02020047 OF
TINO
CI sot DING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS- PERMIT NO.
OWNER'S NAME: APPLICATION SUB DA]'E
POPOV MICHAEL L AND JILL 329 ALMA ST 02/13/2002
[•PHONE: SANRARI'NO. CONTROL NO.
(650) 321-5500
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
CC RLDG ELECT PLUMB MECH
i WI L-:Lj LJ L_1 I_1
LICENSED CONTRACTOR'S DECLARATION
z 5 ? Job Description
z_O 1 hereby affirm that 1 ora licenses under provisions of Chapter 9 d license
with Section]II00 ifDivision3 of Shc Business dProfessions Cme.and licence
iyfng
< ismrwlmre aerr¢t �C REPLACE WATER HEATER 50 GALLON
s-z w¢ Even ense Clns_ _t�]1c� Lic1.4
O o,u m J Z CnnVackB,
+�3 u y J'( ARCHITECT'S DEC1XATION �)
g O; I under,wnd my plans shall le,used as public records
Y is'n O O Licensed Professional
c. OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt Troon the Contmcmr's License law for the
h
following reason.(Section 7031.5.Business and Professions Cafe:Any city or county
<€c worn requires a isrintit
w $ _-. - o'rconstruct,
.t t h p demolish. repairr wemum
-
. 32649011 T. }
$10.5..0
prof t e also y applicant f h p 's signed cement .-
Main slns to the
Prm . of the Connector's is la (Chapter g S Jt. F1oolAreap, Valu
a_ti_on
(commencingw'illyS no of Division J fm BusinessadProfessions Cmc) O0s .+f:eL t. it:
or that he is eampf tary'and The baso for The allijid64rapticii.Any violation
of n703 Idmy,
aplicntfar v . subjects Shevpplicv . oivi....alSy
:of notmore than live hundred dollars 0500). _
APN Number �-- "� Occupancy Type
°1,as owner of She property.or my anplorees with wages as their sole compensation. 502 — FINAL PLUMBIN ENERGY
-will do the work:and the stimpture is not intended or offered fore sale apply
ownrBasJ e f..v Cm The m C tray thereon,
License Law Jac= tow apply m on eedci� SpeCl1Or15
of property em builds o improves Aid such and whodamsmcM1 work himself 507 — FINAL P 1N�
owner r.
or through his own employees.pmviJed thal such improvements is sole are non intended or _-__
-onciW7or xnle.lChovaer;the buildin8 or impmvcmem is sold within oris year of- ' ` -�- - -_..__..._. -. _. - __.___..__ ._..._.____�...._. _ .......
•
'completion,the uwnenbuildcr will hove the burden of proving ohm he did nm build ar
improve for purpose of sale.).
�A9�p amara®. ..._—__-_-__.__.__._.._._.
°I,usct the of ject(Sec.7 am Business
d Prolatrace sin g with licensed conommy to lisi' ;+ -
- '
construct the ors (See.]Oda,Business and Professions Crocq The ves tmcenk
-
License Law Jne,not apply to an owner nlpmpeny who builds nr improves fM1ernm,
-and,who contracts for such projects.with a contract (s)licensed pursuant m She ...-_.._
— JUC 1 q, 204 .._.._._._.....—
Contm i une Law..
❑lam exempt undd « P
er S . - .B& Cfm this recon .+ isC+.:li•ll'17
_ Owner .. - Dane ' ����(( �*s
• 'WORKER'S COMPENSATION DECLARATION 84 Ilan aaI�,yl
I hereby urfrh under penally of perjury one of the following declarations:
: 7 I hn0e and will maintain a Certificate of Consent to selLin me for Workers
'ompcnse ion, as provided for by Section 37W of the Labor Core, for the
4performance of the work for which this Permit is issued.
' ❑1 have and avfll maintain Wok s C 'pc t Insurance. reqs mA by Section
3700 of the Labor Code.for the. efformarne of fire k for which this perm t is ®A
issued M W o c J PoI �W re - _
n _r. .
FR ' - �..,.. _ ...x_.1_-- ._.._
'ad J..G Pace ®
I'CERTIFICA ION OF EXEMPTION OM WORKERS(- '' .1�; 1.1� i,t1LI l ♦ p S,,f 24 1s1I/1:.11 1H`
COMPENSATIONINSURANCE r'• -_ _ -_ - _ .JV7._ ....._._ _ ______ _ __.-.__
— }—'9 2002 . r —
•' (This scotoo nem not be ctmplefed if the permit is for one hundred dollars '
(MW)or hers.)
he ssu d ^ _
I' n fy th( e perfs c of me work for which this pe mit 1 - - - - - G �• 'r,
shyly ( 'ployany pe y <r so as So become. hlea to the Wt kers 'I�LIN
n •
Con p laws of Cel f m a Dane, '
aApplcant.
NOTICE TO APPLICANT.If,after making this Certificate of Exemptmn.you should
z
necome subject the Workers Compensation Provisions of the Labor Cmc,you must Q tiforthwith comply with such provisions or this Permit shall h deemed revoked.
1
CONSTRUCTION LENDING'AGENCY
1 hereby uf0em that thele is'a construction lending agency for She performance
ofthc-brk for which the permit is issued(Sec"3097 Cv C) r.••-
ndet
�.z Isnder's'AJJress r
1
unify that I have read this applicefiov and safe thvrthe above information is
Wt.
. . convit.1 agree to complywith all city and county ordinances and state laws relating
D.0 to building construction,and hereby authorize representatives tfthis city to enter upon
>,;W Sheabave-mentioned property for inspection purposes.
(W) 8 tos c f demmfy'nd keep h I ss the City ofCupertn spirit
to liabilities,judgments. t J Pv ses which.m y in any way ne.ir_i.aid /L--
APPL`
t..) z City - q - ftheg i g fthi Ie i "
SNDSI IDW LCOMPLYW'ITHALLNONFOINT'" Issued Date
�r - � L -11-CZ
A PO
• w Dare. ), Re-roofs
HAZARDOUS LS DISCLOSURE
Will hePp ica t ant reb ila'e
occupant store or handle hearyinficam mate ul Type of Roof
m Island b the Cum o Municipal Cm Ch pt 9 12.and the Health d Safety N , k a-` k , 4 I •i o yI
coo any 2s@a2cal .,: ,, -Al]roofs-shall-be inspe ,r f {3 , '
r p . tf,f +l
- 1(,- '1 S c[ed-pnor.[o any roofing ma[ena] being installed.
` r Will the applicant or future WiddiaB«cupant use eiupment or deuces whim If a roof is installed without first obtaining an inspectioTi•,'I'ttgree,6 remove
Di Siasercam S sd toed by ByA A Quality Managemem
Di
all new materials for inspection. Applicant understands and will comply with
°Ys all non-port t source regulations.
I h va read be hazardim"onaterials iequ rcmcnts under Chapmr1695 of the
Ciddramia Health&Safe,y Creel Scrims 25505,25533 and 25534.1 undersomdthaw
'if the Wilding Ines not cunennly have a renam,that it is my respomibiliryto notify the
occupant of the re hent=which must be met prim ssuanee o
fo ife Certificate of
.r.,.. . .. -
I. r �� • " - r �_i7�d�; Sig
anature_ of Applicant _ .-.Date-,.
,7 net ' All roof coverings to be Class "B•' or'better -
ee ae-t ate
OFFICE.._ ._... -