03010077 (2) CITY OF CUPERTINO
BUILDING olvlsloN PERMIT CONTRACTOR INFORMATION ='
ItUI1.DINC ADDRESS: PERMIT NO.
20132 LAS ONDAS CT 03010077
OWNER'S NAME: APPLICATION SUB DATE
DALE CODER 01/13/2003
HONE. SANITARY NO. COKMOI,NO.
ARCHITEL /ENGINEER: BUILDING PERMIT INFO
BL EI.F,Cr PLUMB MECH
O,YZ 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION Job
uI hereby affirm that I ma limmacd under provisions of Chapter 9(commencingDescription"
w with Sdcdion7DMpof Division 3 of the Business and Prnfcasions Code,and my license is
inlunformandeffeeL. DEMO EXISTING POOL
Ostaa Data Class Ling. r—INALED
F�10 Data Cumracmr
As Moll atuse DECLARATION
o�< l understand my plans shag be saes as Pantie records JAN 2 2 2003
mLLo Licensed Professional
OW NER-BUILDER DECLARATION
a f flN
1 hereby affirm at 1 am exempt from the Contractor's License law for the
00 following reason.(Section 703 L5.Business and Professions Code:Any city or county BUILDING
$� which requires a Permit m construct.alper,improve,demolish,or repair any structure
prior at its issuance.also requires the applicant for such permit n rile a signed statement
�Z< that he is licensed pursuanuo the provisions of lire Contractor's Ideensc Law(Chapter 9 Sq. Fl. Floor Area $7 W00ation
�$ (commencing with Scetion MITI of Division 3 of the Business and Professions Craft)or
that he u exempt therefrom and the hssu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects d¢applicant to a civil penalty of RjiW� Occupancy Type
not mom than five hundred della.(55110).
❑I.me owner of Ne pmpeny,or my employees with wages as their sole compensation,
will de the work,end ere struaurcis not intended oroffered for ole(Sec.7B4a,Business
and Profeaions Code:The Contractors License Law does not apply 10 an owner of equfie nspechons
property who Wildsor improves thereon,and whodo s such work himselfonhrough his
sewn employeesprovided that sue improvements me not intended membered forsme.If.
however,the building or i mart is sold within one year of completion.Ne owner.
builder will hem rdcn of Proving that he did nut build or improve for purpose of
I
u owner of the,property,am exclesimve
ly contracting with licensed contractors to
co n Che project(Sec.70aa,Business and Professions Code:)The Contractors Li
cemse law docs not apply to an owner of property who builds or improves daemon,and
who con for such pmjecuwiNecenwemr(s)Iicresedpursaan..the Conlnemrh
License
❑ tem a Pn un race. ,BBPC rthis son
.net Uerc I
CER'S COMPENSATION DECLARATION
$ 1 hereby affirm under penally of perjury one of the following declarations:
I I I have and will maintain a Certificate of Consent o self-imu ,for Workers Compere
anon.as provided for by Section 3700 of the labor Code,for the rerformmta of the
?
.,it for which this permit is issued.
i ❑1 have and will maintain Workers Compensation Insarrom,as required by Section
7 37Ml of did labor Curie,for the performance of Ne work for which this Permit is issued.
My Worker's Compeneatinn Insurance carrier and Policy number am:
Carrier: Policy No.: _
CERTIFICATE OF EXEM MON MOM WORKERS'
COMPENSATION INSURANCE
i M.section need not he completed if the Permit is for one hundred dealers(5100)
ar less.)
I certify that in the Performance of IM work for which this Permit is issued,l shall not
employ any semen in any manner to as in become subject to the Workeri Comperation
Lawsof Celifurnia.Date
Applicant
NOTICE TO APPLICANT:11,after making this Cerilieme nl Exemption,you shnuW
became subject to the Wurkers Compensation previsions of the Labor Code,you must
OO forthwith comply with such provisions or this permit shall he decreed remote.
z CONSrRUCrION LENDING AGENCY
[r r thereby am lftrNm there isaconsrumion lendingagency lin the Perfurnanmof
ai 7 the work for which Nis rumor is issued Ism.3097,Civ.C)
fA 0 Lenders Name
W
z lender's Address
a
U i I certify that 1 have read this application and slate that theand
shove information misting is
Cf~- building 1 ensu to comply with all city and county terminus of and malt laws relating to
U abovenmennswctionend hereby Inspection purposes. of this city memer upon the
r [t7 above (We)agree
tropes for inspection Purposes.
(s.u agree Ir use.indemnify and hkeepick hay in an the City of Cuptnst against
U cap lnc ty ecjnce of cases expensesPermitch may in any way eccme against aid City
Uz intI venae of of this Permit. �)Z
^
An NT NDERSTA DS AND ILL COMPLY WITH LL N-� — O tri Issued by: Date
S RE LATIO
Re-roofs
at eof Applican✓Con mor a
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant smrc or handle hannious material
as defined by the Curcrino Municipal Code.Chapter 9.12.and the llcaldh and Safety
Code.Section 25532001 All roofs shall be inspected prior to an roofing material bei. installed.
p Yeas. P P Y g g
Will the applicant or future building occupant use cquipmtm or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit ha mous air contaminants as darned by the Bay Area Air Quality Managcmem all new materials for inspection.
District?
❑Yes \ �n
1 mad the ha.W...s materials mipuremenke undcr Chapter 6.95of the Califs,
niallealt 8 fcq Calc,Seetinns255115.25533md2553C.lundemmndthatifthc building
does not'u dy ha we..,t Lit is my spunsiIS try um notify the occurred of the
peril' m hich u Mm pnonoiss cofaCcrificamof coon" Signature of Applicant Date
wrier au som,agem I are All roof coverings to be Class°B° or better