01110043 (2) CITYILDING DIPERONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1042 CRANBERRY DR CUPERTINO PLUMBING 01110043
OWNER'S NAME: APPLICATION SUB DATE
COLE CAROL K 10297 S DE ANZA BLV 11/07/2001
1 10NE:
(408) 253-0618 SANITARY NO. CONTROL NO.
o s z ARCHITECDENGINE dI:
BUILDING PERMIT INFO
rc u BLDG ELECT PLUMB MECH
h ZU to CJLICE
z H z 1 hereby or.th01EDCONTRACTOR'S drDECLAR9ChaN 9(commencing lob Description
5z=p provisions si per
v,tm am
mfullf ](q8)ofDivision 3ofrheBusiness and ProfessiamCode.and mylicenu COPPER REPIPE, WATERSERVICE
C je E is in full farce on H y
e O 6 V Littnx CI _ - J Lic.M� Y U
i 3 u oi Dae S DECLor T
ARCHITECT'S DECLARAI
p,0 AN V
1 undcrsund my plum shall be used as public records
r
erO Licensed Professional
o ad OWNER-BUILDER DECLARATION
='m 1 hereby affirm on 1 am exempt from the Contractor's e,Any c Law for the
following reams(Santos]8315.Business and Professions Cude:Any city ancounty
O which requires ape t 1 w t,after.improve demolish,ore a si any tweets $5000
i = �priwu ]iase p rsalsnmq the applicant for swhpemJtmfikse nedi aw(Chapter9. - _ __ . . _. __ _.. __. ___ _ _------
s
Na he- fttn it p ansa thep s ons of o the Contractors suedes Law(Chapter 9 } p,� ,rs
(romm n s exempt th t o ould an f D alis o t rhe le'S8 d ad Profess ons Code) f;{s,4�? )v3'���41 ' ®�:'lU�iK1 t r$'�,-C.il t Valuation
or Set he Is31Z bth y ppli end c.fou
bass for the allege)eiempbbh My violationof
of raw.than rive hundred dollarsw058),patent subjects ins applicant to a civil penury PN
20� W�"LWRFLOOR PLBINGOccupancy Type
❑I,as owner Of the progeny,w my employees with wages as their sole compensation. n 1 _ RaUnw pT.jTmpTNj�M1:
will do the work,and me structure is not intended or offend for sale(Sec.7Da4,
Business and Professions Code:The Contractor's License Law does not apply to an 502 - FINAL PRVN1V1 PI31dMGY' '• "
owner Of Property Who Wilds or improves thereon,and who does such work himself
or through his own employees.provided mat such improvements am not intended or 507 - FINAL PLUMBING
mmied for sale.ILC68weven the building is soldwithinone - --" -"'- - " ' - ._ .__.. -----
completion,
_
orofpmyear of `r-- -- ---
cam ova O,the owner-buildent will have the burden of proving that he and not Wild or
improve fw puryox of sale).
. . -. ...._.._-. _. t _......._
o ❑Las owner of rhe n - - -----
pmpeY.vin exclusively contracting with licensedconnnemrsto F I' il"a0 ,:.�•t,:"':'+1 ��construct the es n Sec.
appl]844,owasBusiness and Professions Code)The improves
tmnor's 1 F '
License Law does not apply to an owner of property who milds w improves thereon, •..
and who Corridors
License
for such.pmjecu with a convanor(s)licensed pursuam m the. �y�p� 1
- CoI am
Sec.: Ir I'IaCP�Va LI=�-
❑Ism exempt under Sec.: � � .r � 'B'&PCfor this reauo
Owner Dale' JAN 0 3 2002
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pcjuryone of the following decimations:
have and will maintain.Ckficate Of Ganx t to self-came for Worker's BUILDING
f C�fot�snana of the ressu.n. as work fw which tfor hi,Se.if 3188 of the Labor Codc, for the
a Action is issued.
ve and will munuin Worker's Compensation Insurance,as requited by Section
](p or the labor Code,far he Acro..of the work for which this permit is
issued MYW hers COmpC t 1 suranc carrier and Policy bi ate.,
_ ....w...r _. .. . .
amer�Pdmy N A/ AnI TOfwRq' f""l : a ' _L✓. `;_.. ._ - - -
IVCE FlCATIONOF E%EMPTION FR MW RKERS' s `� a). .it_ .. j, r
VS7}g:a„S';ZY;
.:n ._ .. .. COMPENSATIONINSURANCE' ..�________ ,_.'•' `._ _ .....s _
(Thil assets no mar be compleled if the Permit is for one hundred dollar -
fI108)orless),
"1 cenlfy that in the,Performance of the wodr for which dins permit is issued,f - - -' "'-- "' •- — -
shall of employ any person in any manner so as to become subject to the Workers' a "
Compensation Laws of California,Dale,
NOTICE TO APPLICANT If.Of madding this Certificate of Exemption,you should I -
Z bacon¢ b) t t the WodeYs Co pc anon D v ons of the lobo Cad you muss '
0 O forthwith comply with such previsions or this Permit stall W deemed oked.
CONSTRUCTION LENDING AGENCY - - - - - - - „-, - ----' -
�,' I hereby.Rrm trot there is a cdosuve6on leading agency for the pedormxnce t
{i7 of the work for which Nis permit is issued(Sm.3897,Civ.CJ - =
ly Q lenders Name
;;I,Z Lender's Address - -
V .
, 1 unify,to c 1 have with this application and sum that me above inaws mion is '
U toren.I agree to dimply with ell cry and county representatives
o and state laws relating
O V mbaove-menswedpropedhemby ipection pupasemaives of this city to corer upon
;,,,{. the above-mentioned agme to propend for ify and keep,
purposes.,
C. (Wj)Sgmearosave,indemnifyand keephamyin the City of Cupertino against
r4 liabilities,judgments.cons aad expenses which may in any way wane against said
V i City in conxquenc< (the gra99' gof this'pnor
rAPPLIC U:DE TAD'bS AND WILL COhIPLY WI ,A NON-POINT'°'
- SOURCE E" AT ef5. IT'��o Issued by: Dale
s g ti r of 1 p f CO ucto 6 Did Re roofs
HAZARDOUS MATERIALS DISCLOSURE
'.wn the Apra t or firnme building t oe t same car I
done luxradoZ,materialIT fRoof-
Cade:
�ZJ r
as deft rd by the C pent Mun pa,Code,
od Chapter 9 13 d thery Type oRoof
Health and Saf _ - - "^ J• --
Cade.Secu 25533(.).: - ... I
_ 0"s uft ❑No [kx P: .tlrl t t� t -.x ctr (,Y a'f�iS its E .!r , ( '•
. All.roofs shall be inspected poor to any roofing.material being,installed.AOL _
win the appl cam r future bulldog occult-nt use ea Air t .r devices a melt If a roof is installed'without first obtaining an'inspectioti;'llagree 4o remove
mit hazardous air contaminants as defined by the Bay sten Air al Mikes mem g
i""`" .. all new materials for inspection. A licant.understands and will comply with
Oyes ❑N - P PP
t ' ^ all non-point source regulations': . - -
I h d the'h"ardo 'els regdirembms under Chaps 695 of the
Califdm a Health&safety Code.Seinjims 25585,25533 and 25530.1 understand that
if the building docs not cum"
JY nave a moan,,brat it is my responsibility m notify Ne - - -
upam oyge requir menu rich must be ma prior to issuance of a Certificate of
.
e� Signature_of Applicant Date
_ Owner miss ised.gem, All roof coverings to be Class "B"or better '
OFFICE -