01080137 (2) CITY OF CUPERTINO
BUILDING DIVISION PC,RMITCONTRACTOR.MORMATION: '
BUILDING ADDRESS: PERMIT NO.
10180 CAMINO VISTA DR FRAN LEE CONSTRUCTION IN 01080137
OWNER'S NAME: APPLICATION SUB DATE
MICHAEL & NALKA NAGEL 20917 FARGO DR 08/28/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 996-2527
M rem zo ARCHITECGENGINEER: BUILDING PERMIT INFO
re'm B ELECT PLUMB MECH
g<i " _, L-1 LJ IJ
LICENSED CONTRACTOR'S DECLARATION
y Instant affirm mat I an,licensed under provisions of Charter 9(commencingC� DEMO.)
Job DCSCrifon
w L-i with Senion]000)of Division Sof the Business andProfessions Code,and my license
,F:5 is in full force and effect.
eadiU Licari Clens Lic.%
3 a v
Data Contractor
ARCHITECT'S DECLARATION
.u O� 1 undcrmand my plans shall he used en public records
f i p
Licensed Professional
I s,IamestrumOWNER-BUILDER m the CATION
I hereby millionths,1 an empt from the Cession, o License Law o for the
2?M following.,on. pants t 703 onstr Business and ave.de tom Code:Any city or county $10000
0
I F ,,awhich requires n permit re construct.wet.aper.imptnsu demolish,or repair any structure
uaj 3 m ..flo t t ,al requires the itimis f Car th,suchpa.itLicto signed sten t - - -- `.- --.. . . ..._...._ _ __._....._. ..__...._ _
then hq n it pills t to m pin i5 ons of the the Bagods License a IA (Chaps 9'
1 3`". t3'��+li',��a�®a r Valuation
'
(commencingwith Sect o ]0p4)of Division 3 of the Bgsine. d Professons Cod ,�h , �.��,.'� � %lJ3F..
or that he res exempt therefrom and me M1asrs Por the ul16gu1 ciemption.Any violmion
-of Section]031 S by any applicant fm a permit svbjec¢the applicam m e civil penalty- '
'of but mammadrehanarmamlarx(ssw)_ NO I' D INSPECT 0NS''tr, Occupancy Type
owner of Ne property.or my a.,].,cas with wages as their sole compensmion.
will"do the'wofk;and and saucame isnot intended or offered for sale'sec."]044.1 _
Bitemess and Professions Code:The Counselor's License Law does nut apply to as Required Inspectionsc ,`:e 0.;
0
wncr of pmpeny Who builds or improves thereon.and who rhes such work himself
ofir through howeemployeesprovided that.suchimprovementst' render or i
TcQeictfo 1 woe lh building avet improvement ov sold-ed year of.
oprove for
the owner-builder Ider will have m burden of proving then he did not build or
completion.
mprove for Purpose of sole.).
f
l as came,of the grope I iv lyconducting with licensed contractorst
f L •'u r l +
.".at the project f8 4 B in and o f .l ills m The Connector'sSi„ i
Lic n i s oat t r i p pony h bu Ids p
h
' rid h gets r ch m at th a contractons)licensed.pursuant to th ....__.. .._. ... .. ___ ._.. ...� {
Cot i
❑I a laps der t' , fI to //B&PCf th' ream Irt} .,, , In.-I''`�'
O e Datc ,RATIO 1 /
OMPENSA 0 ECL N /
[[[ I herehy off ren Lind ,pens ty of p ).ry, ne of the following declarations: -
- ❑ I h 'd "JI''ma a n e Canis f C t t If far Worker's
Co p t pr d r by Sect 3]00 f th Lab Cod f th
a
perfrmceofth'w f 's 'it isIssued.
111 hav w 11 r kcr p peavation firearaince,as requJ by Sibilant
37Ma pe C f the im nn of the brk'f h¢h thI is
s y tY t ranee carrier and
Pol a be
re •_
w
f tPoIcYNVY'o,
t t T( t) 140;
I" tT C EXEMPTION FROM 0 K RS°
OMfENSATION INSURANC ._` _._..... ..
(Th tsem, n d the lapleied ,if parent' Foyhundred dollars ' W;i;l' ::.•;f (ii:it
51 W)or I )
.._ .._._...,....„., m................ _..
e nfym that the performance of the wor,fr which th Permit is issued,1: PI„ ultP. salt 1i„ Sh t ,JPT ••�,”-.•.�•._ _ _.. _
ti ill t pl y any pc n y anatt o to b li e subject t the Wo kers v
Co pe a Lads of C I f Date` +
_`Appl cat
OrAA"7F7O 'NOTICES-1 TOt AP
If, mc making eCerhficarc of cobs y
n.
should
zbbcmrsb)ecu.thcW Ida,aCp nsdamp of the WoonCom:r.....
Forthwith comply th such Po's ons or th pi shall be deemed revoked
CONSTRUCION LENDING AGENCY-
CT
I hby IF then there s a const ct o lending agency for he Ise man a
Wr> Dien ham r'pick th tI t s .sued lSee 309] C' C f
y.0
L'end %Add ,- __.... . . ...... _..... .._"-..
t
V 0 I crtifyahm 1 have rend thrx appli�ehon end scam mm me above -'flames onis '
W e[r' couch.l agree to camplywith all city and county ordinances and state laws relating i
,m buildiagconstrachion:und hereby a thoiiie ripresedeadves ofthis city venter upon•
W •me bo W)agree fo snobalitined eroceiva�nnify for inspection
ni n pp harmless
„ y _ �.,,_ g_
and kee hmayin NeCt ofa nu against
W Cliabilities.t1 judgments. a and expenses which may'n any ay gain.-'said,
V City uq once of RST gra g f I permit.
”
!SOURCE RE60DERSTANpS AND WILL COMPLY'WITH ALL NON POIN'1" i
soDlacE RenvLAnoes T.s „-,. � Issued by: Date
t XCignamre ofA,,HmmvC.m6aam, It { Dater +:`t
,,HA2ARDpUS MATEftlAlS DISCLOSURE tI Re-roofs
WII Ne applicant or future bJld g occupied store or,handlehazmd'vs material Type Of Roof—
adas ' peen no Municipal Chapter 912 dm Health d_Saf rYl 1< f 'h y.r,d`A -- '--^ .. _..
noticed by d t
Codi Socio 255320 v , ry l �T f_ 3•s t 4 5' r' as , t n j',r 1 t s_
❑Ye 1 No, !v. yr I r .All,roofs shall.be inspected poor to.any roofing materia] being installed,
,t WII the applicam ur f t building occupant equ p t d which '�if a roof is installed without first obtaining an ms ecnon ba tee to remove
e nhaz4d r c nm ma t o roto dbymeB yAreaA Q altyM hagemem- g P g
i , q t p ,t .,.,all neew materials for inspection. Applicant understands and will comply with
District?
t ❑Y 1 No ) .r a 'Will --.. .
r ,•e r , all n point soiiice regulations- 1.,., r , ) , .::.r`
1
use read the hazardous materials re u rementa rid r Cha red 695 of the
CililauriiP q Health& y d25534 I. yu,raandthml
Jthedoes of curten0 have hthPu issuance
tifythc -
::..l1 r p
occu amaof rh rt tame C�h Sections
mu%t X905 25533 an f Cenrfi<3te R I '
building r y
i' Oce pe err n .
Signature of Applicant _ Date
r open nacaug t pe,e All roof coverings to be Class"B"or be
"OFFICE_. .
r.� . ),,, �L ,_ .osis_. ., ,,,_y� - _ - t+.•n C> .,,:_ ., _, ._