03020034 (2) CITY OF CUPERTINO - =
BUILDING DIVISION PERMIT LCONTRACT,ORANFORMATION:',
BUILDINGADDREiS: AAAA-DRAIN PATROL PERMITNO.
10295 CALVERT DR. 01020014
NER'S NAME: 1701 S 7TH ST #1 APPLICATION SUB DAT17
RICHARD TRASK 02/10/2003
114 GNI. (408) 989-6005 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
wo, LICENSED CONTRACTOR'S DECLARATION JobDescri lion
P I herchy affirm m
that I am licensed under provisions of Chapter 9lcomcnaing p
with Secmu�n70(xdofDivisi.. ofda BueiMsgand Professions Cndc,end license is
in lullfnrtdpndeft �J61 SEWER REPLACEMENT W CLEANOUT
z o y cense Gds.. I.ic.p '�f t."7� 7
FZ= D Cono r XMMIs
ARC 1itaeliSDEC ATION ✓w.rsn! FINALE®
lundmatand my plans shall Muuda lytic rccods t^�If✓'
'M u
Licensed Prdc.ional
2t=� OWNER-BUILDER DECLARATION q ']
.u<8 1 herchy affirm that I am exempt from the Contractors License law for the FEB 2003
iaQ0 following rcaeon.(Section 7031.5.Business and Proessimts Code:Any city or county
%S which requires a permit to construct.alter,improve,demolish,or repair any structure
Fzy prior in its issuance.also requires the applicant for such Permit o rile a signed micamit B�ILi �
RigNu
at he is licensedpursuanoOnprovisionsoftheContractor'sLicenseLoc Chipter9 Sq. Ft. Floor Area n
a R (commencing with Section 7(X0)..f Division 3 of the B usiness and Pmfessinum Code)or
Nat he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than firs hundred doll..($Wd. 8r Occupancy Type
0 I,as owner of the property,or my employees with wage as Nelr sale compensation,
will do the,work,and the structure is not intended or offered for We(Sec.7044,Business 106 - SEWN
and professions Code:The Cont.ctoes License law does not apply m an owner of 202 - UNDER Ul b 1 N G
proper y whobuilds or impro as thereon,and whodues suchwork himself ordtrough his
own employees,provided that such improvements are not immridcdar.fered for sale.If. 301 - ROUGH PLUMBING
however.the building or improvement is sold within one year orcompletion,On owner.
builder will have the burden of poising that he did not build or improve for purpose of 507 - FINAL PLUMBING
sale.).
0 1,as owner of the property,am exeluaively co u.aing with licensed cmnmcmrs m
construct the project(Sec.70at4,Business and Professions Code:)The Contractor.Lk .
cense law does not apply to an owner of property who Wilds or improves themon,and
who contracts for such projects with a conmctods)licensed pursuant to the Conuutor's
License Law.
❑ 1 am exempt under Sec. ,B&P C for this mason
1051Nnet Data
WORKER'S COMPENSATION DECLARATION
I hereby.Wren under penalty of perjury one of the following declarations:
I ban and will maintain a Certificate of Consent self-insure for Workers Compen-
")
on,as provided for by Section 370()of the Labor Code,for the performance of the
k for which this permit is issued.
1 have and will maintain Workch Compensation Insurance,ss required by second
of Ne Labor Cade,for dre performanro of Ne work for which this permit is issued.
Worker's Compensation lmu/n/nw carrier�and�Policy number art: yam- ^
er:�f's�1E C 1'�rl4tl✓P No.: -4 —0
CERTIFICATE OP EXEM NFROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is fortune hundred dollars($100)
less.)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so M to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:It,of er making this Ceti team of Exemption,you should
become subject to the Workers Compensation previsions of the IaMu Code,you mum
OO forthwith comply with such provisions or this Permits hall be deemed.voted.
z CONSTRUCTION LENDING AGENCY
[-� r I hereby affirm Nat there is a constmction lending agency for the performance of
!Yi the work for which this permit is issued(Sce.3(07,Co,C.)
aQ Lender's Name
z Lender's Address
U Q 1 certify that 1 have mad this application and smote that the above information is
II. (✓ correct.1 agree.comply with all city and county ordinances and some laws relating to
O U building construction,and hereby ammrim rcpresenmtives of this city to enter upon the
W abovomemioned property for inspection purposes.
(Wc)agree to save,indemnify and keep hamlesa she City of Cupertino against
yliabilities,judgments.costs and expenses which may in any way acerae against said City
in
the granning Of this f1coah.
U WS
APPLICA nc U ERSTANDS AND WILL COMPLY WITH ALL N OErr Issued by: Dat
SOURC FOUL TION
f t7 Re-roofs
Sig u e of Applican Contractor Der
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Ne applicant or future Wilding occupant store or handle harardom material
as defined by Ne Cupertino Municipal we,Chapter 9.17.and the Health and Safety
Cndc,Scnion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Ycs
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hvadous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
mrict? /
❑Ycs g
1 hese read the hared....mmri.1x ctloremems under Chapter 6.95 of Nc Colon,
nix 1lcalth&Safety Code,Sections 25505,25533 and 25534,1 unframed Nm it dtc building
does not currently a tenant.N responsihilily m no yfy the taeupa t of c
m uircmcnts whi stM Our issuanccof.Cedficercucupancy. Q Signature of Applicant Date
GAO r or motizedagent Dated All roof coverings to be Class"B" or better