02070055 OF
NO
CI BUILDING ornRONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1068 WALLIN COURT 02070055
OWNER'S NAME: APPLICATIO SUB DATE
B. K.DEVELOPMENT 07709/2002
PHONE: SANITARY NO. CONTROL NO.
z ARCHITECT(ENGINEER:
O_ BUILDING PERMIT INFO
a IJ BLDG ELECT PLUMB MECH
I_J t-Li I'-'I LJ
Z 8 Z LICENSED CONTRACTOR'S DECLARATION
_ 1 hereby affirm that I am licensed under provisions of Cha g Job Description
F:I_-w with Senivn 7000)of Division Jof the liminess and PrefonxionsCWe scam myllccnse TEMP POWER
a,sof is in roll force and effect.
—ne 6 License Class Lic.x
w c u u Da¢ Contmamr
ARCHITECT'S DECLARATION
1 undoo m id my plans shall be used as public record,
suN
ce v O Licensed I'mfeWmad
o. o OWNER-BUILDER DECLARATION
as I hereby affrm that I am escort from the Contractor's License Law fur the
h=a fallowing reason,(Section 7031.5,Business and Professions Code:Any city or county, $500
Z H C which suires qa permit to construct.alter.imposts,demolish,or repair any ntuctum
frictions issuance.al- 9 ' the pplt forsumbpormit to rile asgnedsmament
that he liversealpu. npmopowni fthC trsae,LcenseLam,chapmr9 Valuation
m ec g with Section 7000) 'fDv. 3 fth Business mad PromisonsCoadel �or�'ear,r�,lr"il:i.�
or that he is viempt therefrom dad the be,.,famine allsgcd exe apt un.Any v olatitm
of Section 7031:5 by any applicant for a pommy wbjecm the applicant o a civil penalty PN er
of not more than five hundred mottos 14500E A
103 L * Occupancy Type
❑I,a owner of the property,or my employees with wages as theirmle compensation, _
will do the work,and.hC,uunure is not intended.1 off rid for sale(Sec.76ta; - - -
Business and Professions Cade:no Cmnmc ar's Livvse taw does not apply to an Required Inspections', ..
owner of property Who builds or improves thereon,and who does such work himself
or through his awn employees.the
that such o.nmm monis are nut intender or
'cnwle IL ei�wever,the buian pnwemen !,-,aid
g ar im t within onFyBar of
oveI. the owner-builder will ban the burden of proving that hedid not buil)or
completion,prove for purpnu of mm).
a�onner ofine property,am exclusively contracting with lmemaf contractors to ��
constancy the project(Sec.7044,Hu,am,s and Professions eds.)The Coomacmr's
T_z'me law docs not apply m an Owner of property who builds or improves thereon.
and who cuntmens for such fools with a cunvactvr(s)licensed pursuant to Jos
C mmnor's ii nsc y,
❑I no w pt nd Se ,BMJ&VP C for this rcaon
Qyinei' R R. OMPEHS`TION D CL ROATION
.T l her y anon and penalty of perjury one at me following declarations
'`� ❑ 1 base and will maihiiiin a Comficam of Coosem m sell-insure fur worker's `lam
- Compensation. as pruvided Ibr by Sectim 37W of the Labor Coda far the
I
of the work for which this permit is issued.,
❑1 have and will maintain Worker's Compematian In tomer,as required by Section
3700 of the Labor Cede.for the performance of the work for which this permit is
issued.My Worker',Compensation Insurance carrier and Policy number arc:
Carcicr. .CE a . t; "1 Policy Nv.: - *,,a..u1.'L: .' t ' Y;1_
C[RrIPICA'1'ION OF,EA ION I ON RANO sV'URKERS'- l.. 1 t
_ COMPF:NSATIONINSt1RANCE'-`Y s L
(This senium need not be aomploted if the permit is for ons hundred dollars
(S 1001 or Ipxs.)
"I certify that in the perfummnc of the walk toy which this permit is ianed.1 -
shall nat'cmploy any person in an�Wgs�mor sit as to hecmne subject to the W'nrker: "
Compenzmion Laws of CalifomiaTOam
APPlitan. - .. _ ... .- .. ..
NO 'TO APPLICANT If,after making this Ccnifcate of E,emption,you should
hccgs�E subject to the Wallace,Ciardam dlois piaci ons of the Libor Case you mus.
OforthwitM1 comply",in such psim
mvi <nr this lennit.hall be Jeune ev
roked.
CONSTRUCTION LENDING AGENCY'''
7 I hereby affirm that dare is a construction lending agency for the performance t
of the work for which This m mnit is issued(Sec.3(197,Civ.C,)
L (]
Leader's
.'7 Z Leman's'.Address -
U 0 1 coldly day i have reed this application and sate that hc above information is
f+' t- coma.1 agree to comply with NI city and county ordinances and state laws rebating
rj to building con,wc.ion.and hereby authorize¢prowynnivei ofthis city to enter upon
'} W the abtw>momi,mcd impsny for inspection purpuus.
�. L (We)agree to save, aamity and keep harmless the City of Cupedino against
W liabilities,judgmat cu a e which mal'in any swy'come against.acid ,
.0 Z City in canm me of tingg sil this permit
APPLI , Elt ISA' WILL COMPLY WITHA LL
S o .r' R 31 .AT9 Issued by. Da
gnat m A . an 'o y - am Re-roofs �.
HAZ 0 US,MATERIALS DISCLOSURE
t o w, ppli t future haw g p t t n orhandle havardtai,mincrial, Type of Roof
a,&F, by the Cpt fit alCd Cyrpt 9.12 duh H lth and
Col S❑Y p2553f It)5 1N , t sulhi:.. ` ,.t ('.n:
All roofs shall be spected prior'to any rooting material being Installed.
Ndl he ISA sea. if b 'Ia'ng - p t reS9 p y J ex ro' n If a roof is installed without first obtainmc,an inspection, I a ree to remove
Dom.laeadaucarcnOfum is: ahnrd by the Bay N...Y r Quality Managemon o p g
ismet, all new materials for inspection. Applicant understands and will comply with
❑Yen, ON. - all non-point source regulations.
In...read the hazardous material,regnirena r,under Chapter 6,95 of the
Califomin Health& in Sections 25505,25533 and 35534.1 understand that
if.hebuildmgd of in have soon(.that i.i,my responsibility to natity the -' -
,,,a ant of th nirc hich u.t be met ,for It,issuance if a Certificate or
ca Signature of Applicant Date
n for t rt g - at All roof coverings to be Class "B" or better
- OFFICE