00100163 (2)CITY OF CUPERrfINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS: _ -
PERMIT NO.
001001.63
OWNF.k'S'NAtFE
APPLICATION SUR DATE
.10/24/2000
PHONE. _
SANITARY NO. CONTROLNO.
ARCHITHCT/ENGINEER:
BUILDING PERMIT INTO
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BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARA'T'ION
I bend affirm mat I um Iiam,ad undo. provisions of Chapter 9 (r nn.mearing
lob Description
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withSection70fgllofDN-....3af the Business and Profe,uiins Code, and my license
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I
Lin full force and effect. ,
icense Class— Lic.N
Data
Pool—/SPA, '
- Contractor
DECLARATION
ARCHI'1'ECT'Stas
•�
unJrtalnnd my m plushall he sued c
cubic Ns
_ OWNER BUILDER DECLARAI ION
1 fiefichy affirm flairl at eventual from file Contractor's License'Law for the
milli
l g (S f 7031,5, B d P I. C J \ y ail, r only'
I a from,t ha I, isluer, improve, dl or repairany structure
w:
pmol I earn, aka reroute,(he appl' t for such perm to f le a signed ornament
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thatIt, dpronoun t the phoi,mas orIh Clthertme, License Law (Chapter9
(cn - g 'thy ( 7000)fIJ' s 3 flit 11 JI f.. inn, Code)
Sq. Pt. PIOOr Area /,Valuatton
:it that he is exempt therefrom d [Ile basis dor the alleged exemption. Any violation
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of Seelnt i70315 by any mineral for a Peri I subjects the applicant It, a civil Penalty
nr not mare than five handled all (5500).
APN Number ' Occupancy Type `
❑I,arnwact of'Ile pmpeny,orrny employee, wish wages as thcirsole acal,mminn,-
still Jo the work, and the smtemre is not Intended or ,hared for sale (Sec. 7044,
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Business and Profeosium, Code', The Contractor's License Law does not apply In an
Required Inspections
owner of property Who'bullds or improves Thereon, and who does such work himself
or through his own employees. provided Thin such inconvenient, are nal intended or
ofiereJ fir still. If. newever, Ihd holding or improvement is .surd within one year of
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1.03 --' UFE R .
mamve or the
c Foo ,utas will have the harden of proving mal he did ma could In
— REBA R J
104 .
❑La,ownerof(hePmPcrty,amexclusivelycontractingwithlicensedcommctontte
107 — POOL/BONDING---r -
eal,lmm he proem (Sec. 7044. Basin., and Profession, Cade) The eonmader's
301 — ROUGH PLUMBTNG
License Law does sol apply ur an ownerof pmlrony woo hard, nr improve, merem
.
and who ennlraels sur such Prjeel, will, a enolneumho reemed'pnor.fit to the
304 — ROUGH ELECTRICAL
Cenvacmr's Lanni Law..
° Inn, rxmnPT unaa and. ,B A PCfor suis.eases
5iZIp — FTNAL PLUMBING ENERGY
Owner Data
503 — FINAL MECHANICAL ENERGY
WORKC:R'S COMPENSATION pEC1.AkAt'ION
506, - GAS TEST
•.I bete, oirm under peunit f'er'al
unity fertility Je )fol
War
51.0'— FINAL PLANNING-
° 1 have and will maintain a ramie er cam at to me workere
chi ],.bar
Crformanceo a, provides for by Seaton glean of the ],.bar elle, For .inn'
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511 — FS NAL POOL
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pmfonnance of Thu work for which Ihls'lwnnil i, is,uel.
516 — FINAL BUILDING
° 1 M1uvc will :mintain Worker'.. Cotnpene, hu'mmnm, hi by Semi on
,
the
3710 of the Lcnv Code, far the pensur ince of the week for which Thi, permit is
of t r bath
sued My Workers Compensation Insurance ensurer and Policy number are:
Cunim: Policy No,
-WORKERS
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CERTIFICATIONOFEXEMVI'IONFRO
COMPENSATIONINSURANCE'
,
(Thi, sccTlnn need not be completed it the fun it is havoc hundred dolk..
^
1$100) or leesr
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I certify that in the pelf amcd or the work lot which this permit is issued, 1
,hall not employ any pn'nm In any manner in, as to become eunjed to It, W..ket,'
Compensation Laws of Califomiti. Dec
Applicanl
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NOTICE I O APPLICANT, II', alcor making Ibis Ceniticmc of Exemption, you should
bcmmd,uhjael mthe Worker, Compensation provisions of the Labor Code, you must
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forthwith comply with-such provisions or mio peon ),,hall be deemed rvekel.
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CONSTRUCTIONLF,NDINGAGENCY
I hereby oflirtn that there I, a onarmiun leading agency fill the p11tormana
or the work for which this permit is issued (See, 30)7, Civ. C)
Lend,,', Nana
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Lender's Address
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1 certify that 1 have read this application and send that the shove information Is
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correct . I agree m mmPly xith all city and county coronaries and stat laws relating
to huilAing cone, ... limm and hereby amnorl[e representtives of this city to enter upon
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the above Iran .iohall properly lir. nNsecl nn purposes.
. (W4)d,nu m save, indemnify and keel IwmJe,s the Ciny of Cuperlina agaiml
liabilities, judgments, coos vad exponsm whth rally in any way acame against ,aid
City In consequence of the gmfifr, of thi, Permit.
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OURCEREGULATIONSNDSANDWILLCOMPLYWITHALLNON-POINT
Issued by: '.Date
Signature or ApphcanVConammr Date
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
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Will the applicant or lhmre buildia,uncepamstnm nr handle humrdous mner,inl
Type of Roof
a, defined by the Cupertino Municipal Cala Chapter 9.12, and the Hudih hid Sale,,
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Cade Section 25532(u):'
ID Yes ° No
All roofs shall be. inspected prior to any roofings mate rial.being installed.
Will meaPpllcant,, game baudingoceapantmva,mymemorecvio',which
ronin hmardon, ter conmmi"am, defined by Bay
If a roof is installed without first obtaining an ins ection, I agree to remove
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as the Area Air Quality Manegenten
District,
°Y" 71
-all•new materials for inspection. APP comply Meant understands and will cont I with
No
all non-point source regulations.
• I have read the felonious maTerials ren limmenla under ChuPler 6.95 mf she
Califomla Henhh de Safety Coe, Sections 25505, 25533 and 25534. T undersand that
if the harding does nil amered, have a rural, hill ivan responsibility r miry the
occupant of the requirements which must he men prior eh issuance of a Ce mean of
Cedric,
Signature of Applicant Date
All roof coverings to be Class "B" or better h
Owneoranmosredagent Dane,
OFFICE