02040058 CITY OF CUPERTINO - '
BUILDING DIVISION PERMIT CONTRACTOR-INFORMATIONS.
BUILDING ADDRESS: PERMIT NO.
02040058
OAT R'S NAME:
APPLICATION SUB DATE
HARRIS ARTHUR S AND ANDREA B 04/12/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�`z u c_I L. 7 u
6L
v Z LICENSED CONTRACTOR'S DECLARATION
I hertb aRm.hei l n3 offlic tl under s ons of CTa 9 nd mmencin Job Description
N v 9 Y provi i Mm y '
F� wiShSecionID00)orDivisionJoflheBusi 3:and Pwre::ionsCodLenamyBcenx GAS LINE FOR COOKTOP .
La in ran ro a2 c.. J�
0 w u Licem Cla Lic.x
D t Con r
A CHITECT S DE RA 0
5 1 underslwd my plan xholl Ue urea u public rtcords
�aF
o o Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby,Bien that I am,Bump.from the Connector's IC 5 Any c law for the
C?0 following reason,(Sectioni17031.5,Business and Professiorm Code:Any city st county $1200
f Ft o whichitsresponses.pemit oc mnswm,alar,impwtat demolish,w rt sig any ca osm.,
i5 3$ •prix .o u s r nee Asu q N Wromsot for s«hpemis r'.Lima.
Law(Chapter
NS.hecermij 4stid pareuant mdie of Dininsns oConuac.wsLKenx law..Code)
_
(commlhea aVsNScet Benue. efD damn,rhea Bu;ineaand'ors.Any
Code) Ir l'�th is-;3J`1217U3 /•.IxW a!L',t ('r(;tl Valuation
or Nor he n cxemp.Ncserrom m,the burs for le corossd`,fica ro s Any t peouon
of Section103f.5byetry'eland ollfor opemit-wbjmatheoppliennoadNtpcnalry-
❑r edi max Nin Me Wndmd rentor 155001. N : OCCll ane T e
20 - C��{I91FLOOR PL MBfNGI O p Y yP
_❑Ld Ownerof ,'.ad she
yawmyemployeeswirewagesus.crfvelec (Sce.70".
`Busine s and PrBlfc3si-Ne ode:n is Lie a Law does
non(Secy Yawn 5 0 2 - FINAL PLR4PpBI"$610SINNIVMGY` `.O`T
Business and Profs ions Cndc The rose.hContractor's, c o does m work
h So oif '
owner of progeny em lodes Or improve dxxo and who dos such rk intended
ar
if
_or through hso -employrca provldedNSsuch_ p mesax m .qn ear w_ . -,_ ,___ 506.._=__GAS._.TEST-,_,__
-cooffmed for- Ie If eowcver, w Wddm{e unen of pr t n la within not Weld of
-------
completion.She owner-builder will have the burden of proving that he did not Wild or 507 - FINAL PLUMBING - �-• �r
imgove for purpose of alcJ. '
❑Duowneraf Ne psopeny.mexclusively cono,aniny wiNlittnxd mnuecmrs to
YI cusum the project(Su.9040,Burnes ond Profusions Code:)The Comswmr's
:s r4 Licenselawdocs.f apply
.om.war of ho builds or im - - E._E-fr 'r'JIs:3 s:E;'H
`: .. ._end who,contaca.for us rN.a co�ime5 Proven Sharron. _ FI_N/r"4_ I_d_IC I®_, _
PwJeatS «()IKelne❑)Y.1 1.10 IIIC
CO vemol L csue V
01. q,p1 ndei Sce ' �10%11 'B&P C partials seldom tr' (`'y:^ ' -r••1
Orna D:k APR"17.2002
's "'WORI(ER'g COMPENSATION DECLARATION
LI,. sl Ncrtb)'eRrm��a�r.0�!?I�yD<Ix.ury oM o�N<<ol�arimB dcc—en—io-5 - B U I LDI N G
❑ I have ;Oil'161' i'Cenifc6te'of Consent'io'xlf-insux for Worker'.
Compcnsldios.-ta provided for-by Section 37M of dre-Labw-Codr;'fw-Ne
performance of die work fur which this pemdl u issued.,1�,�
❑1 cart and will miina n Work r Com sal n 1 suri,Ke,is
pc sequ'sed tiy,S .ion
3700 of the LaWr Code for the perfmiiwKe of the work r h ch Nu a t Sa
r ld«d M W k<r Compenseto 1 s ru«ee �afn1dIPOII eTy ber ale L.
:.�•: .....'L.r. .- ._- d._
ti� AION OF EXEMPTION FRO WDRW l t
L COMPENSAMONASURANCSo -
°` hill,xctio�n'nedna la'campldedd the perm.is for ane hundred dollars s• -` L:i! •' '.as9'>) ;);;Cil Iii!1( l"j)E^
)w mx.l ..ani:+pC,• +r'• ....a.'e.
ccwfy dal m Ne perp. . .f Ne k for which Na pemut is issued.I
na0 0o cmpl y any.pe n ay oar w as 1.1,neome subject to the Workers'
s .rte"
ARctue.o'Lkwt of Cal form D r :
NOTICE TO ALm'he .If, ser making lhls Ceri ncoi th xemprtom Ywshbuld - _--`'Ta" `'•� �'.: :"LL::`
P
Z
btaome wb'cd��o Ne Worl:<ls Coinpensetim piovisiom of the labor Code;yau'muxt
r O onE'iNrom'ly whtibech provisions or Permit be dttmetl revoked.
w
F h. s s ;CONSTRUCTION LENDING AGENCY - - I ,3 L.._i f` 'It r .,tl
a ) 1 hertAY.alfni that ohe s a con tract on lendlny ejeneY[«.W performesices ..
of Ne walk! hich this peml s ss edlSec 3097"Civ C)Lersed&s Nana-'
ssa at L
p'c Lenders Add ass - o
D.,Z.
;4.0 ".1 certify that I have mad this epplicehom end store that the above information is -•
0� c'ir ci,l agsec.ommp�Y.w'iN an city and county w,dinances and sax lows missing '
� �`- to Wilding comuuc.ion.and seiebyeuthodxe reprt3enulives of Ods city to enarupan
Sheebony-mmimsed.Properly far inspectionpuspasrs ,-„,,.F,____
for 6s:. IWej e{roe so save;inaemndy and keephtiinlitS he City of Cape rusejainst
h liab I ala j d{mens:cora cid ape xs hKb mry y ey cc pains.aid
City in eonwgo nee of a sum,of Nls peen t - /
APPLIcn�`{'4\•�e A�vsA,.duyL totfdci",atrHALi: j.'Po�S'` Issued by: r Date
`ymmte pp 5 Co vector I tax Re-roofs /
i AZARDOUS MATERIALS DISCLOSURE L”
win dK,pnbawarmmx Wuame wcupant sax«e+ndt hvaNaa cent Typeof Roof.. -
atdeMedbyNeCupenuwMumapelCodeChPmr912 tlNe HealN end Safety, _ •.1 '.It til y -,+fA `Ai YI - -
Code O Von 25532(,x1* !1f1CY�'Nom..: 1.t I J Ib.(s F 15S.' . l
L_All.roofs.shall.beinspected.priorto.any-roofing.material.beinginstalled..,°_.._.__...-.
dr wllNpplicsntwf ryrt Wilaingw p tuxaqup t. ❑ ccs whxh i t } '
P If a roof is installed without first obtaining an inspection,4�agree"to remove
em t hawdo ur conumn nts ld aefard by ilx Bey Arta',V Qualuy Menayemem ,
Dismci L , L. _ all new_fratenals fort s ection, Applicant under5tands,and..will comply with
1 f all non-point source regulations - . ........--
H, I hasti rtnd'Ne hmraoos maienals xgmrtmena'undm Chapiu'G9
and and h ,
Col ro aHcalNd:Sx(ery Cnd'Secdont 25505:25533 end 255341 undersNes ' ..... ..... .... .... ..... .__ ... _ ._..,._ _. .. .
top
Ild `dpa mol «rtndY have uenant NunamyscspomLbtla tono.ifYN
oZcupeni .h r' i menu h chsnust M met p or m,Swr e e Cenificaa Of t •
O Y
� , Signature.of Applicant._- Date
All roof coverings to be Class"B"or better
oral ..
..' rt ', t ! r. - ....,,.,. .:.. . .-. -OFFICE- -...--- .----.. .. . ...__ .__ ..---. .._ __. -_ .. ._.. ._.