02030111 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7738 HUNTRIDGE LA ROYAL SERVICES 02030111
OWNER'S NAME: APPLICgTION SYR DATE
RICHARDS 4398 MICKER COURT 03/21/2002
HONE: (831) 462-0539 SANITARY NO. CONTROL NO.
' ,
Mai
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U F BLDG ELECT PLUMB MECH
<rL L7 r_U C_1 C_'J
5y= LICENSED CONTRACTOR'S DF-CLARATION
y z_o I hereby affirm that 1 am licensed under provisions of chapter 9 mommeneit, Job Description
mCty within 7W0)ofDivision3afthcRus inlandFout.,imsCafe.en mylicense REPAIR CHIMNEY, SHOULDER UP
SY I 7 is in fu c angwff t ?'
W06Lice )av C—�t'l.ic,
On. pate Contractor
ARCIi seDECLARATI
�j 1 undcrsmnd my plans shallll hense used as public rernmx
OO Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby strum that I am exempt from the Contractor's License Law for the
t i a following reason.(Section 7031.5.Business and Professions Code:Any city m county $1800
I F G which requirespoorer to construct alter, mpm.c amos
demolish,or repair any sa
3$ Prior to its' vane,also requires thpplicant for such Permit o file asgned statement - - . . ___ __ _ ... _.... _...
_
that haslttnspd pars ml the p Iswns ofm<Conwnors License law(Chapler9 pp hI� lipp,,.. a ! - Valuation
(co nnc'ng with Setionio J)of Division 3 ofthe Businewand Enficasnss Code) (�"'.;'r3'§9'�0 fi"Th,:17® a�h.B Sr�,_G{�.
or that he Is exempt therefrom and the basis for the alleged eAempt bit Any violation "
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty-
.of not monin..fivehundred dollars(aso0). 101APN t( JbATION - Occupancy Type
❑Lasmenter affairpropeny,mmy employaswith wages as emir sole compensation, _
CHIMNEY REBAR r,' STRAPS
'will'do the work,and the sumente is not intended Or'oRered far sale(See.-70i,L' -
Busams andProfessions Cade:The Contractor's License Law docs net apply to an 514 - FINAL PTBgiaM IWgGXSns t"''
awns
r of pm,dy Wbo builds or improves thereon,and who does such work himself
or through bis own employees.provided or such im ent hscros are not intended le m
-offe¢d far:ale�IL however,the nuildin--rim mens is sold-ithiii tier!
ge prove w geld or
oprovei for the owner-hil.).will nava the burden of Proving that he em not hila or ^'improve for purpose of sale.).
. .._.-._...__.____-__.__.___ _._ .. ._.wi - T`s� _ _
❑pas owner of the prapcny am exclusively contracting with licensedcontractorsContract to ■ A® o -` q{License const
a the does
project(Sec. too Business and Professions Codor The Contractor's d9 /sea �;,,,,. qf"
License Low tract not apply to owner th property who builds or improves thereon,
sena who commas for loch Prolens.wnM1 a convaaor(s)1 cemed purxuam to Ne. _. _
Col m exempt
License Law, p k�py A.
q .q OOey
_ ❑lam exempt under Sec: � � ,B&P C for reamer � a s f 1� V 4, C L
Owns Dat". .
WORKERS COMPGNSATION DECLARATION BUILDING
Ili rtby affirm under pc shyofp rjury ane of the follo gd Irriions:'
A, ry ❑ I nuve'and wilFramnuim.Certificate of Cement to ndf-insure for Worker's
Compensation, its provided for by Section 3700 of the lvbor Code. for the
performance of the work far which this permit is issued.
❑I have and will'mainum Winter's Comrens iioii Insuruiice,ei requited by Section
37M FG f ih Trow Code,for the performance of the work.for which this pemiit is='
iseued.MyWorker's Compensmimlamrance,rrier and Policy;imaill no:�^
Cun� a. a. FICA XEMPI
" CERTIPICATIONOEETIONINNFROM WORKERS"
COMPENSATION INSURANCE..'
(Th ct oiineed hoe becnmpined if he pernit is for one hundred dollars ... , . t-
(5100)or less.)
O Icarrifyffirm
In h' Provisions
f pihpI,of the workf which thspmit
is,sel
Y shall t enae
Compc aro ay."'. yva bJetoh Wa k rs
_
_ ._—_._..._ _. .. ...-._.. -_ ._._-
IN OPPLCANT (ter making Certificate Exemption,. should
z become uhl no theWok Ctionp hdonsof thL de you must
forthwith mply with h P :inns or this permit nhailI fwd deemed revoked
,
_.
-
' s ' pr arC at the Cf10N LENDING AGENCY
1 hertby'Rmi that the
i a wet leading agency f the peOfonnana
of thework for which this
permit¢ismed(Sec3097'Civ.C)
a,Q -'Lends shame �•... :.._..:. ... Jqi..._. •L.
Ur Z Lenders Address ' ," '( 1 „ I .,t
. • J. t.n :k ._
„y I cemfy that I have and this application and state ihm he above information is
-[r correctrl egad to comply with all city and county ordinances and state laws relating
to building conswction:end herby euthonad representatives of mit city to enter upon
the above-memionem propm,fur inspersion pmrex..i po
fr LS, (We)agru to saehdemnify and keep harmless the C'ry 6fCupenmo ePurs,
Fn lin liabilities Judgments,costa d expenses which may n my y Beane egam s said
V ,7� City r co eq of gmaing of Ihit pd h ”
PPLICANT UNDE TNDS AND WILL COMPLY WIT ILL NON. OINT'!` �• /� ��
OR cuL I S - r_ Issued by: Date
Sigatilisilidf AppllctualCmunnew '--T—�';Data"i(,i Re-roofs
;' HAZARDOUS MATERIALS DISCLOSURE
W , - '.
Il the pplicam or fumrc building od.,sm store or handle harsrdou imamal _Type.of Roof-
"Bred by.th C pert Municipal Cod Chapter 9.12.and me Health end Safety I' 1 '—
odeS❑Y 2j532(i) ❑Nos,'. ly,.c f �. s E ''t°•, ! %' tp "lc('s i.�' 'i,1 .-i le
m
All roofs shall be spec[ed prior.[o,any_roofng.material being installed. _
Will
die eppl a t or future buiId ng occupant use equipment ode des with If a roof is installed without first obtainin an ins echoer, I'a ree to`remove
mit hexamouseu c numi ants u d fi by m Bay Arm A Quality M nage em g p g
Dismn all new materials for inspection Applicant understands and will comply with
rl t, , r - _ . — _. _ _. ._
11
I I
have read the hazomousmmenals regmremenls antler Chap¢r fig all non-point source regulations- '-
Y \
understand
the
Ifahfomta building
dos Safely Code;Sections 25505xt it
and responsibility
1 understend that
If Ow r Ili_-r esPom b I ty to n u(Y the
or uta 4 ssuan c o a Ce fiats ( '
occu rat of the rt n rats hi h mu t be met dor rte
p y q p 3�Z1 f G2 Signature of Applicant Dae .
e Ing acs net rrcm y have tenant that t Is my r
10:
g .Dona All roof coverings to be Class s`B"or better 1
OFFICE
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORIINFORMATIOi
BUILDING ADDRESS: PERMIT NO.
7738 HUNTRIDGE LA ROYAL SERVICES 02030111
OWNER'S NAME: APPLIC TION S B DALE
RICHARDS 4398 WICKER COURT 0321/2002
i� HONE: SANITARY NO. CONTROL NO.
(831) 462-0539
rc z ARCHITECf/ENGINEER:
GIll O BUB.DING PERMIT INFO
lj BLDG ELECT' PLUMB MECH
D o E,'I 1.._1
w i LICENSED CONTRACTOR'S DECLARATION Job Descri tion
x z- I hereby effect that 1 oro licensed under provisions of Chapter 9(commencing p
,yt with Sectio 7000)ofDivision3ofthe BuUsi9cmand ProfeasiourCarl my license REPAIR CHIMNEY, SHOULDER UP
y g y is in to a endwR I y r
rc0 M Lice oss C- •1 e.tr
Data Commmor
ARCHITECT'S DECLARATI
y 1 understand my pions shall be used as public rccoNs
i
I i p O
Licensed Professional
R t4i
OWNER-BUILDER from
DECLARATION
1 hereby affirm that 1 oro exempt from the Contractor's Co License Law for the
t a following reason(Semon 7031.5.Business and Professions Cade:Any tiny or county $1800 18 0 0
�I It o which requires n permit re wmwcl,palter.pli,improve, permdemolish,or,pair any structure Y
3- anormi¢wenance.slaoonto me the VISirr wRustics pecmivo Bleaei-aw(g ,mem _.
this(commend,aud who
Seed.l to the ofDi Division
Ofthmn3o COuhe Business
Licenselaw(Chapter9
(rohathe IngwiNSasian70W)o the basis
ar te.1a,cBcoonQont.Any Code) '13 J`)CY�Y"Y�-170:'i \' < I Valuation
or Then he is exempt N y of li end the basis for the"s cA creation.Any violnion
of Seniors 703 LS by any applicant for a pemdt suyens Ihceppliconuo a evil penally
of not mom than five hundred dollars($500). 10 1A PN 4'M-keFDATION Occupancy Type
❑1,ax owner of the property,ur my employee¢with wages ex Their sole compensation.
Vill'do the work,and the kuacmre is tat intended ne aBered fol'sole(Sec.704,
Business and Professions Code:The Con recuu-s License law does not apply to an 514 - FINAL P1B3*JreI IItlQFMns '
own"of property%a builds or improves thereon,and who does such work himself
or Nrouggh his own employees.provided that such improvements am not intended or
offered or sale.If,however,the building or improvement is sold vithina.Cycv of "' - ----- '- - - -- - -- --- -
completion,the owner-builder will have the burden of proving that he did not build or `
improve far purpose of sale.).
"
. :-. ❑Lesowne ofthe property,am exclusivelydProfeisi with dc;)'Me Contract no -
[ construct the project(sec.7044,Busies end Professionsilds or The ver am on,
License Lew docs not apply t pen owner of property who builds or Merton, .17
and who canines(or.suth projects with a commaor(a)licemed pursuant m The. .,
Contmnori w
License La . -. .... _
❑I am exempt under Sec. B&P C for this reemn
OwnerDim
WORKER'S COMPENSATION DECLARATION
T hereby affirm under Penalty o(perjury one of the following declarations:
1*3
❑ T hive and will'maintein a Certificate of Consent m serf—insure far Worker's
Compensation. a pmvidetl for by Section 3700 of the Labor Code, for the
� p ribman ne,of the work for which Nis permit is issued.
❑1 have anti meiniaia Warkcr's Comp msutipn Inaurehce,as required by Scotian
3700 of the Libor Code,for the performance of the work for which this Permit is
'� : : tied.My Worker s Compenution Insumna tertian end Policy number sae: '
.. .Int ......... ........._......... , .. adPal ._......... .....
'Polity No.: I•' y', :. �:' lir
s ,
Cunt c'
CERTIFICATION OF EXEMPTION FROM WORKB . l .. l. Y
' '' "'COMPENSATION INSIIRAHCE;^ -;
(This secnilin tibed not be'complded if the permit is for one hundred tlollen : .. t
100)or last -
' Itenily Nem Ne perfo sof Ne work for wbch thle perms is issued 1
shall nm employ any person In plyys�p'unncr�f ����to me subject m Ne'Workcn -• '
Cotppansanion U '¢ Cel forma,qts 1�Lj
-Apphaln. �. _ .... _.. .._ _...
NOTICETOa to the or Ir Compensation
Ccmfnsofof Lathor on.youahoart - -
0 0. becomeh campy the each po Compensation pmvisionsofthelabor Code,you must
0 forthwith comply with such provisiam or this permit shall be deemed revoked.
__..... _. - .. .. .. ... __.... ....- .__-.. .. ._ ._. . . _. ..
I:
'CONSTRUCTION L
ENDING AGENCY
1 hertbydTnmh t them isscommorion 1gerne,for Ne pnfonnensti
of this work far whichlhrs pemnt is -sud(Su 3097,Cis.CJLenders me -' '"
O Lander.sAii
— _ .- _ . ... .. ... ..__... .. .
s
...� .. . . .. I .. . .. ._. .
J
I certify Nat I have rad Thu application and state met the above information is '
fL!F,r cbBceL 1 agme as comply wish dl city and county ordinances and stele laws,hating
0 C.) 10 Wilding construction,and hereby industries,pmttntatives of this city to enter upon
.* the abovcmentioned property for inspersion purposes.,
pt'j (Wepeirce to gave,Indemnify and keep ham:lem the City of Cupenin6 against
DO liabilities,judgments,costs and eaPaMal which may in any way accrue agalmt mid
U'Z Ciry in conmqucnce of rotting of Nis permit
PLICANT UNDE NDS AND WILL COMPLY\ ALL NON OINT
Gul S. f _ Issued by: Date
t A
$Igne to of Appbcan1/Comncmr - ' Data "' Re-r00fS
HAZARDOUS MATERIALS DISCLOSURE''"
Will ttie epplicanl m future buildini arnpml state m hurdle herudous materialI�Spe Of ROOF
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety -
CodaSection25532(a)q;-i.' ... .(Ja✓,:. i s I -• ..
-❑Yee ".,.t• I ':.: b I; s
Ala roofs.shall �. nspected.priM.. o-any.roofing matenal.being installed... ."...
;adl the applicmt at(tiro,building oetupem u,equipment or devices which oaf is installed without firs[obtaining an ins eetiori,I agree to iemove
'I hamrdous air contaminants ser des d by the B6y,Ara Air Quality M...gemenl g p g
istdcll �N/
oY e all new materials for inspection." Applicant understands and will comply with
+ �G `; °, all non-point source regulations. .'„
"'1 have read the tiaiudous'melniais requirements uedcr Chepmr 6.95V the
Celifomis Health&Safety Code,Sections 25505:25533 end 25534.1 understand that
is tha Wilding does non mmdy have a tenant,that it is my asponsibiliry to notify the -
occapam of the mqu' nts which must be mat prior m issuance a e C ificete of
ottapanty. Signature of Applicant Date
y .. �3�1r�Gz -
- OwndI .,banned agent' Data All roof coverings to be Class "B" or better „
,
' %:," . ). ..._., ...... , ....: .:C : ....:. .... . .. .OFFICE .. .. . _ .. ...... _ - _.,
r
• APPROVED
IN ACCORDANCE WITH THE CITY OF
CUPERTINO CODES�N 6 ORDINANCES
DATE��� ---�`—
S This s Y
(Z This set of p' . n "n'e3
1 LIm tions MUST
be kept on t,e ;:: a a I es o and it is un
lawful to mel e -1/ �""des or alterations
on same wLh n P°amission from
he but d,r; .• Cepe.tino.
The starrm n' SPecifica[ions
iHAll N01 o: p, mit or to b ar
motovat f rh. v a „n i any provision'
OFFICE COP _ _ -
((A,
�c .
MAR 2 1 2002
B
x{42 Vie«
IfL)o f- o9c L �