01060160 C1 BUILDING DIIVIISION O CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10431 WESTACRES DR WATER QUALITY PLUMBING 01060160
OWNER'S NAME: APPLICATION SUB DATE
TSING JOHN Y AND MICHELLE L 1860 ALMADEN RD 06/27/2001
PHONE: SANITARY NO. CONTROL NO.
) - (408) 267-9330
w O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
uBLDG ELECT PLUMB MECH
A« IJ 1.� L.J I=
z rJ H= RATION
1 hereby affirm thin lic,m ed mi provisions provis ons of Chapter 9(commencing Job Description
°_t_w withSection]00010fDivisian3ofthepusinessarWProfieWcasCodc.andurylicenx REPIPE, MAIN LINE.
6 5,y
is,
s in full force ami
z,ce License Class C S Lica J FII�IALED
ontra
w 3a. Dara S DELLA
RCHrtECi-S DECLARATION
Iu O S I undersand my plans shall be.,oil m public records
tzio sp O Licensed Prom,,,,nal
�—' IL
ce OWNER-BUDER DECLARATION JUL 0 6 2001
e u��I 1 hereby affirm that I am exempt from the Contractor's License Law for the
r z following mown.(Section]031.5,Business and Professions Cale:Any city or county 000
F o which rrquira a perm',,t.cora mt,alto,imprrne.demolish,or mpmr nny structure
n?' prix t vi.. ce.als
dot hq is d pbourcul 19 the ph.1111011111i'llic Contractors License Law(Chaper9 —�1 FL f a rk, Valuation
(commencing ,with Sat J1g)0) f Divisioni f theB int J professions Cads) 3 55`IF 0 7 r
or that he is exempt thcrermm and the Iasis for the alleged exemption.Any violation
of Section]1131.5 by any applicant fora permit subjects the applicant to a civil Penalty
of not room than r hundred dollars(55Wk 202APN6W5'LF{tFLOOR PLBING Occupancy Type
°I.as owner of the pmlamt,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business and Professions Cale:The Contractor's License tow does not apply to an 502 — FINAL PIRW81T bs1K141PRGY" "
owner of property Who builds or improves themon,and who docs such work himself
or througgh his own employers.provided that.such improvements arc not intended Lir 507 — FINAL PLUMBING
-nf(cicd(or rale.If,however,the buildingtis told within
oneyeaFof - -- FINALPLUMBING_
completion,the owner-huilder will have ¢bwt en of proving that he did nut build nr
improve for ImUs"e of sale.).
°L us owner of the pmpeny,am exclusively contorting with licensed a Cmianors to
_ ennswet the does
(See appl]M6,litivi.owner o and Professions Code ild%or impTheroves
ves themon. ,
and nsewho
co does noir such
man owner of a conte who builds seimproves thio the
and who 'a Livens for such pnrjectz with o mntronnrlM licensed pursuant to the
Contractors License law.
-'� ❑I am exempt.oiler Sec. - .B&P C for this reason l
Owns - Dates
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will nwinaln a Cerlhicate of Comentlo self-insure for Worker's
_ Compensation, as provided for by Section 37W of the Wbu Cale, for the
pednrmance of the work f which this permit is issue),,
°1 have and will maintain Worker's Compensation Insurance,as iequired by Section
37W of me Labor Code,for the performance of the work for which this permit is
issued.My Workers Conroy cation Insurance carrier and Policy number an
Carrier _ - 0 Policy No.: _
10ERTIPICACOMPEPETION INSURANCE WORKERS' -_.f
'(This union nccdCOMPENSATIONINSURANCE
. I f..
not becomplete)if the permit is for one hundred dollars
(31 W)or less.)
I certify that(in the perfommdnce of the work for which,this permit is issued.I -
•shall not employ any person in any manner eo as to become subject to the Workers
Compensation Laws of Calihmia.Date
.:APPheom __. _ .. _ .. . .. .
NOTICE TO APPLre Worker's
Couipeaking this Ccniticmc of Exemptlo de,imhould -
Q Obcc6mi�uhicct ui the Workds Cnnmpmmxotion provisions of the L;thar Coda y'nu most
forthwith comply with wch provisions or this pcnnit shall be Jccmcd rcvokcd.
' I . 'CONSTRUCTION LENDING AGENCY
a 7 [hereby dftlnn thus there is a copstmcdou lending agency for the perhnmince t
�,0 of the
Lenwhich this permit is issued ISec.3119).Civ.C)
der'Cs,Namea Na
= Z LenJcr's Address
L.
U C I certify that I have read this epldcat,or ad slam mm the above information Is
OF^ comm,,c I agree as comply with nil city and contrary mdimenccs and sera lawn Mating
C.) to building tuna ruction:and herch.v uithorizc ieprecenimives of this epi iy to enter upon
theE abovemeptiuneJ properly for inspection purposes.:L (W'at a,,ce m.vave,lndnmm ify and keep harmless the City of Cupemmd against
N liabilities,judgments,costs and expenses which may in any way accrue against odd
U•{� City in conwquence of the goami ng milt,permit. '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT 6�z 7�O
SOURCE REGULATIONS. Issued by: Date
Sigpamrc al ApplinnVContraaor_ Date Re-roofs
f1AZARDUUSMAfER1A,S DISCLOSURE •
Will the applicant or filum building occupatstore or handle bazsNous material Type of Roof - - - -- "
as defined by the Cupertino Municipal Calc.Chapter 9.12.and the Health and Safety
Colds.Section 25532(a)',.:,,
All roofs shall be inspected prior to.any roofing material being installed. ... . ._.. .
I f Will the ti,llcamorfwumbuilding sentpant nnecomponent ordevices which If a roof is installed without first obtaining an inspection'; I aome to remove
emit haa.Mo.,mf conounimm is as;def nod by the Bay Arca Air Quality Management
District . all new materials for inspection. Applicant understands and will comply with
Gres - all non-point source regulations:
I have mad t hmurdous numenA,re,mmawas under Chapter 695'of the
California Health afety Cole.Sections 8505.25533 and 25514.1 understand that
if the builJing/1 cot currcndy s senate,that it is my responsibility m notify the
occupant ofjtlm cquirem mutt be ma prior m issuance of a CeniGcme of
Occupat §
- Signature of Applicant Date
o n a.tha a ag<mDate
All roof coverings to be Class"B" or better
.: OFFICE -