02120078 (2) CITY OF CUPERTINo � I - I
BUILDING DIVISION PERMIT „CQNTRACTOR INFORMATION
BUILDING ADDRESS: AAAA-DRAIN PATROL PERMITNO.
7308 RAINBOW DR 02120078
OWNER'S NAME: 1701 S 7TH ST #1 APPLICATION SUB DATE
GLORIA/DIAMOND PROPERTY 12/18/2002
DONE: (408) 989-6005 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: _ BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
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WOLICENSED CONTRACTOR'S DECLARATION
. ° Job Description
'iC 1 hereby alfrm that 1 am licensed under provisions of Chapter v(commencing p
iii with Sta.70(o)nl D visin Ith neem anri Prnfes sC Ylimense is
mfml to a erred Z ___ SEWER REPAIR
=o== Licer C a 1IVgLE®
?y— Cn
—� ARCIIITI:CPS
� a< 1 understand my plans shall be u J as PUM1Iic records
X- a. DEC 1 9 2002
HLLO� Licensed Professional
OWNER-BUILDER DECLARATION
uui a I I hereby affirm that 1 am exempt from[be Contractor's License Law fnr the ��'
°° fnllwing mail n.(section 711,1.5.Business and Profeaxions Code:Any city rat county BUILDING
LL�� which requires.permit ,,construct.alar.improve.demolish.or.pair any stmcm.
'=7< prior In its issuance,also require.the applicant for such permit m me a signed statement
that he isueemedpursuant tnmeprovisions oftheContractors Lice use Law(Chapter 9 Sy. Ft. Floor Area $4987pdtion
y'a (commencing with Section]IXp)ofDivision A of the Business and Professions Coda)(it
y — Nal he is exempt themBom and the basis for the alleged exemption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicant It)acivil penalty of Occupancy Type
not more Nan five hundred dollars($501), t
❑ I.as owner of the prohnny,or my employees with wages as their mile compensation,
will do Ne work.and the anemone (S
is not intended or offered for saleec.7044.Business Wp7yyk�(('' ppkpyD�,C��[[ppp��f.y.��
and Professions Codc:no Contractors License Law arcs not apply to an Owner of 2 02 - UNDERF &C tff19'YffG
porosity who builds or improves Briancon.and who does.soch work himself or through his
n employees.presided that such improsemenls am not intended or offered for sale.If, 301 — ROUGH PLUMBING
however.the building or improvement is sold within one year of completion,One owner- 3O2 — TUB & OR SHOWER
builder will have the burden of proving that he did hot build or improve for purpose or
sa1c.). 502 — FINAL PLUMBING ENERGY
❑I.as Owner of the pmpcny.am exclusively contracting with Bcenma contractors to 5 06 — GAS TEST
ecusur a the project(Sec.7044.Bazineas and Professions Code)The Cmarmi mrs Li.
cense law does not apply to an owner of property who builds or improves Ihemon,and 5 07 — FINAL PLUMBING
who comem for such projects with a conuacmr(s)licensed pursuant to the Contractor s
License Law.
I am exempt under See. .B A,P C for this moon
Owner Dae
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have aro will for by Section 3cnc of the Limit,
ode.for rnr Wnrkcria Compcm
wkf az provided for na Ss isms 3]IXI of the labor COM,for me pcRormanm of the
work fnr which this ocrmit is iaucJ.
❑ 1 have and will maintain Worker's Compensation Insurance,as requimd by Section
37X0 of me Labor Code,for the performance of the work for which this permit Is Issued.
My Wnrkcr's Compcnsmion nsumnc nicT and Poli numbs a.:
! .�
"hey
/ a(o 7SS
CERTIFICATE OF EXHMPfION OMWORKERS'
COMPENSATION In URANCF.
(This section need not be Completed If the permit is li rone hundred dollars($lot))
Or less.)
I cenify that in the performance it the work for which this Permit is issued,l shall not
employ any peruse in any manner as m to become subject to the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject In the Worker's Compensation provisions of the Labor Curie,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
F^ .n I hereby affirm that there is a construction lending agency fnr the performance of
C4 7 the work for which his permit is issued(Sec.3097.Civ.C.)
[e.7 Q Under',Name
0. I<nder's Address
U C I sertiry mm I have read this upplicatinn and shim that the above inlmmatien is
Iy F correct.I agree to comply with all city and county ordinances and mute laws relating m
Q U building construction,and hc.by authorix representatives of this city to enter upon the
above mentioned porPcrly for inspection purposes.
F 1
Way agree to save,indemnify and keep harmlems the City of CuNt irm against OT liabilities,judgments.costs and expenses which may in any way averuc against.mid City
in consegnencc of theranting of hpeis rmit.
U zAPPLICANT UNDERSTANDS ANU ITH Y WO POI Issued by: Date
SOUE RF.GUhATRC
Re-roofs
ie o pli
gn A ...0 — -,,vote
H LARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Same or handle ha mous matenal
as defined by the Cupeninn Municipal Code,Chapter 4.12,and the IIcahn and Sa1my
code.Section 2553.1.)] All roofs shall be inspected prior to any roofing material being installed.
❑res SrNu
Will the applicant orfuturebuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
coil hw.urdous air arutaminanu as delined by the Bay Arca Air Quality Management all new materials for inspection.
District?
ors /�}k
1 have mad me luiard(ius materials requimmenla under Chapterfi.95of me Calift)r-
maHealthekSolelyGide.S -Oonx25505,25533and2551.1 understand mmifthe Wilding
secs not currently have tenant,mat it is my resrymsibility m notify the ueeupanl of the
requirements wK st reoa ir.te
aof eupamy. Signature of Applicant Dale
isthmi - Dam All roof coverings to be Class "B" or better