02100070 (2) CITY OF CUPERTINO °Rw4so
BUILDING DIVISION PERMIT CONTRACT,ORINFORMATION '..
BDIL> 171 Es :OLD HARBOR AV WATER HEATERS & MORE PLUM IP-MRN®2100070
owiGGORGE & JANE LIN 388 BEACH RD APPLICATT)0sYpy97�2002
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ZONE: 650 548-4990 SANITARY NO. CONTROL NO.
ARCIIITECTTNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
C t— 1 hereby affirm that 1 am biomed under provisions of Chapter 9 pr mm ocin p tlOn
gz, w ,
hh Section 70(XoofD ,oion 3ofthe Busmi and Probacium,Codaw mns
ay licees REPLACE WATER A�
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roma nlme and rRert. (40 GALLON)
License Class Lic.#
Date Contractor F of /k D
I"=t-we ARCHITECTS DECLARATION Q
�sSyasaI understand my plans shall he used as public records
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dto� 002
mKi fic
3 W y LmcmxO Professional5;;0EA OWNER BUILDER DECLARATION
<E 1 hereby affirm that I am exempt from the Cnmriclor's License Law for the
m o o following mason,(Section 78315.Business and Professions Cod
o. m which requires a permit hI construct,alter,Improve,demolish,nIG
go
poor its issuance.also militaries the apnrwnl Ior such Permit rile a signed start. $550
�1' that heislicensed pursuant lomeprocismnsofthe cunnaeturLieenaeLaw(Chapter 9 Sy.Ft.Floor Area Valuation
�t-M (commencing with section 7000)of Division 3 of the Business and Professions Code)or
or
3 that he is exempt therefrom and to basis for the alleged exemption.Any violation of 36909033 . 00
Section 7101.5 by any applicant for a pored subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 502 — FINAL PLUMBI G ENERGY p y YP
❑1,as aware of the progeny,or my employees with wages as their sole eo n,vocc tion.
will do me work,and to structure is not intended or offered for sale(So,70,1,1,Business ®��a j�a�,�
and Professions Code:The Contractors License Law does not apply to an owner of 5 0 7 — FINAL �VJ1v1I�11VC5eCtlOn$
506 �T
property who huiIds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are brainwashed reoffered for sale.If,
however,the building or improvement is sold within one year of completlom the owner-
builder will have the burden of proving that he did net build or improve for purpose of
sale.).
❑1,as owner of Ne property,am exclusively contracting with licensed contractors to
construct the project(Sec.7X4,Business and Professions Codeq The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves therrom and
who commas for such projecu with a eotnractions)licensed pursuant o the Contractor's
1-icenric Law.
❑Ism exempt an Sec. ,B&PCforl is reason
Owner 6 d
ORKER'S COMPENSATION DECCAR
1 hereby affirm under penalty Of perjury one of the following declarations:
I have and will maintain a Ccnificare of Conscnl m self-inrvm for Wnrkcrs Compcn-
sarma,as provided for by Section 3700 of the labor Code,for the re formance of the
work for which this permit is issued.
El 1 have and will maintain Workers Compensation Insurance,as required by Stiction
37!X1 Of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number aa:
Carrico Polley NO:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aection aced nm be compleled if the permit Ix for nnchundred dollars(51!X1)
or lost.)
I"city had in the perfmm a of the work for which this permit Is issued.1 shall not
employ any Res nor ,®r me tttl Mer cot it)the Workers'Compensation
Laws of 1 f /o! o�p
f
pewee object
AP CAM': ran cr ma inF this previsions
sof
Exemption,you should
O zbcmmr subfcct to the Worker's Compcnantiis pmal,hol of the Labor Codes,you must
fnnM1with comply with such provisions nr this permit snail be deemcn revoked.
'ZF.' O CONSTRUCTION LENDING AGENCY
[--f I hereby aldrm that there is a contraction lending agency lin the Rerformanec of
the work for which this permit is issued(Sri.3097,Civ.C.)
1 Q Lender's Nam.
C) Lender's Atlnrcu
V 1 circuity Nm I have read thisapplication
and c un and sum that the above information
ng is
W fir building I agree to comply with all city and county ordinances and sum laws relating e
0 V
buildingc-dicutionod nn.and for inspection
resemativcs of Nis city mercer upon the
lU aboveficsjuancdpno ortycost land expenses
which purposes
fy (We)agree to save,indemnify and keep harmless the City Of Cupertino against
UZ,, Iiaconsequene Ofth,ensuing nting of this cswhtch may in anyway acrncagafnst said City
Z APPLICANT
NDERSTANDS)AND WILL
Issued by. Date ✓lam//
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
rDiklnc�l
EGULA 10
�O j Re-roofs
f ApplmaoUCimLmOOr Dales
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
the applicant or future building occupant stere or handle bastions material
y the Cupcnmo Municipal Code,Chapter 9.12,and the Health and Safely
m 25532(x)'! -
es �No All roofs shall be inspected prior to any roofing material being installed.
Willthe applicant or(earn,building.,.Pa.(use cyuipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ous air co raminams as dclincd by the Bay Area Air Quality Management all new materials for inspection.
�(
CD Yes Uryo
I have mad Nc hazardous materialsmyuirementsunder Chapter 6.95 ofthe Colder
nim Ifcalth xr Safny Code,Sections 255115,25533 wd 25534.1 undersand that If the building _
docs not oomcnny have a mnan4 Nut It is my lesrymsibtlity m maty be mrcupont of the
mwimm awnienmua I,ptiorulissaeneeofaCenifcateof0.c xim Signa[ureofApplican[ - Dale
(v u o
own I armorm.aagrnl
are All roof coverings to be Class "B" or better