02080120 CITYBUILDING GIDMSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
20071 SUISUN DR CONDITIONED AIR 02080120
APPLICATION SUB DATE
YMMMEZ NOEMI AND ENRIQUE 1701 LITTLE ORCHARD ST 08/22/2002
IPHONE: (408) 291-2220 SANITARY NO. CONTROL NO.
O OZ ARCHITEC(ENGINEER: t BUILDING PERMIT BJFO
m BLDG ELECT PLUMB MECH
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Z Z LICENSED CONTRAC70R'S DECLARATIONr r.-.a•-�• M Job Description
G Z y- I hereby amour that 1 am licensed under provisions of Chuprer 9(commencing R PLA RNACE
with Section? 1of Division 3 of Ne Busineyyy and 111-<µions C e,And my license
=t: is in Tullio "!"TO
L.'I_ T LlU}C; (P '
C 3.ih M u OLi ak 4V ll!/'iC's•�1ep`•,rbe'nor _ 1 J I
b(J CHI 'S Dp ION ,]J
G g 1 understand my plans shall be used cords
t3 I
S G Licen ed Professional
OWNER-BUILDERIMI
un' G�-y' 1 hereby amrm Nat I am exempt fro rea)'s License Low for the
C z< following remon.(Section 7031.5.B.,mers mrd Professions Code:Any city m county $1700
ISG which requires a pcmtit to consumer,alter improve,demolish,or repair any structure
i3� -priormits ismence,also requaer rhe applicant for amen permiuo Til...gned,uncment.
tha,hp i's,IiumiedyaieQmd to,the plovsdons of the Convenors License Law(Chapter 9 4 �,•�,3�6 E' Q]f 9or(yYgea„ til 1, Valuation
(comggncing wit Secdon 7090)of Division 3 of to�tithelsAna pp{{fasiorm Cu.) {' t',,
.rd,
is txempf therefrom and the basis for the all attempt 0,Any violation
--of Section 7031.5 by any applicant fora pemrit aubjec°the epplicam m a civil penalty
i of not marc than eve hundred Boyars($50o). 3 01 APN1�9D�H PLUMB I N Occupancy Type
01,as owner of the property,or mi employees with wages as their sole compensation, 303 ROUGH M H
-'will;do-the work;'and the srmcmre,isnot intended or offered for sale(Sec.7044." 304 — ROUGH EL] 7T Q CeCtlbnS "
Bushii end Professions Code:The Contractor's Licem,law des not apply m in
owner of property,who wilds at improves thereon,And who does such wort himself 505 — FINAL ELECTRICAL
or through hie own employers.provided that such improvements arc not intended or _
-;-uHecol fdi sale.lf:howeverto wilding or imPmvemem is sold within otic yam of -" 5 0 7 : FINAL' PLUMBING s.
completion,the owner wilder will have the widen of proving that he did not wild or
improa for purpose of tale.). 508 - FINAL MECHANICAL
- '--_._owner _..property,----cl --- - _ - --- - --- - - -- -'-- . —
c nruowner aftct(Sm.TNI4,exclusively and Prazringwitlia:)TheCmctonm :'I•• "'r
construct the project(Ser.7014,ownr Business end Professions who b CodeO The improves
demon,License Low des not apply to an owner of property who builds or improves thncon,
anartram ',Liclas fLaw. h-projecta wit.A.canuacror(sl.lserssed.pursuant m.te
Conuectofs License Lew. _
Cl am exempt under Sec.' ' _.B&PCfor)his reason 3 ' ' tr" �• "3'I
Owner - Daie`"
'WORKER'S COMPENSATION DECLARATION
1 hereby M.under•pnWy of peejury no of the following dechmo me:
O 1 have end will maintain'a Cenificare'of Consent io sel6imurt for Worker's
• Compensation, As provided for by Section 3700 of the labor Code, for the
- 'Performance of to work fm which tit pe"t is issued.
1.11
C 1 have and will maintain Worker's Compensation Insumn'o',as rtquirad by Section
'37M of to labor Cbde,for rho perfomunce of to work for which this permit is
issued.My Workers Compe s t un Into c ca er and NI c numwr are-
INC, • - o wle'yi-4111914 � y y ....1F
Cti en` , •CERTLRCATI NOF E% NFROM WORKERS" { '-3�' �1 L1.i1' .��r.A �.h• tL 141!•x1 iY1.t� t• ',
' COMPENSATION INSURANCE-'' A a t _ _ _ _._..—_.......-.
onii sectimi need not be urnplered if the permit is for one hundred dollar
(S 100)or less.) r
Jointly tat m Ju Let nfom°nce of the work for whish tis perms is issued,l �. t ..''1 tU -
'shall not employ"any Person in any manner so as to became subject in the Workers'
Compensation Laws of California:Data
OTICE TO APPLICANT:If,after making ria Certificate of Exemption,you should
Q Obocome subject to rhe Workers Compensation provisions of the Labor Code,you most
fanhwith comply with such provisions or this permit shall he domed revoked.
I' rl CONSTRUCTION LENDING AGENCY
'1 h by term th t therer dconniucuon lending agency far the perfo6name '
.� f t ark fwhich tr permit u issued(Ser 309'/Co.C.)
Lendr Nm -- . —. . .-_ . .
.�.Z LendersAddoels,2, 1.^•s . "r'Inll
v I unify that 1 have read this application and state that the Above information is
-W F contest.I agree to comply,with all city and county ordinances and.state laws relating
0'U r m wilding consmiction,and herebyauthorize representatives of this city to enter upon
ry the above-mentioned property for impaction parTma. -
Qa (We)agree in cove,indemnify and keep h.less the City'of Cupertino against
V4 liabilities,judgments,costs and expenses which may in way accrue Agoinsr said
U Inconsequence of the givming of tis permit. ' .2—
C4
LICANTuence o STA9DSAYD WILL COMPLY WITH ALLN -POINT Issued by; L &JU Date
OUR . NT ' gR -N
Signature of ApplilifiruContractor ' -' J I Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
_ Will the uppl cat f vete wilding cuponi store or handle hazardoms material Type of ROOF
my deencdbyte Cupamno Munlopal Chapter9.12 and to Health and Safety �y v,t s*,_ •t ,
Code SCaY4n 23533�a) a A° . l .Sqt 4 ' i 1' IVB i { iat 1. •P'a:r{ 4a •s. '� .k.•
All roofs.shall.be inspected,prior to any_roofing.material being Installed.__-- .
WiiilIm appeaanr or Pormre W1 ' 'An"Motma egmpmeAr ar devfe, wMnh if a roof is insfalled without first obtaining an inspection;I-agree to'remove
emir hatmi air comaminunts As deT by the Bay Aro Air Quality Management
District, all new materials for inspection. Applicantunderstands and will _comply with
are, all non-point-source regulations..
- 1 hove read the hmardous materialsrequirements under Chapter 6.95 of to
Cali forma Hemlt&Safety Cade,Sections 25505,25533 mrd 25534.1 understand that
it�the wilding does not currently have a taunt,that it is my responsibility to notify the
occapam of the requircmenis which.,fit w to im m rsmance o a Cenlficate of
Occupancy. d A ( A _ - .. .-
` I/. _ �, /� /b� Signature of Applicant_ Date
wneroraut aeda,cut /"Dale. All roof coverings to be Class'B",or.better'
; �'. ,:, '. - .. - -- OFFICE -... . _.. . ._. - .._.. _ . . . -_ . ...._ . -