02010036 (2) CI BUILDINGUPERONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10183 PARISH PL 02010036
OWNER'S NAME: APPLICATION SUB DATE
TEFF MILLER 01/09/2002
�- i'HONE: SANITARY NO. CONTROL NO.
WOO ARCHITEC/ENGINEER; BUILDING PIMSB r INFO
BLDG ELECT PLUMH MECH
LICENSED CONTRACT'OR'S DECLARATION
o S b ..mr Job Description
o Z— I hereby affirm Thal 1 am licensed under prov sof Chapter Y(commencing
F�h with Scction7")ofDivision 3 of the Business and Professions Crl and my license REPAIR DRY ROT WALL OUTSIDE OF KITCHEN.
m full force and effect.
S
is in o S Coowc0736oS 6 J b—
O n Date
uc ti ASCII,.....DECLARATION
0 g T anderw od my plan..nall nr used as panne reeom.
p O Llttnxd Professional
OWNER-BUILDER DECLARATION
,.+ 1 hcrehy alfinn In,,,I am exempl from the Contractor's License Law for IM1e
C < following masa.(Section 7031.5.Business and I'mfcasimre Code:Any city or county
' S D which requires a permit to consumer,ultor,improve,demolish,or repmr any structure $600
aprior to is issuance.also requires the applicam for such pennit to rile a signed statement
n,nt pgishangd pnrsn.nlmmi posersIto).,,one c++nmcts+tis License L+w(chaptm9 S Ft. Floor Area Valuation
(anmmgifice'npurrual to1lmDlvisino3ofCo BusinessicJs B.wionscwej :_ �'}jYj'! ( k e �,'7 '7f;"+ `
onnaf rte,.exempt mekrroin'.+nu me oasis ran me.ueg=d=��n6rn�'.nor�ialatien .316-4°4 Or141.ti0 0,tZ ,'i 1
of Section 7031.5 by any applicant for a permit subject.me a,.,s., m n d.E penalty -
ofnmmnml,am ri�enandred d:rllms lssan. 516APN FINAL BUI LDIN �" Occupancy Type
°1.as owner or the property.or my employees with wages as their sole compensation,
will do the work and the.structure is ton intended or olrered for sale(Sec.vasa, - -
'Busincas and Professions Code:The Connectors License Law does not apply to an Required Inspections
orr mf pmpeuy Who buiMs or impel thereon.and who does such work himself
Through his own employees.provided that.such improvements are not intended or . . _.
`oTrged for sloe:1f,however.the building or in+p,ose+++ent is sold within one yearor .- . . . ._ ._ .. . . . . I i,s 6t -
completion,the owner Wilder will have the Nolen of proving that he did not build or
improve 6rpurpose or ole.).. pp� //�� y CC
°I:as owneior ins property.mu exclusively cunnaating with licensed eonuucusnm 'FI��q/rq LIG ID
consul the_rairl(Seen]Oa4 Business and Profcssinns Cede:j The Communal
License Law does not apply,o an owner of property who milds or improves thereon, ,
and vvW,emrnu,,, for.aum projects with a co+tmdar(a,lire...it mrs.mnUn he FEB 12 2002
C mnaaors Licca.xe low.
t,' ❑I am exempt on der See. . s , .B'&P C Trains rcnson u'll l� .:III)I:. ❑
Owa .,,. ..;,:.
WORKER'S COMPENBUILDING
" SATION DECLARATION
1 hereby affirtn undo,penalty,of wjcry,;rr of the following drelmni inn,:
F
01 have and will"maintain a Crnificmc bf'Cansem,Li self-insure for worker's
Compensation, as provided for by Section 37(MI of the Labor Code, for the
performance of the work for which Ihia lMnm!t is ie,tuod.,
have'and will maintaln Worker's Com`pcmwtiim Insurance,as required by Section
37M of the Labor Gid=,foil the performance of IM1e work'for'which this permit is
ixe J My Wy,,kdr'zC {�+�e� `)I sect, in Pal y 1
Co r SIKT2 {-W YY'tPoICyN01
- ,,. .•i- r-.: %+}.,;,}..!�•tly{PP[[lA'� ..'.. t. s t t,l. .
CERTIFICATION OF EXEMPTION FROM;WORKERS'y:
coon need nnihrnm Incl alms t for one rut ndrtd doll
COMPENSATION INSURANCE9 s t _
` rlhs p peon s an ' '
s=
(EI(X)l
"II n fr m t in the perfofmaoee of to k f h h th a t siuW l
';Hallnot employ any'person in any man a as to become subject to the Workers
Compensation lawx of Cali l'nrl+in;'Date
Appiciat
NOTICE TO APPLICANT:'IC after making this Certificate of ponn,yonshould
hecomc cns;mion subject to the Workers Clouppdo m .v of IM1e'Labor Curt.you'most
z0 0 forthwith con+ply wilt such provisions or this Penoit.hall rte de=ro=d revoked.
' ""•'CONSTRUCTION'LENDING AGENCY "
,Ti hdrehy off roe lhnt bible 1,a'ouuntctimn lending ngcncyfnr Ibe rperformonce "
of the work for,which this Permit is issued(Sec.3n)71 Civ.C)'
Led Name
r � z Le do Address
� 1 .t _
I til fy.that 1 have rend this ilyapplicationa and state That the eMrve laws re on it'
W 7t.: coned.Ingrtc to comply with all city and county ordinances and state laws relating
'C'V in LuilJing cm.amdion.an<I herchy authorize repecnmtivice of this city to enter upon
(t] he above p,,„Iy for inspcdion purposes. ..
rFi-p„' (We) S.to uce indemnify mid keep Initis ss the City'of Cupertino against
Vj liabilities,judgments, t I Pentt h ch y no way accrue aga nst said
V City t c '1nrf fl L 1 g 1 I .
p1111G Ul:a\TANy ILL COMII\'N'I'T II ALL Nuri PO NT ' Issued by: Date
soups cu ” \ -�Ylo/ y
Signaurof hcnu,Cbrrtcror; ., '., ^ , - , .,,Di,,c"...I Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the pphs-+m mfintuo'butildin,casurearm stemen,handle bacandem,r , 'l _Type of Roof.. . . . . _
1 as illied by tl (' p I M ;plOxl CMI 9.12, dth II Ito dSurely I I
IIA Code Sit z55J_i l
❑Peal k s ° ` All roofs shall be inspected prior-io,any rroo5ng material being installed.
Will !Ilsln, f t bar'ii' g l' tuseeq it t I _e,.rh'sn' If a roof is installed without firs[obtaining an inspection; 1 agree to remove
oil Wes dam mir,mandmaillsax defined by the Bay Arca Ai r Quality Management
A t st - all new materials for inspection. Applicant understands and will comply with
°yes 11all non-point source regulations,.
y h t I Mite read,h h 1 . melon 1 react 25533.J 255 4,I t r ers'a d the
California , I,&Snfny Lode.Se&iotn 25505,255JJ nnd2ImmilI clun,andtont
fnpnulr gl +„ eynas I to tt : yr p ,.'n'I tyt runny me .
re t rime yul cit m st bu met l', m iwar Cetiricmc of
- ' Signature of Applicant Date
O e n mhonzuTag rut ole All roof coverings to be Class"B" or better
OFFICE
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