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02110082 (2) CITY OF CUPERTINO - `- xmt.ntNc ntvtslon PERMIT CONTRACTOR INFORMATION: ''.. B G ,(p FiMT CREST DR CHAM KIT M AND NG SAU L PERMITN©.2110082 UIdAWldEKIT M AND NG SAU L APPLICAI ID1SPIlD@T/•2002 PONE: SANITARY NO. CObL ROL NO, ARCHITECfIENCINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MIMI wooLICENSED CONTRACTOR'S DECLARATION Erol I hereby affirm that I am licensed under provisions(if Chapter 9(commencing SWIMMING POOL Job Description fn<a with Section 7000)of Division 3 of NC Business and Professions Codd,and my license is —.2 Li Nue Classdeaect. ORIG �E$ffi 9�Qa7,CEXPIRED. NEW PERMIT ioyz License class ue.x AND 1 2 0FEES" RGED. 832 . 50/2 41 oZ—o Dam Comin.un =�"tARCHITECTS DECLARATION I understand my plana shall M used as public records APR 2 12003 .0 ae 3 u G Liccnud Pmfenotool t'=0S OWNER-RUILDER DECLARATION in BUILDING py I hereby nlBrm Net 1 am exempt from the Contractor's Liccnw Law for the ce 0 nn BU y0 following reaem.(Secu ]Ip 1.5.Businea and Professions Gree:Any city lir county 6%$li which requires a permit m construe,all improve,demolish.lir repair any structure r2i prior to its issuance.also requires the applicant ler such Permit o file a signed statement �ys< thathe i ifcenedp rmartit)the provisions of the Contractors License Law(Chapler9 Sq. Ft. Floor Area 24900ation y�l-0 (commcncng with Salinn]Ikp)of Drvisinn Sof the Rosiness trod Pmfcssimns Codc)er i that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ibe applicant In a civil penalty of 3 b]k_PlqNWfibe97 Occupancy Type not more than fin hundred dollars($500). I,as owner of Be property,or my employees with wage ss their aide compensation, will do Ne work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Conoweem's Licence Law does not apply to an owner of 104 - REBAR Required Inspections properly who builds or improves daemon,and who docs such work himself or through his n cmpinyet provided that such impronmcna are not intended or offered for sale.If. 107 — POOL/BONDING however.the building or improvement is within ors,year of completion.the owner. 301 — ROUGH PLUMBING but]&,will have the burden of proving Nat he did not Wild lir improve ler purpose of sale.). 304 — ROUGH ELECTRICAL ❑ Las more,of Ire property.am exclusively contracting with licensed eunuacturs to 502 - F I NAL PLUMBING ENERGY convect the project(Sec.7044,Business and Professions Cole:)The Contractor's Li- cerem Law does not apply to an owner of propeiry who WiLds or improves ffemon,and 503 - FINAL MECHANICAL ENERGY who contacts for such projects wit a contranur(s)licensed pursuant to the Conuacmis 506 — GAS TEST License Law. O l am exempt under Sec. .B&P C for this reason 510 - FINAL PLANNING f, 511 - FINAL POOL OR1 ER' OMPENSAI JUN ATION 516 — FINAL BUILDING IWreby aRrm under penalty of perjury one oft following dedanlimns: I have and will maintain a Certificate of Conecnuo self-insure for Worker's Comped, sation,as provided for by Section 3700 of the labor Code.For the porfomance n1'the work for which this permit is issued. O 1 have and will maintain Wnrkcr's Compensation Insurance,as mquifed by Section 3700 of the IaWr Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier: Policy No.: CERTIFICAIM 017 E%EMMON FROM WORKERS' COMPENSATION INSURANCE Golis sectitm need not heenmplcted if the permit ea for one hundred dollars n L00) less) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner;q ay,the uysubjcam the Workers'Cnmpematinn Lawaof California.Date) I // D Applicam �/X Mi1—� W}r10E TO APPLICAt�:If,all making this Ccnificate of Exemption,you should Neonate subject m the Woher's C pereedion provisions of the labor Code,you must O Z forthwith comply with such provisions lir this permit shall W deemed revoked. z CONSTRUCTION LENDING AGENCY (-. N I hereby affirm that there is a construction denting agency ler the performance of W > the work for which this permit is issued(Sec.31N7.Civ.C.) UJ Q Under'..Name z Lender's Address U O 1 codify that 1 have read this application and state that the above inlorrution in F correct.I agree to comply with all city and county ordinances and nude laws relating to QU building ennstruction.and hemby authorise representatives of this city to enter upon the above-mentioned properly for inspection purposes. Fa (We)agree to save,indemnify and keep harmless the City of Cupertino against h llabilities,judgmenu,costs and expenses which may to any way acerae against mid City U z in consequence of the granting of this permit r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date V v SOURCER U�yIryYS. _ q' "moi 11111116" Re-roofs Signature of Applicant treau, Da te IIAZARDOUS MATERIALS DISCLOSURE Type of ROOF Will the applicant or future building occupant shato,handle havardnus material as defined by the Cuperino Muni al Code,Chapter 9.12.and the Health and Safety ode.Section 25532(a)1 All roofs shall be inspected prior to any roofing material being installed. ❑Yea ­Ix� Will the apprcanl lir mlu,e wilding tmctmanl use equipment tar devices Which a roof is installed without first obtaining an inspection, I agree to remove emit haenmoo,at,contaminants as Jerred by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Ycs 1 ban read thc hamrdoes materials requimmenu a.&,Chapter 6.95 of the Califnr ria Hahn At Safety Come.Sections 25515.25533 and 255311 undcrsmnd Nat if the wilding J e,not emovelly ban...... do,l.thit is my respma hhuy to notify the ocen,c ,of the requir hichmuatbemclprinrtniasu:mccmracenircaw facupancy. Signature of Applicant Dale >� All roof coverings to be Class 'B" or better Owner lir uuthnri Jagent Dae