02070021 (2) CI BUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22340 CUPERTINO RD 02070021
APPLICATIONS BDATTE�
D� vNN JUDITH D ET AL 07y03/2002
PHONE: SANITARY NO. CONTROL NO.
,#I
ARCHITEC/lENGINEER: BUILDING PERMIT INFO
z G BLDG ELECT PLUMB MFCH
LICENSED CONTRACTOR'S DECLARATION
. 1 bitch-affirm mal 1 am heen.<a anger -- ra,a tw 9 a'nntmehc;n, Job Description
3z=o ) Prnw,man n s PLUGS
withseninn]I NOoflJivision3nf lh<dosi s and Pmle,sions Core.nnamylittme
m Y 5 is in full fo fid If 1 � ,�/ / ['
z C,6 Liccnu Cln a �+/C Lc%
i`LL y Dyte a �)✓'���'1 Comract.
C \\Y/ ARCXIT€Cr'SD AZIONI
II�yhIJer(..anJ my pl £stuli be u. d az p oras/
p sed P+irffaii-nol OWNER-
BUILDER DECLARATION
y= �I ham exempt aM.that 1 aexemp 's t from the Cmala License Law for the
F i following reason(,Semon 7031.5.Business and Professions Code:Any city or counry
$2000
E o which requires a Permit m conswct,alter,improve,demolish,or repair any simulate
3 s prior m its izmance,else rtquirts the applicant fw such pe g that he is licensed pursltant m Clic provisions of the Contracmht License tL Law(Chapter em.
^
(cum ng with Section 11100)of Division 3 of the Business and Pmfcs,maCe a�'f';\ i ;3 �•.J 1lrV C6'r:"UW I •. '} 1• Valuation
or that he .exem t mcmfmr6 and me bas for the are
ed exam mon.An
P B p y violin on
-of$inion 903 L5 by any applicant for a pcmtit subjmts the apDlicom to a civil penalty-
ofnntmore than eve hundred dollars $5oo). 304` PNTI�� ELECTRI AL',", Occupancy Type
01.aswnrof the property,or my pledits with wages as their sole confirmation, 501 — FINAL ELECTRI AL ENERGY
'Will do emthe work,and the structure is not intended a, pored for .Is t$a.7e$f1, 5 O 5 - FINAL EIR>yL�aH i,n g1EJO�,n
Baiincsx!red CI
AI:Prnfea.ions C <:The Conttalow,License Law enc,not apply Ie an tions
own
t,of property who build,or ironer",thereon,and who does such will himself
or through his own however .provided that such vementeis oy are not ire, ,u or
offuncurplJ fur ethic IL er hailde the holding or improvement fp... n sold within nee rear or. ... .. .. - ... - -
i m improve for
the nwnw.baimer will have the burden of proving mat he did no,bairn or
improve for puma¢of solcJ.
co L tr owner of the n,ten Business trofei s ---- -
' PrePc Y Ycon gwith licensed commeturs to -'1 . ?,•,,.� .., ,
Licari
the project(Sec.
appl 7016,Business and property
who
CWeO The ves mention,
e tor'x
License Low docs not apply man owner of property who builds or improves mto the
-and who l's License
for such propose with a contracmr(s)licensed pursmm to the
Committal's License law. --
_ 4 01 am exempt under See. "' - ;B'&P C for this mason
Owner . . `Date' :• .
WORKER'S COMPENSATION DECLARATION AUG 12 2002
1 hereby affirm under penury of perjury,otic of the following declormoru:
0 1 have and will maintain o Certificate of Consent tin self-insure for Worker's BUILDINGCompensation, as provided for by Section 3700 of the Labor Cole, for the
_ 'performance of the work for which this permit is iauW. .
01 have and will nminiain Worker's Compensation Insurance,as required by Section
3700 of the Lattice Code,for she performance of the work for which this p<rmit'is
issuciP My Workers C pc f Insurance and Policy
/be o e:
1_ ,x7r'
ly ... .n
C GR1'IFICATIONOFEXEMP(If9�R01WORK� CRS \ .I a S, c i,tp w; I ytt it 5tr,? 'e IMI y'
COMPENSATION iFSURANCE'9
.n. .. .:_ ._ .. _.___ . ---------
"This scroodurcell
,_._(Th .croorfncl the completed If the permit is for one hundred dollars LI j', i, _ -_ --
1$100) Ictal -
'1 n fY th t n th peri tion c f m- o k f huh"is pemut ',sued,l
shall t employ any pe any ane so is to become ublect to the Wmkers' •%,('
Compensation Laws of Cal fete a.Date'
'Applicant -
NOTICETOAPPI-10:I :II otter makmgm I Cenirene of Exemption.you should - — - - -- - — - - -
QZ betoihe subject y the such pr Compensation Provisions l I the labor revol you must
� fonhwith comply with such previsions or this permit shall be deemed invoked.
_ .. -_._ .-...
F UO ""CONSTRUCTION
cons LENDING AGENCY'
a 7 thereby affirm that rim ;sabered(See:lending agency for the perfnmtance
W Rhe work for whim this pcimit is issued(See:3097,Civ.C.)
0
y'.p Lender's Nam2:
...._-
t I
U 1 cl,,ify , ppl' at d.....'an b f tion
correct.l g to comply.with allcityri c o ordinances d t relating
V tIJ gc f and
hereby
e byauthrepresentatives of this city to enter upon
0. heIb
- - -
<uncultured p pend far inspection p rpo s
[r 0: (We)agree i ..It: d tify and ke phi I :the way n Cep again, mi
h habil t judgment,in couseqqe d xpe phc h may Imy way nc again, trod r-
U Z APPLICA'6UeV0cR5TA�D3lmg rwgt,COMPLY N'ITH ANLL VOV POINT
buzcEc tunovs.y' / - L �3- Issued by: Date
I, IL 11 i
n m fApp canUf Cot to�r f. - 'Dat
//// HAZARDOUS MATERIALS DISCLOSUREd. - Re-roofs
udefitt dlb pppinant Name bola gocc pam toren handl hatincous mmmal Type Of Roof
y penmo KN.
Chapin 9 12 d the N lth a d Safety CWC$ 11 i❑Yes ' tT1r. 1Allroofsshallbe inspected prior to any roofing.material being installed.wg the it tfare y< a tyAi use .Ai Qu�Y nageces m enIf a roof is installed without first obtaining an inspection; I agree to removeit haaado onto Gned b A B A Ail men
D.'NCI all new materials for inspection. Applicant understands and will comply with
DY -i No
all non-point source regulations.
1 h ve rcaaihe'hazardnus mmerialz regmrements under Ch r fig$or the
Califomm HeahG&Safety Coate.Sknor,
505,25533 and 25534 a d<rstand mat
irmc building es nm eurrcm ha .that it is my rcspo Ibilirymnotify the
Occup Ar requireme/ /hie prior to tss'on a of a Cimbitem of
ts�; Signature of Applicant Date
^t'' ate All roof coverings to be Class `B" or-better
-OFFICE
7_. ':::..': L . .-.. : .. . . --