02060084 (2) CITY NGDPERONo
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
21408 KRZICH PL A & A PLUMBING SUPPLY & 33VC 02060084
OWNER'S NAME:
APPLICATION SUB DATE
NETT, BABU 924 E FREMONT AVE 06/13/2002
i PHONE: SANITARY NO. CONTROL NO.
(408) 738-8878
GC ARCHITECT/ENGINGER:
Lo OOBUILDING PERMIT INFO
Ci U PLUG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION lob DBScnpIl00
j Z C In atch off, Nul 1 um licensed under rovisinns of Chapter 9lcommencing
_fat wdltSocranmyarDiviainn3nfineensiney�pna e5,/cyaZmyucenxe WATERHEATER
'x M d is in Tun' e a atfpCt. ✓ 3
!.z6 Licens a 6 Lic.9
O Contri
u. `fn ARCHITECFS�F�tL,ARAn
'rig 1 understand my plans shall be use Mir records
i O O Licensed Professional
that I i-BUILDER DECLARATION
�—' 1 hereby affirm that 1 em%from the Curnicim'sCod License Law forth,
m m ex
C 0 toll g e m 71131 5 Business d P f ., Code:e An, 'ry stcounty
which ts p< '( n construct.alta p demolish,' p y swment $1500
3� pn t t i n e I ey 5th applicantf such p min fiesignedsmtemem _. -__.___
thorn "'1 sedp annothep Ionsofth C t tr-Ice !e (Cha%erg ,( C•♦ cA7 j F(ppC a• Valuation
(cn m 6 with Section TW)ofDivisionSof theBusiness and Prof scans Cade) - } } J,�r3,("L'[(�',(JQV ���g{�fA 14t`yv
or Net he ni exempt therefrom and the basis for the alleged exempt on.Any violation
-of Section 7031-.5 by any applicant for a period subjects the applicant to a civil penalty e, Occupancy Type
:ofnotmarethanfivehundreddolar:($5000). 1011"N �WErR & WATER ''
❑1,vs owner of Ne propeny,ar my employees with wages nx their sole comPensatinn,
will do'the'work;-and the swcmre is not intended or offered for sale'(Sce:7014,
Business and Professions Code:The Contractor's License Law does not apply In an 301 — ROUGH PW{}'I#WDspections •^' it
owner of propeny Who builds or improves thereon,and who does such work himself
or through h s own employees,provided that such improvements are not intended or ___.302
.__-, TUB & OR SHOWER
";offered fo(islc If,hb r the bu IdinB or nmprovear ins sold within one year of - - ��� _._ _. . _. -. _....._........ .. _..-_ .__ .. ... ._
completion,the owner-builder will have the burden of proving that held not build or 502 - FINAL PLUMBING ENERGY
improve for purpose of sale.), 506 - GAS TEST
1. &ncr - . _._,. - - ..
❑mmem her of Ne prSec.7(am exclusively conwnode:)The ntmnorsm 507 - FINAL PL INGJ- - -
conawn the project(sec Ito a Business antl Professions Cod r improves
Commamr -
Ard,we c does not nuc 1 n owner of p oany ho)liceilds sed pthereon,
...and. h contracts for.such projects.wiN nwnudU.l licensed purcuam t +lie .. .- .._... tS!
sea
ContractorsiL cense 1.w
., ❑I ps ander$ 'B�l cf nhisr n - JUNlg26Qq+ i'n v9
Owner Osie "1 U 1.
WORKER'S COMPENSATION DECLARATION
'a I hereby affirm under lenalty of perjury one of the following declarations:
�, ❑ 1 have and will maintain'a Ceuific.an of Consent to self-insure for Workers Bu1�D1��
Compensation, as provided for by•Senion 3700 of the Labor Cade, for the
performance m die work for which tnia pcmnit is issued.
❑1 have and will mainima Worker's Comjmdsatiou Insuronce,'as required by Section
37M of the Labor Code;fok Ne performance of the work for which this permit is
issued.My
Worker's C
rkersC mpena t on Insurance ccca///���}ttt rend Pal y n/,mebe`
k�(m ' \.7�tTY. KI/kCA .PoL yN�. 4,05M
t�1 JJ/.V� _ ....v�
. rf.CERTIFICATIONOFPXE OM,WORKFR ERS , e_:!.' kfk ]k' .f ,ys. . ,.-'l rl Y[ �slt.T
..__•_.__., ,.'COMPENSATIO IN RANCE
°j 'MA aavti6 need not be'completed if the permit is for one hundred dallva - •'�' "'•-'1t
($10()orless.)
''' I mfy that in the pe form ce of th ork forthis t is issued'1 1 t - `, ri 'i,
khan not employ ono pC nn n any manner o's m become
ome suhJect ct m the Workers' i
Compensation Laws of Calilurnis:Dem•
O
forthwith comply with non shaltof t e Lamed rooked u muad .._..._ . _ ._ .... . __ _. ..... . ... ... . ..___... ..-_ __ __ ....
Applicant
'NOTICE TO APPLICANT If, ft making this Cen Oct rExemt rl ,
Z Work Compensation iPro s y t
O such provisions or Nn a
Z ^ .. _. CONST _ . ._ .. ..._
'4 I ben RUCTION LENDING)rand AGENCY-' - ' '-" '
thereby firm NctNm' a anstiucuon lend`gaged yf th'perrormance
-� of ad ork f -which his permit
sued(Sec 309].Civ C')
Q Leader's s Nam
�.z Lend rsAddress -
U O
I nee to t I h read all city
c t lid t t that the h information a
cote t I g t comply with II au and county ordinances and city reading
O.V mbuilding bovedanwtanionand,for imecodvemp . vesafthnscirymentyr upon
96 the ales(cmemianed propeny far if madion purpose h )i._ _
t~ L (s,)ogre m.c¢ de ipswad keephamyin the Qty (Cupertinoagainst
VJ Cit 1'i es js n¢,costs and a ponies which may in any . ec. . . ., said -
V,� City neons lice of the prom gat Nis perms
APPI ICA DER$TANDS PLYWIT ALL Nb POINT
s(uRc TIssued by: Date
glia m_ PPI14HAZARDOUS MATERIALS DISCLOSURE Da Re-roofs /
Will Ne ifidicirriC.,findire Wildiigoce.pimsore.ehandle liezallousmaterial Type Of ROOT..
as dcfncd by ih C pcnano
Man c at Cade Chep¢ LIZ and the Health and Safety i
Code Se wan 2553_(a) - • . .
ClYe t . - N. 1 'ti, ills .4 't k `-iv , _ 'F: fr tv i•. � - ...
_ All roofs shall be inspected poor to any roofing.matena] being installed.
=nth pplica t f t bu lingoccup tuseequipmentordeviceswhich If a roof Is installed without first obtaining an ins ecuon,I a roe to-remove
cmich zallou aroonum t s Iused by the Bay Area Air Quality agement g p g
Dild - all new materials for inspection_ Applicant understands and will comply with
qChapter -
all non-point=source regulations
❑Yes N ..,
Lhave Health
,the Sa ety Code
materials requirements a d 2 r 695ndf the '
if the building
Health s Safety currently
avea tenant,s 8505,t it is end]5534.1 underso if Chet
if the building does nm ancras ly have v obe-othat it is my responsibility m notify the=toy
quiremenu v�hlch an to be met prior to issuance of h Cenifcete of
Oceu toy Signature of Applicant Date
net or eatf riaetisz. D e All roof coverings to be Class"B" or better '
OFFICE. .. ._.
G ,t.