02040042 CITY n DING DPESSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
10516 WHITNEY AVE . CRAFTSMENS GUILD INC 02040042
OWNER'S NAME: APPLICATION SUB DATE
REOPEL 10566 S DE ANZA BLV 04/09/2002
.'HONE: SANITARY NO. CONTROL NO.
(408) 366-1000
nre0 o ARCHITECIFEN'GINEER: BUILDING PERMIT INFO
Ei m❑ BLDG ELECT PLUMB MECH
h a t
h= LICENSED CONTRACTOR'S DECLARATION Job Description
i z—G 1 hereby affirm shot 1 am licensed under provisions of Chapter 9(commencing
"td wrentuition]uoo)nfrn,sioh3ofthaBt,=Inf..,�naPrnre,�'�nn>cr.le,andmrrana a ADD 534 SQ. FT. & REMODEL.
ad f= ' t fjg� ir59•
re0 i License W,4 Lic.
Da /O.e�.�— Conuvctrn
2
cul;.
a "ARL'T11TECr'S DEC ATI N
w; 1 undersmnd my plans shall be used as public records
cu
i n p p Licensed Professionot
OWNER BUILDER the CATION
'9—'v. 1 hereby affirm on 11. exempt from she C Professions
ou License c Law forma
t?a following reason,Icemen]031.5.Business and improve.
dri cli h.or Any city s weary $90000
E o which requires a permit m consumer,ober,improve,dnnolieh.°r repair any atmewre
t is rsswncaal>ort rhea I tmr,cam no!least Wnanumnt
i 3 ac
= poor o i ' quire pp ns panni gn
that me cinglithovi pursuant 7"mme pm Division
n m<sheContractor'sInerand Pelrw(Chapter9 _
or that a
(commencing therefrour ad she bason3of the Busineseand Professions Code) (.1„ �•s3�,� �. Or-Area•.. .a Valuation
or that he is 3115 b therefrom and the basis for she subjects
th it dempnttto Any violation ".N 1 Y�.' $'k 0 0'+"'
of Section](1}I�.S by any applicant for v permit suM1jcax the applicant m a civil Penalty
:of not more than five hundred dollars($500). 30S1PN 1��E Occupancy Type
°1,as owner of me propertyi or my employees wim wages as their ante compensation,
will do the work,and the snunurc is not intended or offered for sale(Sec.]014,'
Business and Professions Code:The Contractors License Law does not apply to an 601 - ROOF TEAWS6Wnspections
owner of property who builds or improves thereon,and who does such work himself
of through his own employee,pmvidcd that such improvements ate not intended.or _ 602 — ROOF PLYWOOD NAIL
offered for sale.If,however,the building or improvement is sold within otic year of
completion,the owner-builderx ill have the burden of proving that he did nm build or 603 - ROOF BATTENS
improve for patpnse ar sale.). 604 - ROOF IN-PROGRESS
Ei I.us owner of m. . _ . . . . . -. ontr ......-..._-. . . . ... . ...... .. . . - - .._- .
property,am Businevely connaning with licenced contractors m
construct the project(sec.]Oaa,owner ca and Pnd'eshom GW e:)The Co,menco .
License Iotw daps not°such m mj owner of a comY who builds or improve thereon. '
and vectors License
for wch.projeas with v comracmr(s)licensed pursuant to Ne ..
'
Contractors hi<eme Law.
°1 am esemp, Mer Sec. .B&P C for this mason
Owner . Date t
' WORKER'S COMPENSATION DECLARATION
,+ thereby affirm under penalty of Perjury one ofthe following declarations:
❑ 1 have and will maintain a Certificate of Conical to self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor Code. for the
performance of she work for which this permit is issued.
°1 have and will maintain Worker's Compensation Insurance,as required by Section -
37W of the Labor Code for the performance f the work for which this perm t .
issued.My Worker's Compensation Intura li
ucy number arc'
tiTr more,N .' f58?362'
CERTIFICATION OF FAEMPION FROM WORKERS' f.\ I ;< .
COMPENSATIONINSURANCE' _
to t
flfiis sectio°need not be completed if the permit is for one hundred dollen
(SIM)orleas.) .
I,empl that in the pe in any
inn ren work for which this permit a WmIm I shelf ompeot employ any person in any manner>e as in became>ubject m the Workers' "' t
Compensation lswx of California.Date
Applicant
NOTICE TO APPLICANT.Worket's after Compensation
this Cisions foe Labor ion.yousmWold
st
becomeh chm ly ith...hp .loans ,,his provisionsof the Labor Code.you must
CC fonhwith'rnmply with such provisions.,,his permit shall be dame)revoked. .l
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a consumption lending agency for the performance
f17 o-.t of me work for which his permit is issued(Sec.3097,Civ.C.)
Q L'ender's Name. ..... .. ._ . ... .. . .... .. . ... ..
Z)D
'Z Lender's Address - - - -
V 0 1I agree that 1 have read this city
and
and sots that the daboveSW information is V
C) U tortes.1 g con to comply with all city and roomy ordinances and maty laws recusing
V mbuildinghernioetion.,Mharinspehonaerlpresematives of this city to carer upon
%' [s7 me ebo(We)alimc to T.an,indemnify
for inspection and keep
p harmless
rFn y' (We)agree to nails,indemnify and keep hamlets one City ofa against
TA liabilities,judgments,costs and expenses which may in any way aceraerm,agaiain.0 said
[,7 Z_ City in consequence of me gaming of this permit. .
�APyLICE RE UNDERSTANDS A' LCOMPLY W'fTH ALL NON-POINT Issued by: r Date
NNURCE REGULBT7yj�L�^ Y•
SSignammufApphpanncn�mr . me Re-roofs
HAZARDOUS'MATERIALS DISCLOSURE
Will thezppllcam or future building oeupom hom or handlehWaspardicita,ancedal .Type of Roof.
as defined by the Cupertino Municipal ,Code,Chapter 9.12,and the Health and Safety + .
Cade,Session 25532(al^ / ' ' a,. •., 1 'f t ,` }.�.• ,.: '
°acre . 's Ne r ,1. :,. `' _ All roofs Shall,be-inspected prior to.any`roofing.material being installed_,___-___-.
W ll the applicant or future building occupy t use equipment or devices which If a roof is installed without first obtaining an inspection; I agree to remove
mit h dm t fined by'hee Bay A Air Quality Management
•�istrt t all new materials.for inspection. Applicant understands and will comply with
° "° all non-point source regulations:
1 have read the haardWes maedels regotremcnts under Chapmr 695 of he
Cxllromia Health&Safety CMG,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a tenant.that it is my responsibility to notify she
occupant of the requirements which most be met He,to issuance of.Cenificam of
Occupancy. .
Signa[_ur_e of Applicant - - Date .
Ow a min agent � '. J Dam. All roof coverings to be Class "B" or better
OFFICE