01090032 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO. ,
7732 CARRIAGE CL BOB GERE MASONRY 01090032
OWNER'S NAME: APPLICrfTION SlJB DATE
NICOL RICHARD AND TINA M 480 CROSSLEES DR 09/07/2001
PHONE: (408) 972-1285 SANITARY NO. CONTROL NO.
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° 'ARCHITECIENGINEER: BUILDING PERMIT INFO
p 0 O BLDG ELECT PLUMB MECH
H d b
r n 12 LICENSED CONTRACTOR'S DECLARATION
Z 4 a 1 hereby ellimh that I am licensed ander p visions of Chapter,9leommencing Job Description
with Scrfon]0 f n3ofhe Bmvmcvan mb,,siom Cadaaand my license REPAIR CHEMINEY.
is in full fore / 1
sU License- Lic.g�eiJ3a '
O y U Date Contme
i E a y ARCHITECT'S DECItFiCA
y O 1 unde:smnd my pluns shall W used as public mvmdsWe1V10,7
:wa
I n p OLicensed Professional
OWNER-BUILDER DECLARATION
w o a 1 hereby affirm thin m
1 ain exepfromt te hContractor's License law for the
C?.Q following reason.(Section 7031.5.Business and Processions Cadet Any city or county $5900
wh h acipures.Permit m construct alter,impmve,demolish or rePan ony structure
a3bi"pr t t issuance,al q the frown Permit fl signed statement .__ .._ ..�
_ ..._,_ _. . .�
i h,1ha `licensedput' nt to 11,16 of deo of CommsinsLce. Law(Chapter 9 �. c3,{` ,�'j rilyra st1 v'1"p trey 1 Valuation
Ic omen m6 wth Section7(100)of Division 3 of the Business nd a Professions vi Code) x, (, j S
.,that he is exempt therefrom and the basis for the alleged eeempQon.Any violation
-of Section 7031:5 by any applicant for a Permit subjects the applicant to a civil Penalty
t of not once than five hundred dmlars(8500). 5164P241141 l BUILDIN `" ffif. " Occupancy Type
❑T.as owner of the property,no an,employees with wage.their sole compensation, f _
will,do,the work,,mrd the swcmre is not inrertaed"or offered for saW Sec:7044,'
`Bmviiauto,and'Professions Code:The Contmcmr's License Law docs not apply to an Required lnsoectiohS"
owner properly Who builds or improves thereon,and who does such work himself
or
through his own employees.provided that suchimprovements is soltintended r i
-mem'. Id nhnone arof.! .... .. _. _,__ _._.. _..._... ._ . ... . . .... ... __.._ ......_._ ._.. ...
..i offs ele fo tle.If,however the budding p y
improve to the owner bmlaer will have the buNen of proving Nat he did not Wild.,
improve for purpose of w1eJ. .
ott the imoret(Son.] _.._._ ALED ; .
_.I I oso n fthoI pony 1 s ly u t gwthT nut on.uactosm
1144 Business Prof.a ns Cade)TM Comaet �— ,tl yt
Law does not apply to an owner of pronsify who builds or improver the
T
...end 'h
. .. ... . .., mmcts.for ochc nwa ds)licensed p uom the .....
G an' License ,_......_,._, 'T 9200
BPCT is son $EP❑Ibnexcup,uiderS c ,
2 ..Isis:. .._.. .. .... r ..
Owner-
If
r
WORKERS COMPENSATION DECLARATION BUILDING
1 hereby afTim under pFmthy of r ry one of the f II wing declination.: '
1 ° 1 h - lnd'will' a 1 n a'Cenife t f Conum'to selLinsum for Workers
Compensation.as provided for by Section 9IIID of the Enter Code. for the ,
+ `perormmitai the Work for,which this permit is Is sued.,,,
e of th'
k and will maintainn Worker's Cd pe t Insurance,ai'equired by Section
00 fdie Lebo-Code f the perform nee of the e*f which fl t is
is d My W k f.(' p o Insu ce ams sd P i y be
.,y., ....., _.. _..
a ......
Canta �ol yN ✓�"'// OV - f -
f ` t COMPENSATION INSURANCE—
ehondred do ` i u
! E TIFICATION OF EXEMPTION FRO t
... CE .,� i. .. ..... ,.
(Th zf
section need not be completed, the permu Ilars
shall not tin to f Pe
18100 I centfy,thai in the rt rm ace f the oik f r winch the permit is issued,i I' f s
n, i,q
p y any pe u in any man e w us to become tsfla t to the Workers I
i C p unlawsofC if - :Dt •' .,
-`Apple t . ,..r - _ _.. ..._.. _..
NOTICE TO ApPPLICANT 1 ftmaking NP Certificate of Ewe at on you m Id. . -. - ... 4 y 1 . ...... ..... . .. ..
Qbcc m b u theta ket C softy Libor Code
forth th I with h ions a thisE
a ... _ «...... ...... .. .. ... . .. . _ _f . .. ..._ _ _. _. _
F-ice ^J r ("":CONSTRUCTION LENDING AGENCY �'"' ' i�'• C i .'t '
1 h reb 'arm thanhe e t a An win un I d gag ncy f th pert mtnnce } .,i.
Un Neove Inch th4perms sianaNKci09] Cb.C) -
Nome.._...h ...: �,: ...,. ._ ....... _ _... _._._ .. _., .__........__. ._. _...._...... .. .. ..... _..... _... .
Benders
Lender Addes. 'r -r: i.. _.i i .
Ice ify that I haved this application and stare thanhe abo a fonnm ss
,c6irect.1.agree In comply fill If city and county ordinance,and t to laws Mining,
Oqt) Ito building constrvnio4 antl hereby authonaeiepresentiewes oftbis city,mmpo
enr un''
k7 the bo t ed p p ny f 'aspect on p rp _ m
(W)ag m m t de ify and k p harm s the we of C pelt e t hist'
F h liab 1 f judgment,, e d pease h M1 may:n any ay c rue eg last said
-ee N gmn f th s p t `
A PL qND LY W' LL ' N-POINT
TT
r. N O Issued by: Date
9i to fApplic .art ) 'v` 4 'Dam' "P
ps d toed h the Cu A OUS MATERIALS D LOSURE p' r Re COOTS
r w WII Ne apple o Tum baa tcc pant t m rharMle hawdous mmenal :Type Of ROOF.
y pert no Muq¢i C d Chaps r 9 12-and the Health a d Safety
L
IN All roofs shall be inspected piior_to.any,roofing material_being,installed ..,.
,,°. W 11 sae applicgnt fuWm bu'Idi upanl use eq p t a i�cswhich,, If a roof is installed'without first g
obtaining P ah,ins eetion'';I'ra ree;to'femove '
mull d a ronwmmant a d fn by th Bay AreaA Q ItyM wgement
ad.tne Iwaina m;''r 1 i ,all new materials for inspection Applicant understands and will comply with _
D
all non- omt source regulations;,
t i o
P
1 ha o renals regmreme t' nd Chapter 695bf the
Cahfom a Health&Solely Co a S=eimns 25505,25533 end 25534.1
founded,
'if,the bn ldn at currently,h tens t that lis my ie p, sbility'ut onfic...o '-
I up t V
r= ba be n m issaa qra eriir=to r Signature of Applicant Date
unN All roof coverings to be Class B or Metter
_...OFFICE-..
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