02020092 (2) CITYBUILDING DIxV�'ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22067 CLEARCREEK CT CUPERTINO PLUMBING 02020092
OWNER'S NAME: APPLICATION SUB DATE
WHITE JOSEPH D AND SHIRLEY J T 10297 S DE ANZA BLV 02/25/2002
PHONE: (408) 253-0618 SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u G BLDG ELECT PLUMB MECH
z�z LICENS1 hereby affirm licensed under provisions ons of Chapter 9(commencing Job Description
ECLARATION
?„�9 is di Sect Oi4�{(3oftheBusine�xp ndPmmxsaonsCodc.amdmylicense COPPER REPIPE, WATER MAIN WATER HEATER
:0'Uinfo J
o LNiQ<f Li<.(� 2 5'
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Onlra
ARCHITECT'S DEC ARATIO
LI understand my plans shall Is,used as public records
OO Licensed Professional
_W o y .. OWNER BUILDER DECLARATION -
1 hereby intimation I am exempt form the Contractor's License Law for tM1e
t g a following reason.(Section 7031,5.Business and Professions Cody:Any city m county $5000
E x O which requimitres a perm mmunics.alcor,improre.demolish, pa
or rer any strstructureetu
a 3 _Poor to itsissuance.also reclaims _applicant for such permit Osignedumemed. _
morn nlicensediin rt a u tit p t o sof of
a nsrL Cor) Sg t, g�3 p�. Valuation
Icon e _tit Sect am an-f eivts is 3 of she Business prW Professions code) CON"``L Y 3 Z•� t510:C�C.-tCJ.�;r,t),Wit(;;i_Y.',
or Tito He s excmpi Nertfmm and the per for the subjects
the
tl applicant
to Any violation
of section 7031.5 by any applicant for o permit,unje<u the applicnm to a civil petrify-
ofnmmmethaarivehundred dolkm,($500). 20: PN �"9RFL00R PLUMbINGr Occupancy Type
C 1.as owner of the propertF or my employees with wage,m sncir sola econ,mmion,
will do the'wmk;and she n,mature is not intended in nRercd'for sale(Sec,,-7 W, 201 —
'Bnsines.s and Professions Code:no Contractor's License Law does not apply to an 502 — FINAL P$ IB4 C45PSi49 GY' '
owner of property Who mads or improves mercers.and who a«x such work nded or 507 .F FINAL PLUMBING
or emd or his own empinyces. puncta that men improvements are not intended of — 1
.offered for dile-If,thM1awevlde he building or unen off,eni n sold wimin'not year of - -.___.. ..
oprove for the owner-builder will nave rite burden of poving that he air not build or I' •.. .
improve for purpose of tale.),
CUai..at allm n'am as t rwith.. ... .. ..... .............._.. _ ..._.---_ ....,...,. . .. . . ....._... ..-. .... _ __..
Pn`Ite Y Y i I ccnaae Contractor's
ontr ct m
_
construct the eco(Sec.]WS.Business and Professions wi ons Code)The Ces Cher up. t "
and.wh o co Roca not man owner with
rt who builds or ire - -
`� apply pope y w prorca thereon. -" - •
:. .. and who. Livens lLLsuch projects wish a.comnnor(s)licensed.pursuant m me '
111 am exempt under Sea. B&PCfor this rcamn 1VALE®
6vion, Dam
WORKERS COMPENSATION DECLARATION _ MAR 2002
I hereby alarm under penalty of perjury one of the following d¢Ivmions: p�
} C 1 have Compensation.
rill maintain o Cey Sect of Consent m self-insure for Worker's BUILDING
a� Compromaion, as province for by Section J]Ou of the Labor Code, for the G
performance of the work for which this permit is issued.
C I have andwillmbim5in Worker's Compensation Insurance,as required by Section
37W of the Lihm Code,for the performance of the work for which this permit is
issued MyWorkers Compimation Instrames,crunne, ad Policy number arc
Ctln t71/C TI f N' ON XEicyN im.w K I K I @�Q]yy i -
'CERTIFlCACOMPEN COMPENSATION
INSURANCE
OM H'ORr RKERS'f— "_:'L1• f J �- 7 �;1E, _ Lx '+
-'_ COMPENSATION INSURANCE "
(Th s tat on nem not be completeG if the .it is far one hundred dollars -
(sl
l ccmpl that nth p f an n< nth' k for- which this ct t issued,lkhall
Comp of tai my any pe in any manner m as to become sub3ect to the Workers'
Compcmotion laws of California.Date '
. Applicata � .. .�
NOTICE TO APPLICANT,if,aper making this C<niticme of Exemption.you should
bireme subjenmthe woAe'r's Compensation provisions of me labor Code;you must ` "
CC fon ovitti core with such rovismic,m this domed revoker.
ZAAFi ^^ p Y perms g ally
f+ of Ne work which mONSem is a coNmENDINGdAGENCY - - -'
p fearair hall M
a f 1 h by off that mere sea trey f the perfo once
t ,
a Q issued(Sec.1097 Civ.CJ 1 .
. 'Amine Name:
�,z lancer's Address,' -
U � 1I agree that 1 hale recta this application and scoreanc rhe above information is
�-FT+ U 'torture.1 agree m comply with all city and re,reordinances and stay laws era,.
U tobullve-onemimedinefemy far
minby specodu rtprtuntativ�of Nis cirymenmrupon
�.rSr1] the ebo'we)areeto pmpenymify andk6puh=lc.
tiL' 'we)
gbgme issave,
ostind d expesesk hihamay II the City of Copeniooagainst
VJ liabilities,judgments a ccs,costs a expenses which may in any way accrue against said
U Cityr qtr ce of the wing of this pemtii' - ":
P ICA. U )Eil TAN AlJ 1:{�L Cyo�PLY WITH'A NO
AN
• •\� -� Issued by: Date
srgnamrcof APPnnanr/CAsc�nor \ 'nary• Re-roofs
as defined b Ne Cupen tteM��uunici Municipal Cde Chapter 9.12,and the Health and San
HAZARDOUSMATERIALS DISCLOSUI -
W II thea 1<m nut building pant store o Bandl In6do s material
Type of Roof.
cae Sat on 25532Q)? p p -. - Safety
CYe ' 'CN civ [�
G" (` All roofs shall be ms ected poor to any,rooting material being installed. _
will u"air hmant future building <pa t use cquipme t devices which If a roof is installed without firs[obtaining an inspection,'I a Tee to remove
emit hezaMous air cone is as defined by ih Bby Area Ar Qal ty Menagemem gg
°anC11Y ON all new materials for inspection. Applicant understands and will comply with
lall non-point source regulations.,
1'have*re d ohe'Hamadan,mmetals requirements orderChapter 695 of she -
Calif sma Health&sof ty QMa'Secions 25505 25533 and 25534,1 understand that
it the build g does not c rely have a tenem.that it is my responsibility to notify the
expand o
He
cocairem Ls which must be t prior to issuance of a Certificate of
npe � ----= e—�ate
Signature of Applicant_ Date
net m .�ag Date All roof coverings to be Class "B"or better
OFFICE