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02100175 (2) CITY OF CUPER'11NO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:° w nul"(1,2)fiRUSnENISON AV TG PLUMBING PERMITN92100175 OW%.11--3g4EHUANG 151 ROUNDTABLE DR. APPLICAT!2451 �ogl�t2002 19111, orZONE: (408) 605-2201 SANITARY NO.! 7 CONTROL NO. ARCHI'IY.CI7ENG WEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECII 0 0 0 1 0O LICENSEDCONTRACOR'S DECLARATION JOal DCSCO 1100 K V F I hereby affirm that[am licensed under provisions of Chapter 9(commencing p y w wilM1 Swlinn]agB of Division 3nf the Oucinc.vand PrafcssimnsCrxlc.anJmylimnse is REPIPE 1 2��3 infill tome and effect. APR 1 _OZ P'LIZ License Class Lic.N -0 Dom Comracmr 2' 1 ARCHITECTS DECLARATION BUILDING < I under..+send my Flans shall W used az muhlic records 3'� F LL 0.G 1 Licensed Professional 3 OWNER-BUILDERexemptDECLARATION <0 I hereby affirm on l 1. exempt from the Gonias Code: e:Any Law for the $2500 a pO hollwhich requiresa Permit 7031.5.Business and improve. de imre Co de:Any tiny or county m which myuirea n permit nl tures(e aalter.pplicant improve.demolish, fie pair any 9tuclmat 2Ey that hpoor e its cnsedpursuattyo,due provisions Of farthe such Permit lLiienseLaw(Chapt cm C�a< scommiscingwitpSectionoNc(ifDivinnsnlNCCnhe 3uiness niProelzw(Coma)or 3Sg6®18fFlo"b9A@© Valuation that he (commencing Section70(10)and of Divlslnn3,f Gleed exsanJon,Any Cale)Of i�$ that be is exempt Nemfmm end use basis for the alleged exemption.Any violation of Seeman]031.5 by any appoorts,for a permit subjects the applicant o a civil Penally of not mom therm finhundred dollars(S50o). 301p NROUGH PLUMBI G Occupancy Type ❑1,u owner of the Propcny.Or my employees with wages as their stile campewtion, will do the work,end Ne Slmclum is not intended or offered for sale(Sec.7044.Business �y��{ EEiy Code:The Contractors License Law arcs not apply to an owner Of 507 — FINAL Ulvl �c OnS property who builds or improves Nerean,and whodues such work M1imrelf or through his and Professions C Own employees,provided than such improvement,the not intended oroffeted for sale.If, howeveu the building or improvement is Sold within one year of completion.the owner- builder will have the burden Of moving that he did not Wild or improve for purpose of sa/kJ V 1,as owner of the prmpeny,am exclusively contracting with licensed contractors to construct the project(Sec.7 W4,Business and Professions Code:)The Contraetof6 Li- cense law does not apply to an owner of property who Wilds or improves dermn,and who comracu for such projects with a conlractons)licensed pursuant o Ne Contractor's License Law. I am exempt under Sec. ,B&P C for this resume WORKER'S COMPENSATIONDECLA ON 1 hereby afEtoe under Penalty of perjury ave of the following declaretions7 I have and will maintain a CeniOcam of Consennm self insure for Worker's Compen- .ashim.as provided(a,by Section 3700 of the UW,Cuba.for the Perfmmance of the work for which this permit is issued. ❑1 hast and will maintain Worker's Compensation Insurance as required by Section 37(x)mf the Labor Calc,for Ne performance of Ne work for which this I,.I,is issued. My Worker's Compensation Insumnec carrier and Policy number art: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This aus iron need nm M complcicJ him Permit is(iron,hundred dollarso IO(B or Icie") 1 certify that in the performance of the work for which this summit is issued.I shall not employ any Person in any nnnCrs 1 a'a ac ad 1p the Workers Compensation Laws of California.D Z NOTI a ._APPLICANT hf-a G AN NOT 0 APPLICANT:If,after making this Ccnifcac of Escmptimn,you sM1nu1J secon c Sol to the Worker's Compensation provisions of the LeWr Code,you must O z forthwith comply with such provisions or Nis ponord shall W deemed revoked. z O CONSTRUCTION LENDING AGENCY PI hereby affirm Na there is a conationumn lending agency lin the merfoomuccul :4 the work fur which this permit is issued ISce.3157.CivCJ kc Q Lender's Name .7 z Lcndcr's AJdm,s t U C I certify that 1 have read this application and state that the above ialitm,atiun is ty Fcorrect.l agree to comply with all city and county ordinances and.state laws relaongu, �U abovenmentioned mostly hereby authorise rcprcunmtivcs of this oily memo union the above-(We) gm properly for inspection purposes. (W,)agmen to cove,indemnify end keep harmlessn the City of against against H h Iiahililies,juJgmenq ttuu and expenses which may in any way accrue against Sail City U z in consequence of the gmnti ng of this perm it. tl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date 6 SOURCE REGULATIONS. Re-roofs ,gnawre o ppiicanVCnnua<mt Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tW application future building mecupant store or handle hamNaus material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Ifcahh and Safety Cndo,Section 255321e)m ❑Yes [VNo All roofs shall be inspected prior to any roofing material being installed. Will the beam or future building equipment If a roof is installed without first obtaining an inspection, I agree to remove pp g r,ccupam Lice a em of devices which g P $ mil hamNous air contaminants as JCEned by the Bay Arca Air Quality Management all new materials for inspection. Utes VW 1 have mad the hamfdous materials requirements un ei-CWpmrb.95of the Cahfim- meHcalN&Safely Cak.stations 35505.25533 and 25534.1 understand Nm ifthe Wilding doer mu currently have a tenant,that it ix my responsibility In nomy the¢cuPanl 01 thc re rms which martWmel poor it)issuance ofaccnitcmnanxcamanny. Signature of Applicant Date /v aS-aL owner ar iced spurt Dam— All roof coverings to be Class "B"or better