02070064 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10161 BILICH PL KOPELS DAVID N AND BARBARA S 02070064
OWNER'S NAME: APPLICATION SUB DATE
KOPELS DAVID N AND BARBARA S 07/10/2002
PHONE: SANITARY NO, CONTROL NO.
e ARCHITECDENGINEER: BUILDING PERMIT INFO
iFF BLDG ELECT PLUMB MECH
6 f.7 CJ U LJ
LICENSED CONTRACTOR'S DECLARATION
ZZy' IhertbyaRrnthatlamlicensedunderprovisionsofChapter9(commencing Job Description
F=t wiNSectien]W0)of Division 3 of the Business and Professions Core,and my license COPPER REPIPE
is in full fame and effect.
OU License Class Lic.N
3
Data Contractor
C p 0 ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
6 p o Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 ami. exempt from,he Contractor's License Lew inr the
C Z< which re reason.(Batton]o str Business eM Professions Code:Any city structure,rnunry $1200
Y F O which requires a permit re cares the,aafter,pplicant
improve,demolish,orerepairasig any .
a.3 ..Primto isiasuan.,also rilto s theevpions of the Contractors
tors LfileseLaw(ned(Chapter
-
that helnnian5edtiSwinital!h ,of Division
orf,heln,Business
Lind P.fgw(Chapter9 cyys sG,�.s aqr pO �A y` a� f l Valuation
(c ommencingemptfi titff0h70)ofhe basisorteaBminessandtch,Anyvi Code) �,t3Ta;�3e1�OL•l+Vf/1Ud:IlI Ve)'n'4�s')..N.Yvl:.l1,^: i
or that tic is exempt zany applicant,re basis for the alleged applicant
to Any violation
- of notmomthanfiv anyapplicantpermio-subjecte,heupplicummarivilpenalry- P y,ryp
of not marc man Bye hundred datmr:asap. 202 FLOOR PL BINE " Occupancy e
°I,as owner of be
propeny.0 my employees with wages as their sole compensation,
r
,111 do the'wrh:amd ihe'airucturc Is'norlmentled-er-oRertd for'sate'(Sa.']DU;' - - -- t),,.., r�{,. -n's�-sem.
sBbsineas end Pidf-and Core:The Contractor's License Law does not apply to an 5 O 2 - FINAL PLt7T1tB44 (tns�Qb'Itl'SY
owner of property IMm builds or improves tremor,and who does such work himself
_or through his own employ...provided that such improvements tae not intended or _ .5,07_- FINAL. ING.
dlfeeed Infinite.If.lidwevu.the building oe improvement s sold-within one ytnar of -- -'---- -----------"' �---�--- ---�_--- -�
cont le.m.,therwnery '•`1:'• `. ... ..�:,2( � •
p buile.y will have the haNrn of proving thin h<did not builder I S'
improve for purpose of sale.). i
e
01 s ownerofthe property,am exclusively contracting wthlce d contractors,ho "I 'la'
co ii ct the projec,(Sec 7044,Business vad Profess i Cada:)The Connector s
-' License Law does not apply,o an owner of property who builds or improves,thereon,
_and-who ca"'1"0"!
racts sue miens,vth iice vacter(s)licensed pursuant to Ne.. . ._.. .. __..__...-._. ._..._ _. .... _._ .._ _.._. :. Y ____ - .._ _------.__..
fy8t sem ` r 6 �P D far Thisrcaaon JUN `20'p
✓moi n WORKE 'S COMP aE1�. / CLOAR ON - -
-+� 1 hereby affirm,under penalty of perjury rne,of.the following declarations:' suit ��
° 1 hivend'awillimm
�nin a Certificate of Consent to self-insuin for Worker'.
Compensation,-as-provided for by Section 37W of the Labor-Code, for Ne
performance of Newoh for which this permit is issued. ,
T °I ha nd will maintain Wo kei',s Compensationlmma e,-aa required by Section
31W of the Labor Cede,for the performance of die,work for which this Permit is
" imbed.My Worker Compensation Insurance carrier and Policy number oro:
' Camay t�'�('( �*F.3i.+`si Pohcy Nd. t, ..a,n �.1•' vi ,j.i...a�.i..\ y 't'r Ep�.- ••A:te�'h '�I
I AERTIFICATIONOPEXEh1P1'IONF0MWORKgM,J`- s_3,/ 'ro :��•\y, id+;l t \'f R)ta� „�ia
_r.- COMPENSATION INSURANCE'ak
In ,1-(Thii saws. dined ust be completed if the permit is for one hundred dollar [+ \' 1, .; _ ,• .�f \r':.' -P`..
IS 100)or less.)
. Int rif l e wormian of the wort w h m i
� Y_ pe pe t d I
ah�lpl}Envtpnt I R Y the'W !u
'Ap
NOTICET p it after making jpeCani4ate of Exemption, .. _ -- ._ . .. _.__ .__. .
C m t
is
e you nonld -_ . ,
Z become see N (offices Com nation ro sins of theLabor Cdde,you must
,
O forthwith corm 1 with such rovisions or this t shall be deemed invoked.
n _ -- _. -- -. ._ _
.
_--_
GI CONSTRUCTION LENDING AGENCY - --
F+is�i 1 hereby fli that thirsts a construction clutinj agency for the,.;.f. iarrce n. I r J.
W•r of the work torr which the permmi a issued(Sec J097;Civ C.I
� Q ..Eenders Name--.............r... _.:. ..•___... ......- ..... . ._. ._-.-. .._ .._ ... ___ __ _.. .__ ....-..-...._.___...-__-"'-------- ._.,—_._._.._._.
Lender's'Addressj' ^ L,s
U�� ,, pi I cenlfy to comply with all cit antro county
acme tmuhc d state laws rioe is
ke 'ri 'a bull.Degree to comply with all cry and county oNinunces and state laws relating
Fr building conorvcu.n;xnd hereby'nmborue reprcientatwcs of this city to enter upon
W the eboe-mcniibned propcny foi.inspcmiorn purposed,,,
y_qr (We)agreemscronify and keep hartnlessilic Ciiy of Cupenfnoegaina
-W liabilities,judgments..co aeJ see which may in any way seems again.said
" U.z City in<onse crux fNii permit:'
APPLICA' 1"A JD WILI•COSIPLY N'ITH'ALL NONPOf:
- r &buRGP_ - Ici' •els Ad 7 Issued by: Date
gnnr• jpphrt cammcwr, ."' - �nat Re-roofs
HAZARDOUS MATERIALS DISCI OSU'
.. W II lh pal cat future b 'Id g ccupini stre u ho dle hm'dnus ,n I �I e Of ROOF. -
asdcf ed bythe Cupenin 'Mumeip-IC d Chapter 9.1Y and theHealth and Safety 'JP
Code:Bent on 2563yOl N ` c s ih s o Sv' , y. A'F '"' G 11i [ is q,�"alts FS I�S4-Ntti 1 I
°Yea: All roofs shall be inspected prior to any.roofing material being Installed
_.. e
t' WIIth pair s f b Idngac eBavAeq ipmentotdefana bum' If a roof is installed without first obtaining an'inspechriri, l!agree'to remove
e t haWill mr comamma s ss Infing by the Bay'A�n Quality or devices which
ement
Distnct all new materials for inspection Applicant understands and will comply with
ova a all non=point-source.regulations,
1
eve read the hamobut,materials requirements under Chapter 6.95 of the
Cithhunia Health A Safety Co it 'S tions?5505,25533 and 25534.Imnderstand that
-ifthc buildingd w y c amJhat i[ismy rcsponeibil'ny,or notify the
bcdup:mt o It met priorto itmitncd'nPia CeniOc tc Lif t
Occupen . "
Signature of Applicant Date
rte uAngen,,", All roof coverings to be Class `B" or better
- OFFICE - - - - - -