02070201 (2) CUP
RTINO
CI gut DI c DIViSIiotNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20075 FOREST AV CUPERTINO PLUMBING 02070201
OWNER'S NAME: APPLICATION SUB DATE
DIASK FRANK AND JARMILA 10297 S DE ANZA BLV 07/30/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 253-0618
O.F.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C7
LICENSED CONTRACTOR'$DECLARATION
C =0 1 hereby ofiirm Net l em licensed un provisions of Chapmr 9(commeneing Job Description
FHF J wires' ]aa)nRovi,ipn3ordmBarn eprore„io,emr, namyhnenm REPIPE/WATER MAIN/WATER HEATER
e a License C,
w Cr
3 ca H Dale -7.�S.671 Co n
ARCHITECTS DE RATIN
,Q,, 1 understand my plana shall be used es`a bla,records
KMrofessonal
Licensed Pi
OWNER-BUILDER DECLARATION
6 "I.
1 firmly affirm Na I am exempt from the Contractor's License law for flueF a following reason.(Section]031.5.Business and Professions Cade:Any any or county $5000
E s D which requires a permit to construct,inter,improve.demolish,or repair any structure
a3m •.pnonoi¢issua«r,also requires the applicam far suchperand”
Fit
a signed uomment - __ -
tkat he.is IiecnW purso0m m me provisions of the Comrxmrs Licenm law(Chapter 9
Valuation
(commencing with,Sdtion;]IXq)of Division3of the Do{iness ymA Professions Calc)
w that he ix exempi merefrom'and the basis for Jmc it"c"ckamlinum Aa,violation
-of$«tion]031.5 by any applicant fore permit subject,the
apphearmoa as"pcnalry- m Occupancy Type
or net more than fivebandredaobs. S50o). 202APN f�FLOOR PL BING '`'
°I,as owner of the pared,or my employees with wages as their sole compensation.
"will do the work:and'me'surmarm is 001 Intended"or Offered for Sale ... .. ...___..._ ..
'Businessland'Professions Code:The Contractor's License Law doe,not apply to an 502 - FINAL PL&R %MVs GY''l
owner of property Who builds or improves thereon,and who does such work himself
of to . .through h' wne ply< provided thts n improvements t intended or ._ 507... . .FINAL PLUMBING.--...__.- . .. ...._ _ ._.......__ _ .,.
.offered'for ale If,H e th build ng o provemrnt -IJ thin oearne yof _ . - t -
o pletlon,the crone-bu Ider will have the harden of proving that he did not Wild or '
improve for purpose of rale.).
❑I ne f the p or;w; eukavdy contracting with licensed commarms... _ . .. _ ... ..__._._. ___..__- _ —.._._. .....
..consumer he Project(Sec ]OMs,Business and Profexs ons-Ill:)
o :)Th Contractor s
Li to d notapply wanownerofproperty who byIds r harpies""ancon'
andhoc Lr such pro3ectswmN contcmland.pursuant m the.
Contractors License
haw.
111 a pt undersea'.• ' " B&P C for this reason AUG1 t q
-' O mer - ..Date - ..,.i. AUG J 2002
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pepalty of p:"j ry ofthe following dMamtions:
° 1 have"efd'will'maimain i'Cenircac of Consent m self-insure for roofer's BUILDING
Compensation, as provided for by Section 37M of-lhr Labor Code, for the
Performance of Na work for which this permit is issued.f„•�
°1 haveand will'ina t n Work ds Co pe t n Insursn as required by Sectio;
J]00' f the'Labor Code.far N paAorlsu ce of mewd&'for,which this pc.I,is
issued.My Worker's Compensation Insum«e c ear and P9.1 y umbo are: -
a
_15rH7�—'r;oCa_N,,o0"p
am
Pnr J13o1 Vral( 'rllc0 al nr
%' CERTIPICATION,OF EXEMPTION FROM WORKERS a .t /. .f„}, v •'f a.6 m }(y \`
' " COMPENSATION INSURANCE''''lrn va eI'. "'"
of�+'(Tilissrctiivrird ndibe bdmpletrdifthe permit is foronehundreddollvx
($100)or less.) m ,
v rem.fy thr in the Performance afth-workf which thPermit is Isdl .•_: ..:._. t,_ - -.-:...._ _.. -....
Am mpioY any Perron m any men ear,m os m become rAgmI m Ne Workers
hall ,• - L .1�t.c.,( f. �: f
Compensation Laws ofC.Ii.lorma.Dom
.APP t -
�N 1 TOAPPLICA If ft making this Certificateof Exemption,youh Id -_---- -- --- -- — - -"-'
z sb3 uotheW kir C pl. t pn sOn.v Of N<Lubo Cod,you mus[ - �cd"
Z pIY with ch prior aions or this perm t stall W dreamed revokM,
____...__ __.__ __.__ _____._.._. . ____ .__.___.__
Ems„=„�3y ad If !`CONSTRUCTION LENDINGAGENCY'
1 h by affirm thin N is a construction lend ng agency f the pcifmirmantt
Lde None
q
1`4 sof th k fo which thispe t i issued(S .ILID Civ.C.) -
y:c :..
o'z
Lenders;Add . UU ;Jff (CiL:il
V.0 1 r - -
cn1 cm fy.fhat 1 have read th.application d tram that aboveinformation u
il Iagreet ply with alleityand frordinances and sure laws retailing
.0 1U mob Id g .t' db bpp .senmfiva'fth's city menet pon
(x] the bo etroned pmpenyf inspection purpo
-L (We) gmemo djmnifyan parm'Lithe Cry of penino ego st
V] liab t f s 3udgm s c f nil pe a mmf yin any y rue again t and
U'4 City ne q re oft mi r)�tK
APPLI T pbHR ANDS tw OMPLY wIT \LL tiON-PONT' 1 '
sOU )tr�3 ) s ?DG d Issued by: Dale
SM of ApprcanVcnmm to .. .•..st •j.. ate_. .' RC-roofs j.
HAZARDOUS ALS DISCLOSURE
.. ; WII the pylic m ftore builJing car.,m tore or f ndlr n li dous m teaal _.....Type,of.Roof....._.._---__
. , = C d f d by th C pen n Mmtic pal Code Ch pt 9 12 d th Health d Safcry ... - -»--- --
C
.-........,_ .. _ ...� .
cad Sero 25512(al \N \ KCOY l.T ',A � s, 7' I'`. t1 9"yv y.' t m�mr
°Y roofs,sfiall be inspected pronto-an .roofing,matenal being installed
pall to applicant rcoree lar goccupant equipment devices-, ,which If a roof is installed without first obtainin an inspecnon�I'agree to'.remove,.,....,.,
m t h rd tin has ad rd by the B y Arcq Q y M g e t g
all new materials for inspection Applicant understands and will comply with
°Y all non-point source regulations _ — -
1 h ve real a hay dous men Is requirements under Chapter 6,95 of the I
Cali I HaI Safe Cade: Non 505.25533 and 2553x.,I,undersrand that
if Ne build' d s not nil a nam:mat it is my rerachub.a-a to notify the
&cuplm th qui w c m n be mei prior m issuance of a Ccnifcam of "t
�300a Signature_of Applicant Dale
m mpn All roof coverings to be Class `B"or better
------'--OFFICE . . .-.—. .. . .... .... .......