law dos not apply to an owner of property who builds or improve thereon, and who contracts for such projects with a commamrls) licensed pursuant to the Cmntnaors License law. Olam -c-P. under Scc. - .B& P C for this reason '• ''s'-::;�1 •:H Owed Date " WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I IV, have and will maintain a Certificate or Consent to self-insum for Worker's ` Compensation, as provided for by Section 37W of the Labor Code, For the peAamance of the work for which this permit is issued. ❑ 1 have and will maintain WoHer'a Compensmion Insurance, as required by Section - 37W of the Labor Code, for the performance of the work for which this permit is .sled My mikes Compensation lTuraaw carrion Polic umboam: ' 11tli�i�-e dmer ' " • ` Policy--- - k eta 't ; " t . a • -;.. t'• I t . I t- 'I 1}fre t •F: ill LCLIOIMCAT[ON OF EXEMPTION FROM' WORKERS. `,t 6: , INSURANCE';w _..-.,—._,...-. .__COMPENSATION ,J',V s ,set y.• ... '• s.n J-11;f"'iCrAr'.: 1,,.,, - (Thissunion need not be compined if tM permit is for one hundred dollars (SIW)nr lers.) 1ll cemfY fh t' n dic,performl of the work f6r which this permit. ''ssucJ, l shall' not employ any person in any manner so as to become subject to the Workers' c6m m law. or cal r me . ARA t TO king C n'f m of Exemption. y should iNOTIICE APPLICAMI, If, after 4 Z n Code,y must the kap. Compensation pro s of the le becomesubjectcomply � O a (onhw with c ply wnh sutM1 p or this permit : h 11 bed recd rooked su _.._. .. a ❑, uj CONSTRUCTION LENDING AGENCY' 1 hereby affimt that there is i comuoction lending agency for the licdmmarmc ti oftha'w6rk for which this permit is issued (Sec. 309]. Civ, C.) . I<ttder's Name .. ....... .. . . . L'q Lender's Address_ 0 1 certify thin 1 have rend this applieatimn had ,are that The above information is 1 to city and county ordinances and state laws relating C.i to'is. agree comply with all o building construction, and hcieby authonie representatives of this city to enter upon (t] she above.menkmed properly for inspection purpmu,. ,, .. , r Pa (We) agree to sswc.indemnify and keep hxrmlcssthe City of Cupertino against ,y liabilities, judgments, costs and expenses which may in any way accrue against said Cityin'consequmceofThegramingofthisp,rmit. '. 1� - APPLICANT UNDERSTANDS AND WILL COMPLY WITHALLNON-POINT Issued by: Date / NRCE REGULATIONS'"' Signature f Appl a UC v cdr - - Dat • .. Re -roofs HAZARDOUS MATERIA SCLOSURIS .l' wuNeappl ant r m b la p t tore handle haram .mammal Type of Roof sdefined by the C peri Ismaili,a a Chapter 9 13 and th H hh d Safety a., ,i fk r' r > ` coda's f 25532m)o .. , 1 , . ' oY _-All roofs shall be inspected prior to any roofing material being. installed. . Will the applicant or future building occupant use equipment or de vices which If a roof is installed without first obtaining an inspeetion�,I agree to7emove emit hazaoloue air contaminants ai defar ed h the Bay Arta Air Quality Manegcmcm nistHen - ., all new materials for inspection. Applicant understands and will comply with p °Ye'( all non -point source regulations;' s� 1 haze read the, hawrdoui 1mamnal requ mmcnu under CWpmr 6.95 of Ne CJifomi6 Health Safety Code; Scdtions 25505,15533 and 25536. 1 understand that ifthe tuddingdoes of currcndy have a tenant, that it is my responsibility m notify the - - . occupant a the' ui hh an itil be inn prior m rs.music of a cenifcem of - �wh ecu-!/Y/A/©� Signature of Applicant Date All roof coverings to be Class "B" or better - ow pgenr' - Data ermraummriae . - OFFICE