02050123 CITY UOPERT,NO
BUILDING PERMIT CONTRACTOR INFORMATION:
W�T'RffliLYNN WY TOM' S PLUMBING PERMIT No, 02050123
TMNtft OSWALD E AND AMY 12246 SARATOGA SUNNYVAL 11@V"0P2`1y"R02
PHONE: (408) 867-6010 SANITARY NO. CONTROL NO.
4 O O ARCHITF.CDENGINEER: BUILDING PERMIT INFO
°m— BLDG ELECT PLUMB MUCH
C-:J 1_:3
i8
N2 LICENSED CONTRACTOR'S DECLARATION
O Ihercbyalirtmthmlamrcensedunder ovisiorm'Chapter9(commencing REPLACE WATER H ription
:wain with Section 7")of Division 3 of the Busin rid ProressinmC e.and."license
fullr�f<cane eRccL
Ia,�< cen:<e>dea f• —�G uea I`IiS
ARCHITECT'S DE R
.'=0 g I and<mmnd my plans shall be used a,5!c mcnms
ce
i o`o uanaed Pmresaional
c y OWNER-BUILDER DECLARATION
u n 1 hereby.from that 1 ran exempt from the Contractor's License Law for the $2000
t z a following reason.(Section 7031.5,Business and Professions Code:Any city or county
whicM1 requires a permit m cnnutruct,cher,improve,dmnulish,°r repair any awdum
,mg3w .poor t e rrce.also rcqu res the pylic tk hpermiuonkangrred sutement _._.__..._ __. ._..._-_ ....__ - - _
mnlilr I dporiudnnothe prnsinn fw C tractors Canso law(@ap¢r9 yY r3 F aatt3r .�,•55 d-v Valuation
onhatneu,'with
Sthciori7")of Dcbarsnf3 oftelBusiness
and rofeessnons Caode) f_;.l ayl !ti.- At)..\ .:Uf t?E\lsla5tt�.o
0 ge V y Am
of Section 1031:5 by any applicant fora permit subjecm rhe applicans m.civil penalty
of not more than five hundred dollars(3500). APN t.N: Occupancy Type
❑Las owner.f We pmpeny.u,myemployees with wagesasmeirmkcmnpemition. 506 — GAS TEST
will do the wmk,-and the structure'is'not intended or offered for sale(Sec:104: 'NAL
Business and Pmfessions Code:The Contractor's License Law does not apply to an r WInspections, "
owner of property Who builds or improves thereon,and who does such work himself
or Ithroughfor Ms own employees.provided that such improvements eii,mems arc not intended or
offered for sole.If,however,rbc buildin - '�- fi>sold wirhin one- ' (
gelmdem 'no year. s .
.prove for the o se of sailder will have tM1<buMen of proving rhvt he did not Wild., t
improve for purpose Of sale.), '
❑Las owner n(ihe ro err ran Businivel trams lh licensed uunmemts to
P P Y Ycon gwi ,..
Licenser the oes a (Sec. II,,a Business and Professions Code:)The Contractor's
License tow docs not apply ut an owner of property who builds o,improves thereon, C C
:. . _ and-who.eit Licets for such projects wiN.a c°mmetorts).licensed purwant.to the _. . ..___. _ ._ .. .___ - Ir8 NA.I�IG®.
Contractors License law.
❑lam exempt under Sec. _.B&PCfor thisrc
0wn?rDate MAY 2 3 2002
- WORKER'S COMPENSATION DECLARATION
I hemby aBvm under penalty of pe jury one of the fallowing dmlaaions
O 1 have end will maimaio a Cenileme of Consem'to self-insure for Wmkcr's BUILDING
4" Compenvatim, vs,provided lou by Section 3100 of the Labor Code, for the
performance of the work for whim this permit is issued.
❑I have End will mainmin Worker's'Compensation Insurance,as required by Section
37W of the Labor'Code,for the pd,f°rmance of the work for which this permit is
wMined. oke
yW ' or�ryp�ee t I mmrrce tamer and PolicynuTI
,dTrCsaMd' .eJ Pol dy WC U11 $ !(aU
pp _
SERTIIgCATION OP EMPIItOM WORKERS' !-" �.•I� t Ftt.v�. at,}O I.s�` Y12.11tk541.) 1. ,r
VVVVVV COMPENSATION_ VRANCE ""
('ibis scnion need not W completed if the permit is for one hundred dollars
($
108)of less.)
' I certify that inth p<rf of the work for wh¢h th permi, rssvcJ 1
shall'not employ any per on n any manner so as to Wcome uhject m the Workers - " ' '
Applicant
Compensation laws of California:Dem""
NOTICE TO APPLICWorke',ala mntatio his Certificatesof h Exemption,you,you Trulst
Wchwithc ropy the Workers Compensation provisions of
the Labor revok you must
0 O forthwith comply with such provisions or this permit shall W Jarred revoked.
1.
f2 "i" 'i' " ' CONSTRUCTION LENDING AGENCY ' '' I -
C ' I hereby affirm construction them is a consvtion lending agency birdie Performance "
'., of rhe k for which this permit knmed(Sec.3007,Civ.C)
U Q^ I Cindy i that floor, d b pylic i e t t thank aboinformsr n is
IN;'F. eoircct I ago t comply with II city and county ordinances d tate laws rel ting
0 V rob o mentioned
t ed pr dh ' insm icon p itvei of this city to onto poo
�,, f6 'he above ) nod pmpcnde yadonpuryo _
.Fi nst
(Z) (We)agreets,costs and expensesnd
hi hamay in the way c mmeCurscagainst
said
Z liabilities,judgments,costs and expanses which may in any way name against said
U z City in conaegCNDE f the granting D this peCO . ` ' "
^- A Pk1CANI'UNDERSTANUSAND YILCCOMPLYW'fmALL NPOINT Issued b r Date V 1/
5 'RCE REGI'.A710N5. � r k y'
VV%
mare or peucam✓contracmr - ,. ... DateRe-roofs
HAY-ARDOUS MATERIALS DISCLOSURE -
Will the Wgsant or f rare Wilding occupant store or handl hisamous m t 'I, Type of Roof _--
as d f ed hY the Cupen Muni al Code.Chapter 9 12,and the Health and Safety,
- - - - -
Code Semion 55320) t '/• Aft . , , {il t t li:, ', q•
�Y°' y a xl d All roofs shall be inspected pnor,co,any roofing,material being installed,.., _
Will the applicant or r mimildirigniceffort equipment a 'cq..which If a roof Is installed without first obtaining an inspection, I agree to remove
eonmuffardionsifiremirmun sidefined!b5 the Briy Area Air Qual ry Marruilictivert
District all new materials for inspection Applicant undeI.rstands and will comply with
1` pYNo ' r -' all non-poinCsource'regu]attons,;`.
Y1 1'have read'thehazmdous mmerials regmrcments under Cbapmr b95 of,the
California Health&Safety Code.Sections 25505.25533 and 25534.1 understand thm
ccs s n p - y resp mobil y m notify the
. .
% - issue ce a C< 'ace¢of
if the building d a of currently rvea�e t that t sm
t f the requirements t which must W t ' r to
p r -..
-• t - : Signature of Applicant Date
o
4T ii'migiontioedeg t ,.arca, All roof coverings to be Class "B"or better
. _..; .. , ...- .... ,.....:... ., ._ OFFICE- .. . .. _. ... _ ._ .