03030121 (2) CITY OF CUPERTINO
BUILDING Division PERMIT CONTRACTOR I�7kORMATJON_�
OUILDING ADDRESS: PERMIT NO,
WILLIAM JANZ ,
OWNE0.' A E: TERMITES
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12
12
NE: I - SANITARY OL NO.
ARCHrMCTXNGINEER: BUILDING PERMIT INFO
BLDOELER. PLUMB MECH
t� t o t�
M0'z LICENSED CONTRACTOR'S DECLARATION -
I hereby storm that I am licensed under provisions of Chapter 9(commencthg Job Description
with Section 7")of Division 3 of the Business and Professions Code.and my license is ,
I.full fume and effect.
Lt.,.clan Lic.0 REPIPE �'INALED
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Do —¢ - Contractor
9W ARCHITECTS DECLARATION
1 understand my plans shall be used u public records 5A ry R 1 8 2003 0 Licensed Pm(easinnal r
OW NER-BUILDER DECLARATION
f 1 hereby affirm mat I am exempt from the Commune,License Law for the BUILDING
gO o following reason.(Section 703 1.5,Business and Pndessinns Code:Any city or county
a$ which requires a Permit to consumer.alter,Improve,demolish,or repair any structure
�Sn prior in it,issuance.also require;tbe applicant for such permit in file a signed smemnt
< that he is licensed pursuant to the provisions of the Cminctors License U.(Chapter 9 Sq. Ft.Floor Area V ion
(commencing with Section 7")of Division S of the Business and Professions Code)or $2 v
that W is exempt therefrom and the bum for the alleged exemption,Any violadon of
Sectlon 7031.5 by any applicant for a permit ubjeem the applicant to a civil penalty of ,A ypy ryYe...k.
p
not more than Ran hundred dollars($500). 3-yp l VOer O O. QCCllpanCy Tyo
❑1,uownerofthepmpwy,mmyemploycowlthwaguulhoirwleeomMnutlnn,
will do the work and the structures Is not(nmnded mattered forule(See.7011,Business
and Profeuimu Code:The Contnclot's Llamas Law dors not apply in an owner of 202 - UNDERFRQQRd R4&kIUBJG
Progeny who bulldsorimprow:s thermn,andwho does uchwmk hlmselfor through his 301 — ROUGH PLUMBING
own employees,provided that such lmprovemema are not Intended m offered for We.If. SO2 — FINAL PLUMBING ENERGY
hm,w,,me Wilding m ImmnB the
provst Sold within one year of completion, owner•
builder will have the WNn of proving that he did not Wild or improve for purpose of 507 FINAL PLUMBING '
sale.). _
;11
.as owner of sire property am exclusively contracting with licensed contretms to
Sumer project(Sec.7044,Bushom and Profession Code:)The Conuacwr's LI- -
e Law docs not apply to an owner of property who Wilda or improves Merton.and. -
contract,for such prejeetswith aeuntraetor(s)licensed pursuant m the Coronaries '
nse Law. ..
unesempiunders � .B A P C fm this reason
ner Dam-?? �
WOR R' 4PE t ON DECLARATION
1 hereby of ono un r Ily of perjury one of the following declarations:
Wveand will maintain nifinteofCometh to self-(mum AnWmkcr'aCompereon,as provided for by Section 3700 of the Labor Code.for the performance of due _
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as requited by Section
370D of the[.be,Code,for the performance of the work for which this pemm is issued. -
MyWorkersCompensationlnsenncecarrierandPolicynumberam:
Cartier, - Policy No.:
CERTIFICATE OF MEM MON FROM WORKERS' -COMPENSATION INSURANCE
(ITIS section need not W completed if the permit is fmone hundred dollars($100)
or has)
1 comfy that in me performance of the work for which this permit is Issued.I shall not
employ any person In ray manner an u In become subject to the Workers'Comnenmlon
Laws of California.Date -
Applicant
NOTICE TO APPLICANT:IL after making this Cenificale of Exemption,you should
become object to the Worko's Compensation provisions or me Labor Code,you most ,
.JO forthwith comply with such provisions or this Permit hall W doomed rewind. -
Zy CONSTRUCTION LENDING AGENCY
[r (hereby affirm that there Is construction lending agency for performance of -
�i> its,work for which this permit is issued(Sec.3097.Civ,C.) '
W Q Lenders Name '
z Lender's Address
U O 1 ceNry mu I have read this application and state that the move information is
W F corm.I agree0to comply with all city and county ordinances and cum laws rtbOng to .
U building construction,and hereby wthorin«prment,tives of this city to enter upon the
W above-mcnoonnlioned progeny for inspection purposes.
Ov (We)agree m save.indemnify and keep hatmlea the City of Cupertino against
y Iiabllidos.judgmonu,costs and exMmes which may In ray way acorea against SaidCity
U"z Incnmecsensco(thegra Ingafthispermil. '
APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3 �. ..
SOURCE REGULAT NS, — /
Re-roofs
Signature of ppanUCon or Dam "
HAZA US MATERIALS DISCLOSURE Type of Roof
Wil applicamurfumre building onuparismrem handle haurdousmaterial
as defined by the Cupertino Municipal Code,Chapter 9.13.and sire Health and Safety
coda,oYG 35533(01 All roofs shall be inspected prior to any roofing material being installed. '
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haumous air conuminanm u defined by the Bay Area Air Quality Management all new materials for inspection,
ntrict7 '�a!
❑Yes l]lt4u -
Ihe. ad the hmsmouuss mAAaterials requiremmis under Chapter 6.95 of the Califor. '
nia Health d:Safely Codc,Senium 35305 5533 arm 75534.1 undersuM thin if the Wilding
does not currently hoc a Sense,that s my msponsibllity m notify the occupant d the
requirements which mus me In issuance or Cemnnte of Occupwey. Signature of Applicant ' - - Date
Owner orstrourilad age Ads, Dam All roof coverings to be Class "B"or better'