02070140 (2) cI emt,°NG DIVIISSIIONNO CONTRACTOR INFORMATION:
Y']ERMYT '
BUILDNG ADDRESS: PERMIT N
10300 STOKES AV CUPERTINO PLUMBING 82070140
AIMoIE:MICHAEL L AND JILL 10297 S DE ANZA BLV APPLCATIOPI`/"T$2002
PHONE
(408) 253-0618
: SANITARY NO. .S/ CONTROL NO.
WO w0 ZO ARCHITECT/ENGINEER: BUILDING PERh11T NFO
& _ BLDG ELECT PLUMB MECH
-1 C7 u
LICENSED CONTRACTOR'S DECLARATION
la v- 1 hcran affirm tot I..licensed under Job Description
In Lam, ) sl pruwisionsof Chapter 9laommencing WATER SERVICE
Ins- withSmionn )of Divi onJof the Business and�r°fessions Cale.and my license
-Z in full fo c and ellen. �j S
z=< License Cla G• LIC.c
O c U Dae Contra
i LL Q� -��/ A C TECT'S DEC 10
t ,a ✓rundcrrnnd my plans shall be used as public acoNs
T
OLicensed Pmfcssianal
as OWNER-BUILDER DECLARATION
t�+ _o. I hereby aRmn that 1 am exempt from the Contractor's License law for the
C? following..on.(Section 7031.5.Bminess and Professions Cede:Any city or counry $5000
E O whieh requiresnoir to constrvct alter int
a pc prove.demolish.or repair any structure - -- -- _ -_ —
3 m .pow to is _ ee,also r 9 _ the pplieam fw such pemuuo file°signed smtement � ,5a�n� n�[� ....-.. . ...
that he is lim6I pursuant to the provisions of the Contactors License Law(Chapter 9 ,� 38Cp+ s`PHOir-.*.ary r• . '� Valuation
(commencing with Section 71)(D)of Division Sof the Business and Professional Cale) t j;. ( (p, S _• k s e. - ti !T1 1 )
or that he If esenipt therefrom and the bast'for the alleged exeinptian.Any violation
of Section M31 by any applicant for a permit mbjens the applicant to a civil pmalry
:of not more than five hundred dollars(ISM) PN RORN7 & WATZricy Type
❑Lasownerofthepopery,ormyemployeeswithwagesastheirsolecompensation, 202 - UNDERFLOOR PL MBINGi
will'do-thdwork,-and the.structure is not intended of offered for sale (Sec.70sl
Business andProfes,ions Code:The Contractor's License Law docs not apply to anectiOns
0302
caner of property Who builds or improves thereon,and who does such work himself 3 0 2 — TUB fit 0
of throw r his own employees.provided that such improvements an not intended or —,___ _ .,
r oak. w hawevn,the wilding or int en of
n sold tha he min one year or 502 — FINAL PLUMBING ENERGY ---
completion.
pryfme owner-Balmer wiu have the burden ter prowmg that he old not build or 506 - GAS TEST )
improve for puryose of sole.).
_.._.--- _ .507.. __F-INAL- PLUMBING
ElI,as owner of the propcnY,am cxelusivelY contracting with licensed contractors to ------- -6EE,Li 1'_ ..__l --- -
_ construct the project(Sec.7040.Business and Professions Code:)The Contnaor's •',] i rtr;l
License raw does not apply to an owner of property who builds or improvice thereon.
G
i .and.who pontnna.fw..zuch.projects with a contnnw(s).licenced purbart.m.the .._ _._ ...__. __... .. _ _.-._..._
Comnaolz License Law. ---'-01 mc ,B A P C for this reason
Ownerrisse
WORKER'S COMPENSATION DECLARATION A
1 hereby affirm under penalty of perjuryone of the following declarations:
0 I have Lot] will maintain'a Ccnrficaie of Consent to self-inmre for Worker', AUG 2 0 2002
Compensation,-u provided for by Section 3700 of the labor Code, for the
performance of the work for which this permit is issued. .
C l haveand will maintain Worker's Comtensainr Imamoce,as required by Section
3]00 of the
BUILDING
lobr o Calk for the pert rmu c f the work for which this permit a
k/ Compc ton 1 nw d Policy number ere: _
cd My
r,,icr
CERTEFECA ION OF EXE" ION FROM.WORKERS - -
N INSURANCE'_,
1
COMPENSA
Is section need not be completed if the permit is for one hundred dollars - _ ' ('i '
IS I Wit or busy
ComW cenJY th t n er parr raawa In the work fortorme u pens t s'orke,l
pent employ any fermi m any manner so as m become vub)ew to the Workers
Comicarm ion Gwx of California.Data'
.Applicant _ LI •: .. .. - ._ - _____. .. ..
If.
i Ncome subject
the Worker's
is Co making thisCminso or Labor Con.de,you must
Q z forthavidi comply wild such pr Compcnmt is provision'of the Labor Cade,you must
become subject m the Work
z O -- Y wi provisions or this permit shell w deemed revoked. - ._ . - ., __ - -
.E4 1 `( t"'CONSTRUCTION LENDING AGENCY " " t
�i ? dre wo
1 he by Rrm th t di Is a conswct o IerA',g agency! thgperf once' .. '
tan lirt fa(wh¢h this permrLs mucd(Sec.J09].C v.CJ "'
"IrI Name....:. ..v_i_i..._:_.. .:... . :... a r... e., .. ._ ._...._..... . .... . . ... ..... . _ .. _. _ __.. _ _-_ __. ___. - _
5:.z I<ndch Address' -, .
1 certify that 1 have read this application and orate that d stat information is
0 Ea cBrrva:!egret to comply with all city and county ordinances and stag laws relating
O U to building commotion.and hereby onhandee represenmtives'of this city to enter upon
(y the abo -m mioaedyrop oy for inspection puryo s.-_
. 6e (We) gra I.. ode ry d keep harN s the City of C into o against
m livbil r a j 8 is bsu d yW s winch y n any way c If ns said
V z City in in 91 'ce she gi tong this pe t '� >
I soft UNo RSTS sA�ll.l,C �YWTI'HALLNONPON'fZ Issued by: Date J l
A
Si a o,APp1r a apt' to^..,' Re-roofs
'.HAZA MATERIALS DISCLOSURE
01 the applicant or finite w Id ng o cupmt stare or handle h a macrid :. _Type of ROOF - - --
}s Leaned by the Cupenlno Municipal Code Chapter 9.12.and the Health and Safety
Cade Oyes 255J2Or) 111+N7 z r r. I a i
>t All,roofs shall.be inspectedprior.to.any,roofing.material being installed.__-__ _. .
1'Will the applicant o mlu i Id ng w p t qu pment or de ices wh ch If a roof is installed-without first obtaining an inspection,d agree toiremove
ri,voiddousu tammmits as defi'd byth Bay Are.Air Quality Management
Dstr t all new materials for inspection. Applicant understands and will comply,with
°YeB r ° , all non-point source regulations.ri
d I have and the hazardws materials re inti emenu under Chapter 6.95 of the
Calitomia Heald & cry C c tions 2 5.25533 and 25574:I understand that
ifthc buildin 9t
cuff,
u 'a ten I.that it is my respo sibiit to naify the - -- - --
aie'vpent of e r s!wttiev'us, ei prior.to Issuanc of a Connate of
•:�"p!ppy '' ' '" Si nature of Applicant .. Date
Da,a: All roof coverings to be Class "B"or better
-.':
- OFFICE._ -. ..