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02090084 CITYBUILDING UOPERTONNO PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 7496 TIPTOE LA CUPERTINO PLUMBING 02090A07E84 B D �2��1��Arf2T CHARLES M JR AND MAR 10297 S DE ANZA BLV APPuc09/13 /2002 PHONE: (408) 253-0618 SANITARY NO.. CONTROL NO. G ZO ARCHITECf/ENGINEER: At BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LL.D TJ L=_I L__l Z <N= LICENSED CONTRACTOR'S DECLARATION Job Description OZ-Q Ihercb alyml that l am licensed under visions of Chapter 9(commeming COPPER REPIPE/WATER HEATER F Ei t with Section )'Of Division 3 of me Buri and Professions Cade,and my license, Y is in full f d ff<n'G3�I 6??,?05- Ow K Data as Lia.a L K Dale Cnmmnor '6CAVEs A21,1011aO ARCHITECT'SD 1@ �y� //�'7t:-,�g understmtd my plans shall be used as pis is records Lk f z p p Licensed Profasinrul OWNER-exempt R DECLARATIONI hereby affum ohm 1 1. eBusin from the Csoon C•s License Law county AF y 3 S, B�b SPP..(fE4 r,,. C?< following reason.(Section]0715,easiness and Profession Cade:Any city or county D which requires a permit to commit alter,improve,demolish,or repair any Structure 3$ pdorro isissuance.alsorequires die applicant for such permit to fileasigned Inez hp it,liansci Wnognf Id O,eprL'vidons o(the Conuocm/r Ucenx law(CTager 9 of r ea,., Valuation (commentingwiN Sm,ion70gand the bsion3°r N<legede xampinn.An vi Codelotion 5;�S .a:e . v.. a.9e "I'l%}i.:ie.� 10 of Sec he Is exempt,any nppli and the basis for sinal tfic ex cant to Any violation of Section]036.5 by any hundred .q fore permit subjects the applicem t°o civil pcnAry- ;of Out maretnanrvnnanarcad°gm<(ssnB). 202APNLX9pLWFLOOR PLB'ING`tOccupancy Type ❑i,amwneroftheproperty.mnsy employees with wages AS their Sale compensmims, 301 ROUGH PWMBIN 'Businel do'th<_work.md theswiroreChotuctor'ded-orse La doe sale(See.7044,- 502 - FINAL PLVKPaa(Ttis�i Y• - --- `Businai end'Professiom Cade:The Comrecmr's License Law does not apply m m owner of property Who builds or improves thereon,and who does such work himself 507 - FINAL PLUMBING o IN gh his own employees.provided th, h p nsm s mended or ...._..._.... ......_._._ _ __._ _ __..,_. _.._; offered( sale lf'h e e the Wild"g p vemcm -Id th n one year - - "- completmn,me owner-budder will Mvo the WI of Prov ng thus he did Am Wild or s I'' Pl �.- t improve for purpose of rale.). s1 coi,t owner ofthe property,am exclusivelydProfessiwird Iicenudcomrmmtato dCiJ:I`d Pt •.[? c:n _ - conswn tw does no(Sec.7044,Business nM property Professions Code:)The Cer ducror's ,,, License Lew does no,apply to ci owner th property who l Ica sor eimproves Nereoo, :. S ..andwho e,Licens.forsuch-projects.with.e.caosmcmrtm.luxaN.pursmn,.m.the. .______.... _._......__.-.—___.-.____.ti _____.__— Conwnols License law. _ ❑lam exempt tinders&" B'&PCfar Wxrmson Owner"� ,u' "Dote WORKER'S COMPENSATION DECLARATION . • I„':•'Ihemyaffirmunder mit f.. _ .. ._.. -. by pe y o pe0ury one o(Ne following mfour Wort ❑ I h and-will mo m a'�Cenifc t o('cons37M of Labor de Workers . C pen aeon.-a p d d far by Section 3700 of the WWr Code, for Ne ;,, 'perform ce of me work f h ch thi puma a issued. v J 111 heti Bndwill maintain Worker's Compar,udan ldsbmnce,u mquir<d by Segtion 3700 of the Labor Code,for the peifortnance of the Work for which this permit is _- sued My W rkee'Compe' ton Insumme carrier aml 1.Polity umber w r3' �"/"G �NV4Policy co,/--/�;�0////V�70G �/ ,� f r ra tit.lb srl $Hr''. y 3 a - dt Id,. fit CERTIFICATION OF EXEMPTION FROM WORKERS _ J;� v .k.rA. lsf, ..._;:. COMPENSATION INSURANCE r ._- abfi section need not W compleeJ if the permit is for one hundred dollars - ISI00)orless.), n �Icm fy-a, n the Performance of thewrk f ' hich this permit a issued„1, - _- -� i�_,i1 . -Tw'�il�„- A:r `- 'shall nm employ any person in any trer so as to become subject m the Workers NSI CTOAPPLICANP IIf.'aherDmkm Nn CioftEeme of Esemtion.you should -bac it AN A. all Com notion .visions of the lsbor Code . .- 1 pe p y u mull � Q foMwnh comply wird such provisions or this patron shall be deemed rcvak<J ' a-� --' CONSTRUCTION LENDING AGENCY 1 hereby'-Giro that there is anon buction leading ugen y fur the peifmm nee Lender's Ne wb k fm'which Nie perm t ri issued IS- 309].C'v C) _ ____ rti ndeFs AddZL ,al .r �/ V..O I comfy that I have read this Application and st a that the above information is l(///t/J�/`—' W-"H' correct 1.Agree I comply with all city and county Ordinances and state Iowa relating to bis ld ngc nswwon ndh by mho see represlmarives nfth'pcitymene�upon the above-menituneJ n (or' tion u c`lo sawn 'fy rid keep harmleu the City of Cupenino`egainv h liebilisies ju rte,a an sec which may in any way amine against said V V. City in” n can e gr of this pe L' _' 'APP[ A U\DF TA OV OMPL,Y WI ALL NON�POIYT Issued by' Date Z. vc cur r ., Re-roofs ' W 11ih R RIALS DISCLOSURE Oam -- y pplwan re ung omupun stere cr hmdl harallo a--on' Type Of Roof. �.._....-.. a fnedbyme Cupenrw un, pal Code Chepter9 l] um,b He IN ndS fery' Code Section 3551643 I I IT ` i u ill- s 1� ,'It ,,,' i ' I ,I1.k.YE. . .. f QYa No t , r '', _ All roofs.shall be inspected prior+to.any roofing material being installed..... . District? ordev¢ev hich If a roof is ihstalled without first obtaining an inspectionk I agree'to remove r WIIINemrc iam,nfuwrc Wil, mcu amuse m t ityManagement- q all new materials for inspection Applicant understands and will comply with r Ihnve,ce/ISh, oxi�' •- . . ,_.. epP c n or emu hernrdo ons efined by me Bay Arta Air Quality 4. ° all non-point source regulations , Nous m len' s rc uiremenss.under Cheper.6.95 of the .�. rt _ Califn6a HealttyC a no 35505;3553Jad35534.l understand thatthebuildingdu I a maL,hat it is my responsibility to ramifytheoccupant ofihe 1 s, mei prior ro issuance of..Certificate of a. neY. 4,1-3,101- Signature of Applicant Date - - J ow All roof coverings to be Class "B” or better .._, c. ..... -. -. ::--- . _ ._.. ... . - -- OFFICE --. .._._. _. .- -- - -- • - - --� - - --- - - -