02020010 (2) OF
CI BUILDING DIaVC'ISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
7508 ORANGE BLOSSOM DR ROYAL SERVICES 02020010
OWNER'S NAME: APPLICATION UB DATE
WACHS HAROLD A AND DIANE K 4398 WICKER COURT 02/ 05 2002
PHONE: (831) 462-0539 SANITARY NO, CONTROL NO.
p ARCHITECf/ENGINEER: BUILDING PERMIT INFO
WOO BLDG ELECT PLUMB MECH
s„”
a LICENSEDCONTRACTOR'SOR'SDECLARATION Job Description
oz_o thembffXk.fthalumlicensedunderprovisionsofChapar9(commencing REBUILD CHIMNEY SHOULDER UP.
F,v_,t-w wish Section]Bflfl) fDivisinn3of me Business and Pnm&scions Cpdemdmylicense
a y f rs is fW�ores and ifcIt y
rc rc a.< Licensa�C Lic. I,--
a.
1°f ef w U a¢ Comma
W 3 ou n I-n ARCHITECT'S DEC RATIONTin
C=a 0 g 1 undentanJ my Alam shall be used as public mcoMs
25 p O Licensed Professional
a. OWNER-BUILDER DECLARATION
us
y I hereby affirm mm 1 am exempt from the Contractor s License Law for me Z� 1700
5 i 0 following maws(Section 7031.5.Business and Pmfeasions Cadc:Any city w caunry
which requires a perosis to construct,alter,improve,demolish,or repair any stmewm
dualhe
is
issuance.also requites theapttesoffor suchpermiuoicense aw(stammer. - - -
wit
licensedPursuantwtheprovisionsoftheContrador'sLittnaLaw(Chap¢r9 r, ,,. t. r a„ ( ,ry Valuation
(commencingwithSection 7000)of Division 3ofNcHuffinevitudirPlecomin.Cods) (�,, ,; 13613,ht �elrfQ, (;•x,� ' �
or thai he N camps thekftlsm and me basis for the alleged exemirdmi.Any violation '
-of Section 7031.5 by any applicant for a permit subjects the applicannm a civil penalty
of not room than rive handfed amara nu.). 101p`P-N Ye'BtMAT ION . • ) Occupancy Type
01,as ownenof the pmarar,Lir my employees with wages ns their sole compensation,
will'do'the work,and the structure is not intended or offered for sale(Sec:']6U-
'Business and Profession;Code:The Contractor's License Law does not apply to an 514 - FINAL PUa4iEf2d Wfs RKBns' •�•- " -
owner of property who builds or improves dr mon,and who does such work himself
"- mhis own employees.provided that such improvements art not intended _._ ._,._______
or
.offciid cd'fofor fila.If;however;tM1e holding or improvement is sold within one Ycu b( '—"""----__.._._... ._.._._. .__._ .._ .... . 1 .
...
ci
completion,the owner-builder will have the burden of proving that he did not build or
improve for puroox opiate.).
__-._,.,_._.. ----------- ----._ ..___. ._._.__-_ ...._____..__.___..._....__._.._____ ......__.
01,as owner of the property,am exclusively contracting with licensed contractors to s' I'.9\s'✓t:••.t,T
_ construct the prnhect(Sec.]BJJ.Business and Professions Code:I The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
: and who comsa m.for.such projecu with a command,)licensed pursuant to the
Contractor's License Law. .
01 am exempt under Sec: B&P C for this reason
Owner r,�:..., Date' .0 ,
- WORKER'S COMPENSATION DECLARATION
I hereby off sunder peoltgofpcjury one of the following declarations:
0 1 hive and will'msinmia a Certificam'uf Consent to self-insure for Worker's
Compensation:us,provided for by Section 3)W-of the Labor Coda for the
performance optic work for which this,permit is issued.,,,,,
_ ❑1 have and will•mamb in Norker's Compensation Insumnce,as required by Section
3700 of the Tabor Cade,for the performance of the work for which his permif is
is'sued.My Workers Compeniaisin lnsuiance carrier and Pulicy,number ore:," " _ _
Ger ,m 'CERTIFICATIONOFEXEMPTIONFROMWORKLR51 - t t�nt� ' '..�.P�FFiDl'S. S'.'t i''mt,:P� szmp �k�t ;
COMPENSATION INSURANCE s ........
1 plms scams need not be cmnPlemd if the permit is for one hundred dollars - - tl)"
151 W)nr less.),„
t..
...c ::_ .. .._... _ -
`oI eco
if;that 'er performance iv me work for whin h this permit rs thawed;1 „. -,1 }I r-:.
xComp tet PI Y any pe Y man - t become,s b)ca m tM1'W'k '
01 C l Data
Pp .. _. ._.. _._ . . . .. ..._.._._ _.. . __,_. ..... . ... _.
NOTICESTOA�lf ager mek8tg n prosnfcomme Pt Y
n, ou ho Id
Z become em-n m the 14o k r' Can pen p . nslI she Labra Cole,you Liss
st
Q 0 fonhw the plywth -- so the pe -h. - demJ okeJ
i m CONSTRUCTION LENDING AGENCY `.
a ' I herabytiffirm that them is a constct on rulending agency for the perfumi ace : m
:r of lh work for which this print :issued(Se 3097 CivC I
SLender's Name..._. . _ ,. .. .._.', s:.. . ...._.. _..._._.__.. . . ._. _..._. . _._ . .
Lender's Address'.
V 0ya :'1 ccnify mat 1 have mud cols upRli<aiun and scare mat the ahovc infurmotion is
fir Fa mrreut,9 agree to comply with all city and county ordinances and state laws rclming
tobuilding construction.nail hereby immunize representatives of thil city to enter upon
y.W the advisementioned Property for ispeer purposes.
.
yt (we) ince tot a indemnify and keep hmml sda,Cy of Cupertino mg.nit
y liabilities.judgments.Cost J expenses aluch may inany way cLmC allian't said qq
ZCity in consequence of the B ant ng of this permit
APPLICANTUNDERST/�tfDSANDWILLCOMPLY WITH ACL
I\10,N-Py�INT's Issued b Date v
SOURCZ',WULL.AA1T1 y
sur (fA / , rte. Re-roofs
Signature of Appl ca AZ t t - _
.HAZARDOUS MATERIALS DISCLOSURE
- 6aW lO , t future b.ding t core h dl h idols sl Typsof Rko.o.f 1 ` :i mJ
-.
df dby.th CecrM: cpalCode.Cl p 912. ad the Health ad Safety
CMe Seicn 255) 1a1
!
: ❑r. '` °: t All roofs shall be Inspected prior to any roofing-material being installed.-__._
•• __ -
Will the applicant more b Id g occupant equipment devices which If a roof Is InstalledtWithou[firs[obtaining an inspection, I agree to remove
em s F and s contain as deEn d by he B y A A Q ed ty Management
District? all new materials for inspection. Applicant understands and will comply with
Dy N r all non-point source regulations.
.. I have read.me learn does materi Ix requirements under Chapter`695 of the
California Health&Safety Qiatia.Se2siom 25303:25533 and 25534 1 understand had
if the building does not Opiianfyhave a¢nam.that it I,ar, ci,mbhilirytg,.ify the
'dcc p t'f the -q t hich nsu t bei t p lir to issuance' f a Cmirecur of
Q upancy
GZ Signature of A_pplicant _ Date
ow"�" that, igen,
Dim All roof coverings to be Class'Bra' or better
-. ,.. ...,.,�.:....... .... . ..:__ ( "OFFICE.