02040053 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20171 JOHN DR BELL PLUMBING INC 02040053
OWNER'S NAME: APPLICATION SUB DATE
JOHN FURUSHO 2420 PRUNE AVE 04/11/2002
PHONE: (510) 438-9000 SANITARY NO. CONTROL NO.
ARCHITEC IE-NGINEER: BUILDING PERMIT INFO
Opp
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
5'? Job Description
�z 1 hereby affirm.lila 1 am licensed under previsions of Chapter 9lcammencing
.,nCug withScaion]IgOlofDivision)oftheBusinea ndPmbxxonsCode.andmylicense REPAIR SEWER
is infml@@rr��evraeffect. / a7P� <`3�
i O,U Littnsc Lk✓— 6 3
j ic O i- D-a',',y' Conl(nC��loyy'/' Pt 1 n'.Vq
/` ARCHITECT'S DE XARATION T—
y I andersmnd my plans shall be used os public recoNs
7 i p O Licensed Professional
rq 6� OWNER-BUILDER DECLARATION
1 hereby uffnn that I nm exempt from ILe Contractor's License Law for the
following reason.(section 7831.5.Business and Professions Code:Any City or county $4000 4 O O O
Y F c which rcgwrex re t t C earn t Ia imps.a demolish opulently stmnure Y
um13Cm prior to its issuance,also requres the applicantfo such permit to Glee siamestualmormod. - .. ... _ _ _ _ —
that
(corn r hcsed gwith a amt the pro t ions of the C m.ant License W onsC me) Sp,•sp' ],D r �aj'O,I Valuation
.(c that
g with Section7000) fD tri noohheB smc and Profit-sinus Code) (.,°v�'�„ + {:307)" �E@8 ;'.V"U 1.'t�t4•y„ "l; s"
of Shur he 7 exempt therefrom and the buxm for the subjects
ed eA lie.at to Any violation `
of Stttion]831.5 by.ny applirnnt for a pertnit aubjtt¢the vpplicam to a civilpenalty �y��
mrnman ot mare five hundred dollars rs500). 10 6-PN-St*gR & WATER ”' -' Occupancy Type
171,vs owner of the property,many employees wish wages us dmir sole eampens am",
wlll'do the work,and the st ortair is not intendedoroffered for'sale'(See.7044, 00R P1 7 p
UG
'Business and Professions Coak:The Cmdrne.r's License Law does not apply to an 301 - ROUGH P$UR+'1;34tj@spections '
owner of property Who builds or improves thereon,and who does such work himself
orthrough his own employees,provided mat such impro.emems aye cut intended or 3 0 2 - TUB & OR SHOWER
-oRered for sale.If,hi+wever,the building or impmoonen,is soltl within one Yesr of- -----'----"-_" "-'-"---' ""
,cmuldetinn,the owner budder will have the burden afpmving ilia,he did not build or 502 - FINAL PLUMBING ENERGY
Improve for purpose of sale,), 506 - GAS TEST
----- -' _ . -' - '- --- - --- - usb
xtherojecps(Se,7,am Business and Professions
Code:)
Connector's
507 - FINAL PLUMBING ''1•' , „'License Law
the present Iappl]044,Business and Professions Gsde:1 The vea thetor's _ 1
Licmme Law Anes not apply m lar owner th.raped who builds rte improves thereon,
_ond.who co License
L.such-pmjttts,.with.n con0anor(s).licensed pursuant.to.the.
--
Contractor's License Ww.
1 am exempt under See " 'S B&P C for this reason
"p,�6 pp C
Oviner . . ,
° D`aie., .. .I s.I. . FB 16OIm®
WORKER'S COMPENSATION DECLARATION
1 ' I hereby affirm under penahyof perjury one of the following declerotiune:- APR 'I 17 2002
01 have and will'maimmin•a CenlGcme of Consent to selLinsure for Worker's n / L L
Compematin, as provided for hy:Seerion 3700 of the Labor Code, for the
performanceof the work for which this promk is issued. BUILDING
°1 have arid will meinmir Worker's Compersarina In+uronce,ei ixquirca by Section
3]01]of ilia I:ahor Code:for the perrnimvnce of tfic'work for which.his
his
issued My Worker's Compensation 1 surance carrieramd tilPol y ber are71
. ..u. ..
Policy No
CE0.TIPICATIONO %EMRrID FltOM,WORKER51- i s. s + C t. .r. J. .. - s
r" COMPBNSA'fl•ON_INSURANCE,;.'6� ' s- ,
(Ths scelmoeed nor hetorpleudf the permit is fur one hundred dollars _ r
($100)or less.)
.thrI1 certify matin the Performance m of the k f which this permit e assured,"I + i
nail um employ any person In any manner sit as ro become subsea on the Worker ' -
Cpplieta..ion Lows of California'Dole
.'Da
NOTICE TO'APo the Workers Compenter sation
this Cishods of of Labor Code,you muld
st
z bey me unroll thaw rkers Coimus.,this
,t s , tsions of the Lobar Cod y6u must
O forth .h mplY 1h such p v s ons or th pe alis((be deemed revoked.
� .w .. _. __.. - _ .. . .. ._ .... _ ____......... . ... _ .. .„..... _ ..-. _ .. 1 - ._..._.
'CONSereis cons LENDING AGENCY h”' r.0•' .
1 he by (firm that there o construction n le a'ng agency faiths perf'vn nee - r
Wgsx,0 of N<xork far which the perm t rs issued'(see.]897,Civ.C.) `
-Lender's Name...: _.,._.,a•:_.. ...:_):..._.. ...:_�.... ._. _. _....... . .. . .._.
D'Z WVde Addres
V c I certify to I have d intapplicationiu nd state that sa above law, tion is / I
QGL [r come. 1 greet comply rh ell city era County d naves and stet ser upon
(, mbuove-me waionand hereby nvthonu prentatives o(th city 10 cmtt upon 1
a�}aW the bo ronedproperty annif,and
inspection
F.r-(Z) (We)agree mm indam per,ex which
may
any
6 t,of CLpert 'against
h City in
)udgmems,cows.end expenses which may an uny wuy secm5 ogaimt said
V'Z City i'ri dons equence of the gmntin finis perms.'', " '
—UCANTUNDERSTA, TI.LC101- '(H ALL M1ON:POINT'
a urace T Issued by: Date — l/
.. `sslgr,ame.fApNicardcammet „' '+:..:'. are
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 1 "' T made
Wilr1applicant or foto bu10g upon.nwc or handle heuNous.steno( ,. .Type of Roof... .-
az def red by,h C pen M terpol C e Chap 9 R .nam x Ito ora Safe, .3
Code Seection 25532b4 s �'+'^'a v i I 11 t l: at + s. . .A +J i J :( t L s -+
M, 1 1 1 , I __All.roofs shall be inspectedw
prr to.any_roofing,matenal being installed.,,.
11')' Will theapplicant future bu' oagoccupant equipment devices xmcn If a roof is installed'without first obtaining an inspection';I agree to'remove
mit harerdousar comumrsness as efired bytheB y Area Aur Quality Management
DGmc1 m, all new materials for inspection Applicant,understands and.will comply with_
°YeS1/''0.;, ' -a all non-point sourcer atlons .,�
nxx ell have head the'hocarchhus materials requarcruents under Chapter 6.95�of the
25534 1 der t,M that
p q ar c rreml have)lana t Ihat qs m responsibility m nrnify the _ -
Calif mus H odau Safe Code SecrioI 25505 25513 nd
fihe bmld gd sit Y my
occu em f th re uirements N Rws.be er t rcsuonce of a Certificate or -
✓ Om Po y ,t: ` ate
o, .- - gnatureof'Applic _ .
All roof coverings to be Class B' or baiter'
o �06 m v -: �. t Dom.
v t 1
-nr r - .. -_ OFFICE ..._.. .,_ _,._ _.._ ._ ..... .