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01070047 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 22641 SAN JUAN RD CUPERTINO PLUMBING 01070047 OWNER'S NAME APPLIC TION SUB DATE WADE JOHN L TRUSTEE 10297 S DE ANZA BLV 07,12/2001 PHONE: (408) 283-0618 SANITARY NO. CONTROL NO. � s z ARCHITEC(ENGINEER: BUILDIN PERMIT IN 00 tq BLDG ELECT Ub MECH ¢O LI LJ _ 1 LJ Asa z H_ LICENSED CONTRACTOR'S DECLARATION Job Description ell I o� o, hcrebyaffmthalamlicenscdunderprovisionsofChapmr9(commencing COPPER REPIPE. w,m Sedan 7" 'Divumn 3 al the Business nnd.Professions Code,and my license 6 $ is m Poll fovea pO leo Li ensu Class _ Lic. _I FINALE® O a.U Dam SDECLAr 3 w 11 w1 ARCH ll be. DECLARATI N h"LLvQ�to O Q 1 unslersmnd Iny pLms shall be useJ as public records AUG 2 8 2001 �yT H S p Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 lin exempt from the Contractors License sew for He I BUILDING$fj Q Q 0 1-z a' following rcasna.(Section 7031.5,Business and Professions Cade:Any city or county 4 C which q permit o construct.alter. p demolish. p tu y strucre w .pdo tow I req the ppl ra t f xh pemuu fI gned va¢rrcm _ _-.. _-__. e3 (hat he I,licensedpr_ar .total posi,ion, the Contractors L' to (Chapter9 Valuation formporicing-w ithe i-.7000)of Division l ofdrB mep end Prof< ns Cale) ice,�i "•y'�!3 8'1'7,( �{"®n4a� S1 `a i il.J:k: t or that be is exempt thcmfrom and the basis for the alleged eaemptloiiAny violation of Section 9031.5 by any applicant for a Permit subjects the applicant m a civil penalty of not more than five hundred dollars(S5oo1. 2024PNbffl!�BRFLOOR PL BING'" Occupancy Type 111,as owner of the propcny.o my employee with wages as their sole compensation, — I -wilt do the work,and the structure is my,intended or offered for sale(See.rose, 502 — FINAL P]litJ41 '1KGs�NBRGY ' Rusincss and Professions Coda.The Convaaor's License Law does not apply m an owns,of pmpeny Who builds or improves Ihcreon,and who does such work himself 507 - FINAL PLUMBING m through his own employees.provided that such improvements am not intended or offered far sdlf If,hostwer,the Wildin - improvement Is sold within ane ear of garurden of pas y completion.Me owner-builder will have the burden of proving that he did not buil)or Improve for puryose of salc.l. t con asowner ofthe pvpeny,ame usinessacantmmingwithlicensed CQmemnao I . ... -o . _ awd the project(Sec.)to a owner o and Polsny w ions Cod,:)The Co then'. License law dors not apply m an owner of progeny who build.uor eLpanvea Hereon, f and.who contracts.for such_Prnlens.wiM a.conmxm,ls)IicensW.pursuant.to.tbe Contractor License Law 01.. . sm czemptuMer Ste. '� � t' s �B&PCfm this rennin Owner Dam WORKER'S COMPENSATION DECLARATION 1 hemby affirm undo penalty of perjury One of the following declarations: ❑ 1 have'and will maintain a Certificate of Consent m self insure for Worker's _ Compensation,to provided for by Section 37W of the "We Code. for the performance of the work for which this permit is issued . a and will commum Worker's Compemmion hicumnss,as required by Section 01e,7110 o"the Labor Code,for the performance of the work for which this permit is issue 4 Y IVorkee,Comps satmn ln:umnce ca ' dPol y number are .. .. - /rya{I.�1^ ft Puh YN VS/�J�Il •.s.' 1 t t .,a fl y I .. `_ _- __._... .. RTIFICATION OF EXEMPTION MOM WORKS '�� COMPENSATION INSURANCE ung(` od not be,completed Iran permit is for ane hundred dollars ISI WIs.I •I certify that in the performance of the work for which this permit is issued l t. _ "t^: P' - xti511 not employ xny person in any manner ad aa,u,bemnm subjett m the WorkerC Compcnsation Lawa o alifornia.Dam ' . Applicant. _t K NOTICETOAPPLICANI':1L alcor making this" his Cerlilir m off Encmptiun.you should Q Obecome subject to the W'orke/s Cnmpedsbtiari provisions of the Labor Code,you must forthwith comply with such provisions or this pcnnit shall he doomed revoked Z ':CONSTRUCTIONLFNDINGAGENCY a:> Ihsreby afloo,h,them Nacaotow,un lading,va,lbr Heperformmnce of the work for which His permit is issued(Sce.3097,Ci¢C:I Q Lender's Name. •- .•. _ 4' Lender's Address ' ' U I certify that I have read this application and sonic that the above information is Lr. f, emiect.I agree to comply with all city and county ordinances and state laws relating'. 0:E) to building construction,and hereby authorize representatives of His city to enter upon ;s, W the above-mentioned property for inspection purposes. -, E„ p, (Visitagree to sa indemnify ndk ph 1 ache city fC pen'nail VI lialadilies,judgments,c t loparses a hich may in;nY way seems against laid UZ Cn fohe Join,'o1M p 't SI LICA NSTSAND WILL COMPLY N'ITH ALLr�NON POLYP [SSUed by: Date 4 (J 2 Q Signature at Applic. UContractr t '., pate Re-roofs k AZARDO S MATERIALS DISCLOSURE Wtn Me ppbra r Pom wnatn,x cupant t dt na or wn :,nmaa mat I' ..Type of Roof .asd fn JbY @eC petno anteral Code Chapter 912.and the Health and Safetyi1 .,,1.j Cad S❑t 2553'_ (al �N ., i f. . s. t. _ _ .All roofs.shall be inspected prior to.any roofing material.being installed. _ . Will the applicant orfuture building occupntuse equipment ordevices which If a roof is insmlfed without first obtaining an inspectioli'"I agred.to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management Diamer all new materials for inspection.-Applicant understands and.wlll comply with J °Yea ONO - - - all non-point source regulations,,, _ 1 have read the hamNnus materials requirementsunder Chapter 695 of the California Health A Safely Cade.Sections 25505.35533 and 25534.1 understand Mat if Me building does nm carnally have a amort.than his my responsibility m ratify ahs. ecu am of a requirci nis whi h must be met prior m ill...ee of a Cenificam of ., 0 .. Signature of Applicant _._ _ D'ate . ownm ar aama tea agega, Dam All roof coverings to be Class "B" or better :. OFFICE .