02110092 CITY OF CUPEKI'INO I �ea
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION:,
wirk64DVATERFORD DR ROYAL SERVICES PERMI'rNO2110092
owp'10M.,GHT GARY 4395 WICKER COURT APPLICATIP1"tT"4TJt2002
ZONE: (831) 462-0539 SANITARY NO. CONTROL NO.
ARCHITECfIENGINFER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Orsi, CONTRACTOR
LICENSED 'S DECLARA'T'ION �
..G IherebyamrmthatIamlicensedunderprovisioazotChapter9(commencing CHIMNEY REPAIR'
yiw with Seminn]1XXB of DivisiunJof NC Business and RnfecsionsCmle.anJ mylicenu is
'c
in feu fnme and of p.
atO Ia License Class Lic.N r
FZ�,B Dam 'CSD�onum--ol" 9 n 4
"' ARCHITECTS D,PLAR ATI N
0 z I understand my plans shall be used as public rttvnds
XOaO
w3 u,y Licensed Professional�LLOg OWNER-BUILDER DECLARATION
`f�v a Y I hcrchy allirm Na I am exempt from the Contractor's License Law tnr he $1600
00 following reason.(Section]1131.5.Business and Professions Gwc:Any city or["only
in 2
n'X m which mquir a pcmot it,coommil,alte,improve,demolish,or repair any.amnum
pdnno itsissuance.also requires the applicant for such Permit o me a signed smtemenl
Nal he is licensed pursuant In the provi,iontof the Cualmcue's License Law(Chapter 9 3Wfll7IFla25A&G Valuation
y1-0 (commencing with Section]IXX1)of Division 3 of the Business and Professions Cole)or
i 3$ that he u exempt Ncrefmm and the haze for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a peril subjects the applicant to a civil penalty of i JAPNN Occupancy Type
net mom than Rw hundred dmlars(S5(X3). 312 - CHIMNEY. REBAZ & STRAPS
❑1.axowner of the property.of my employees with wages as their sole compensation.
will Bothe wok,ands. he intended License Law
for sale(Sec.]014.Business
5±i Fiiiiati,
and Pmfeainns Cudc:The Conuacinr's License Lew urns not apply m an owner,of eM Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements arc not intended or offered for sale.If.
however,the building or improvement s sold within one year of completion.Ne owner-
builder will hate the burden of proving Nat he did not build or improve for purrw of
sale.). �rC\
I,as owner of Ne prd eny,am exclusively contracting with licensed contractors f"
construct the project(Sec.](146,Business and Professions Code:)The Contractor's u-
se taw does not apply to an owner of properly who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's r
Lice nY IAw.
❑ I am exempt under Sec. .B&P C for this reason
Owner Dae
WORKER'S COMPENSATION DECLARATION
I hereby tlRr under penally of perjury one of the following de[laraions:
1 have and will maintain a Certificate of Consent toself-inmre for Worker's Compcn- O
7[37fi)
tion,az provided for by Section 3]1X1 of Ne labor Gtde,for the perforarce"f de \
rk for which this pc.if is issued.
1 have and will maintain Worker's Cnnt ofthe,,W rkfor hi h required by Scninnof the labor Code.for the perforance of the work fnr wbich Nis peril is iaueJ.y Worker's Compcnsafion Insumna carrier anJ Policy numMr artnicr: Policy
CERTIFICATE OF EXEMPTIONFROROMWORKERS'
COMPENSATION INSURANCE
(This¢trims nwd mm he compleded if the peril is for one hundred dollars(SIIXB
or Ica.
1 emit,that in the pi ffnrar.of the work for which this permit is issued.I shall not
employ any person in any manner aha to become subject o the Workers Compensation
Laws of California.Date
AppliCan
NOTICE 3�APPhLI ANT:IL alter making this Cenilicate of Exemption,you should
become subject to the Workers Compensatinn provisions of the labor Cale,you must
OO forthwith comply with such provisions of this permit shall Ni deemed revoked.
Z CONSTRUCT ION LENDING AGENCY - ---
[..i .Ni I hereby affirm Nat there is a construction lending agency for the Performance of
a 7 the work for which this permit is issued(Sec.31197.Civ.C.)
tt1 Q Lender's Name
7 Z Lender's Address
V 0 1 certify that 1 have read this application and sure that the above information is
uaF comes,l agree to comply with all city and county ordinances and Stam laws relating hr
DU building construction.and hereby authorise representatives of Nis city to enter upon the
uJ above-mentioned property for inspection purposes.
G (We)agree to save,indemnihat
fy and keep less the City"f Cupertino against
In liabilities.judgments.aosu and expenses which may in wry way aceme against said City
in consequence of the granting of This perm it.
U Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
REGULATI
i Z .
f�3am^feo2L% f.4ulaZ Re-roofs
AARDOU S M ATERI ALS 1)ISCLOSURE
Type of Roof
Will the applicant or future building nomI ant store or handle M1aiaNuus material
av defined by the Cupmi no Municipal Code.Chapter 9.12.and the Health and Safety
Code.Section 25532(a)T All roofs shall be inspected prior to any roofing material being installed.
p Yes 0N
Will me u scant ser Troon nodding"cca ant use a of m devices whim If a roof is installed without first obtaining an inspection,I agree ro remove
Pp 6 e a Air
l
oilict' nu airnmuminanuazdonnedbytheBayArcaAirOmliryManagement all new materials for inspection.
iaria]❑Vets ❑Nn
1 have mad Ne bavandous materials requirements under Chapter 695 of the Califor-
ia Ilerida dr Safety Coude,Sauna 25N15.25533 and 255]6.1 undersand that'd the huilding
oes not eumently naw a ton i,Nef it ix my resftonsiniliry f"mrtify fM rccupant nl Ne
myuircments which mus et pr;m to iasuance oracemrcato orator cr Signature of Applicant Date
f Z All roof coverings to be Class "B" or better
O er or authermed agent ate