00070176 (2) CITY OF CUPERTINO
BUILDING otvtswN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS _ PERMIT NO,
NER'S NAME:
21884 MONTE CT ARAKAKI STEVEN T AND WAYAT041'00070176
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RRAKAKI STEVEN T AND PATRICIA ILQI fIr/J5�4��,•11I1L[�I
O a>_ ARCHITEC'17ENGINFER: • - BUI LDA NG P17 Rod I INF0
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Y�`•,w RLIIG n.rcr PLUMB ml:a3
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S v y LICENSED CONTRACTOR'S DECLARATION
sm=F NnDETR)N
_
Job Description
Ihereby afin all,IFian.cdunder maw imno.1'Chnpter 9ac O will,Seen 7000)of Uv lin 3(nhhc liwncPmessiors Code.unit ley heil
da
sii is in full Later and effal.
_
a 0 i 6 License CId,, Li,.Y
0 Done (Contractor
ll.v, ARCIII'r be nSDECLARAPION SEWER CONNECTION /
1 understand ter Plans.hall be moldin Public mcam.
w--
du all
p Licensed I'nhfessional
%ems OWNER 'in DECLARARON
hereby affirm that I am exempt from the Cantraclor s License Law for the
h Z v tollnwins maeon,(Section 70315,Bu,ine,s and Pud—ion,Code'.Any city or euamy
adi which requites a q:ntth to construl alter.impmve.dcmnllth,at repair any,vucmm
t-m priori its issuance,mat requires the applicant four such permitto Idea signed statement
e, that he toficanallfmwnmmlife inas silra,,afthe CaraaaLicenocLaw(Chapter 9 Sq. Ft. Floor Area Valuation
(Garen ting with Section 70(h)Of DivAFoot 3 of the Buhincas and 1'ndosleit,Gme)
Far thou,he is esenr u hemfmm and the basis for the alleged exemption.Any violation
Of Scetinn 7131.5 by airy appl icanr far a pemrid subjects the applicant)a civil penalty
FI non mare than five I...wmd dollars($500) - APN Number Occupancy�TYpc
r of the pmprrty.our(lir emhlnyer.quoin wages as their ante cmrpert,alian, 1
x
a'
it' unJ me struuurre iv ria(it rc.de lir tiered or nal,(Sec.7U4.
B 'Bess and Pmfcsaans Cade:'ILc G(mracuu's License Law doe%not apply Io an ,�py,�q uired Inspections '
we fpmpcny Whinbuilds or imprints thereon,and who docs such work himself 3261.9079. VJ¢,
OF hmagh his noon employcw.Pmvrdal that inch improvemontn Fire Far irmndcd at
uttered tar salt-If.however,aha molding or impmverrcut is add within ane year el _
completion,the awne' utl106 — SEWER & WATERder will have the burden of freeing that he did not build Or
reprose prest(Ibpo
❑1.a,Owner anheproperty.mmcxmushelycanaacrns„'ith licensed canaailot 202 — UNDERFLOOR PLUMPING
Lmurua the project(See.7044.RF%iro and Professions,Cmlc:)'Um Contractor's
i,ii Law dao,oat imply total owter our pmpery who build,our impmve.merear. 301 — ROUGH PLUMBING
.ad who contract,Ito.such pri with a emarri licensed parslraat to the Limme Law 302 — TUB. & OR SHOWER
nactois
❑Ia''rosey�lander See .R.@ P C lot this max'” 502 — FINAL PLUMBING ENERGY
Ovarw 1-27'H 506 — GAS TEST
W'D (_R'. C MPENSATION DECLARATION
Iherebyarrnaunder penally afPerjury One Ofthe follow�ingdeclaration 507 — FINAL PLUMBING
❑ I haeC rid soulirl ailabor a Ccnircaw of Canwid m ,df„nsrm tit Worker's
Clon,tvation, a, provided far by Section 3700 of he Lahec Case. far oto
Pcrrmmana of the work fur which his permit is iavncd.
ClI huvr and will rrudnwia W..cross Cmnpenlmiwr euarnnce,ax lialum l by Section
37(X1 of the Later Comb,lour the thermal of he walk for which this permit is
issued.My Worker.Compensation Insurance carrier and Policy number am:
Cameo Policy Nn.: '
CERTIFICATION OP ENEMPI]ON FROM WORKERS'
COMPENSATION INSURANCE
(This worian need not hi completed if the permit is for one hundred dollars
(SI yd our los.)
I comply dead in the Pctln(manec of the weak far which this mtit is issued.I
shall not employ tiny reform in any manner no as to kerrim subject to the Warkert
Contprnaation Laws of Callfomie.Late
Applicant
NOLCE TO APPLICANT.if.after making this Certificate lir Exemption you,hadd
banns snhjemnNC Wader's Compematio t avikinn,of he Lahar Cale.y..in.,, '
Q 0 forthwith"amply with.wch previsions our this Permit shall be deemed revoked.
z ^ CONS'rRUMON LENDING AGENCY
I hereby allia t Thal there is a cargmcean leading agency tar the naballau.
of the work far which this permid is issued(See.3097.Civ.C.)
QLcndcrs Name
z Lender's Addles,
U Q I certify that I have real this application and state that the all information i,
�• [lir carrect.I ngne to comply whh all city:red enanty ardirl and stale laws miming
QU :if buildingcun1tim,nn,and eaahynathnaim rcpe,anali-,of Nix city In eater upon
} rya, he aMracmenunned Property Or imprerlon pur rear%
t.., 6. (We)agrecto,mvq indemnify and keep hormlev,he City of C,vmiim again
Z IiuNI..less judgnwnu,n.,t,nab rxIa F,,s Much may it any way acerae against said r� •••���
U z City in AN'r ND R the
grUS Ag til this permit.
APPLICANT NDERST DSAND WILL COMPLY WITH ALL NON-POINT 'lssuedb Date I/
SOURCE R ( 1. TIO 71
A
Signn a1 , rear Comembr - _ - t/� Date Re-rool's
HAZARDOUS MATERIALS DISCLOSURE
Will ret applicant lir foram Building«enmwu.aohe or handl,Ifni.nwrrfal Type ofRoof
as defined by the Cars,,am Municipal Code.Chapter 912,and the Health and Safety
Cale,Slalom 25532(,)7 '
DY,, • Cl No All roofs shall be inspected prior to any roofing material being installed.
will the applicant or lntmr building,ecapant use egaipment(if devices which If it roof is installed without first obtaining an inspection, I agree to remove
CT lit imardous air car inrans a,deincd by the Buy Area Air Quality Management
Di.rriefr all new materials for inspection. Applicant understands and will comply with
oyes 0N all non-point source regulations.
htrvc read tee hrmurdous na e,in,t(yutrcnmrt,under Chafer 6.95 til Ie,
�1 Cullfomia 11ca1h h Safety Cade.Sections 255115.25533 and 25334.I understand that
if the building dews nor sunemly have it tenant.that it is my reslwnd ilily to notify he
o
,aisa of remm
ter yaire . s which matt he net tart to oimmcr ar n Cenincam of
Or'COpaacy. Signature ol'Applicant Date
Owner our call,adral agrr,t Dam All roof coverings to be Class"B" or better