01060035 (2) CITY OF CUPERTINO
is BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10385 MELISSA CT 01060035
OWNER'S NAME: APPLICATION SUB DATE
DERRICK MAR 06/06/2001
PHONE: SANITARY NO. CONTROL NO.
O-Z ARCHITECT/ENGINEER: ERMIT INF
W— BLDE „ PLUM MECH
a- —1 I_I
. 00
u
F;¢i
c z„��i LICENSED CON'TRACTOR'S DECLARATION
H� 1 hereby affirm that I am licensed under provisions of Chapim9lrommeric al; Job Description—
p!nL. with Seaionl000id`Divisim3ofine Businessand Professions Cole,anJmyliceme
=yl� 'm
roll forte and cBwt r
rca XOina ueennecm.s - Lien INSTALL S PUMP FOR DRAINAGE .
a Dam Cnntra"a' _
ui;m h ARCHITECT'S DECLAR TIO
= 1 undciamnd my plans shall be uuJ as public mco z �Q jya iR I '
W25
p O Licensed Professional 1
OWNER-BUILDER DECLARATION
—so 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
!•Z following nations.(Section]0313,Business and Professions Code:Any city or county
5 2 C which miotics a permit to construct.alcor,improve,demolish,or rep it any structure,
oc
n 3= _,nm,I.ts. u ..aho e9 the pelta tf hpe.at.flea ugncd s...to, - - - - --- - -
'hat net hmpGd pursuant to the Provisions of thec I aa Lteme Law(Chapter ar _ , (( , ,Sq:Ft Floor Area ., f :t $15)uation
Icmn emg w lh sccuon'!OW)of Division J r the Business and Professors Code) • ,y ,_ 1.., -1t p „a\ ..hn'i..%
nr that he is eierript mcrefrom add the basis fm,ha alleyul aempti.e.Any violation
of Section]031.5 by any applicant for a permit subjects the applicant to a civil perwlty
or not mom than five hundred dollars S500). 3421`4RJtNWTa50 ,,.ill Occupancy Type
C 1,as owner of the property,oe my employees with wages as their wlc compensation.
will eco the wnrg,and ssions odestruThe is nnnnt.na.,or a eredLaw does alenot(gee:moanthear10 6 — SEWER & IOABp�lnspections ' '
ownerof,ropeand rry Who b Code:The Coves dic mi License o d does not apply m an '
owner ofh his ow Who Wilds or improves thcrcon,and who does such work himself
d.or
armmlfordm:If,hmpmy«.,. Mallei mi ygmimpmvanyolargnot inline.,nr .._..... 202. -__UNDERFLOOR_.PLUMBING__.
-oft. er I If, a bimms P nt rs. Id m Tal or
completion,the owar, ldrwll base ffic barren of prm,u,mat head ant hold or 301 — ROUGH PLUMBING
improve for purpose of sale.). I
_ _ _ _._3.02_.-_ .TUB._&_OR SHOWERi__ -. ---
conarutrtner ofthe
tP(Seer](W�exclusively
ncontracting
Pmu onxcde:)Th cnnte�°tory 502 - FINAL PLUMBING ENERGY f �
andLim.,v,wh Law J«s sat apply mat owner,of pmpery who buildx or seimproves action,
andreamr,nim.w,rLrwsuch projectawim.a.nnlm.mda)ReemnlParaavLm.m. .---- -----506.--= -GAS -TEST-------._._.:..--__ ----
01ciaenactors pr!rode Law.
❑lam exempt under Scc. '� '.B@PCfor this mown 507 - FINAL PLUMBING-':`
"WORKER'S COMPENSATION DECLARATION
Ie ad will puntaipct.Ci of,,m ofadcofdi.following declarations:
Wm:
{a C 1 have ad will ro lid id for by
n 7W of m se Labor for Work the
Compensation.o as provided for by Seniors 3]00 0l the Labor Code. for the
'performance of the work for which this permit is issued,. D
C 1 have and'will mairmin Worker Conal;criation 1 "tured by Section /
37(X)of the Light Code.for th p rf a f Ih kan "hirlb his permit is
isw.N My Workers Cs pc lyyi 1_ ra-S c me nd
a
ca;..er-Covt'}I i1Pwd"Q� P y 4161 ogZ 1S 19 ZS `F.., f ._ _ . . .
:CERTIFICATION OF,E%EMP'TION FROM WORKERS] - ` •t �`� %5 ' ,r 5•
COMP[NSATION INSURANCE _... _._.._.___.. _
'(Timwniva need not he completW if be permit is for one hundred dollars " I'"•� i'r,r ;
M 00)or less.)
'1 certify that m the o in
an,unf the w,of b which Ihii permit is issued, i,;•..� j ?h.
Compensation
employ tiny petals r any Date m as m Wconw'iubject ei the Workers'
Cpmpenzaion laws of California.Dam ' -
NOTICETOAPPLICANM..If.after making this Ccnifiate of Exemption.you should -
z
become bleu to the Woken Cminicionfimi providia,'bf the LaborCode you must
Q Q 4inh th comply w,In_ h p irth:pe ):hall bed aeJ evoked.
Z .- . .__ ._ ._ .-.' ._ _ _..._.... _ __ _ ......-... ..._
F 7 _ "CONSTRUCTION LENDING AGENCY.
1 hereby aBirm Ih t them kammetruction lending ages y for the fomwnce
I
sir of me work for which mist,mnd i,ia,c IS c 309],Civ,C.1
y'Q 'Lender'.Name" •._ .. _..._-n.. . ....,.._..- .. :--. _. ......._.. ._-._- _ .._.._.__....
.Len der's Address
i1 certify 1 have mad this application and stain Nut the above inrmmmion is
�T• E., correct I agree to to comply withall c mJ county ordinances and state I enter
u ng
I
Q U cob , g n tams and he Tinyu rho p (rives R .hcity ter upon
A. the M J pap nde - p nd P N - . .
y tW ) greet indemnify d keep l ml.;:the Cly f C pe I n ago nsI
JI I ab ties ,c I. W pe ons h h Y n any .. gamy sec d
U z. CIt c qucace f the atoning of cots permit. '
P A IL DE STANDS.1" , LLCOMPLY WII'HALL N OINT f� n&1Z)�CC I Dale G G —JI
o RCT s:' I Issued by:
Si am f plicani/Convacmr, .Dae> Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Rin PPrcara f t bolding occupant.t handle Initiation.material .Type of Roof
r-
asdefined by theComo M Chap 912 ad the H Ih ad Safety `ir... .
Code.
Section❑Y. 25532(a) , r. x. r�r 7 .,
All roofs shall be Inspected prior to any roofing material being installed.-
-Will
nstalled._w R.he avidw.mn fourebuildin,« Iit -eegap I u which If a roof is installed without first obtaining an inspection;I'agree to remove
•
emir hazardoui air coramnammt,;,hazard
/defjttd by the -By A A Qtml,y Management
Dict a: all new materials For inspection, Applicant understands and will comply.wi[h
°Yu N. all non-point source regulations'.
1 have read the huzartdous mamnals mgammens wider Chapter 6,95 of the
California Health&Safely Code.Sections 25505,25533 and 25534.1 understand that' -
'if the'h ))Jing dies nm curinnly huvc a tcnamjltf t it is my revp,nsibility Tri ndiify the ,•
&Topa t ems which tnuu be met primto isxuancemfa Cmificam of
_G � Sirnature of Applicant Date
-Owner nr, nor ea agent .Date All roof coverings to be Class,"B"or better
OFFICE
_ - . .-