02090084 (2) CITYBUILDING UOPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7496 TIPTOE LA CUPERTINO PLUMBING 02090A07E84
B D
�2��1��Arf2T CHARLES M JR AND MAR 10297 S DE ANZA BLV APPuc09/13 /2002
PHONE: (408) 253-0618 SANITARY NO.. CONTROL NO.
G ZO ARCHITECf/ENGINEER: At BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LL.D TJ L=_I L__l
Z <N= LICENSED CONTRACTOR'S DECLARATION Job Description
OZ-Q Ihercb alyml that l am licensed under visions of Chapter 9(commeming COPPER REPIPE/WATER HEATER
F Ei t with Section )'Of Division 3 of me Buri and Professions Cade,and my license,
Y
is in full f d ff<n'G3�I 6??,?05-
Ow K Data as Lia.a L
K Dale Cnmmnor '6CAVEs A21,1011aO ARCHITECT'SD 1@ �y� //�'7t:-,�g understmtd my plans shall be used as pis is records Lk f z p p Licensed Profasinrul
OWNER-exempt R DECLARATIONI hereby affum ohm 1 1. eBusin from the Csoon C•s License Law county AF
y 3 S, B�b SPP..(fE4 r,,.
C?< following reason.(Section]0715,easiness and Profession Cade:Any city or county
D which requires a permit to commit alter,improve,demolish,or repair any Structure
3$ pdorro isissuance.alsorequires die applicant for such permit to fileasigned
Inez hp it,liansci Wnognf Id O,eprL'vidons o(the Conuocm/r Ucenx law(CTager 9
of r ea,., Valuation
(commentingwiN Sm,ion70gand the bsion3°r N<legede xampinn.An vi Codelotion 5;�S .a:e . v.. a.9e "I'l%}i.:ie.� 10
of Sec he Is exempt,any nppli and the basis for sinal tfic ex cant to Any violation
of Section]036.5 by any hundred
.q fore permit subjects the applicem t°o civil pcnAry-
;of Out maretnanrvnnanarcad°gm<(ssnB). 202APNLX9pLWFLOOR PLB'ING`tOccupancy Type
❑i,amwneroftheproperty.mnsy employees with wages AS their Sale compensmims, 301 ROUGH PWMBIN
'Businel do'th<_work.md theswiroreChotuctor'ded-orse La doe sale(See.7044,- 502 - FINAL PLVKPaa(Ttis�i Y• -
---
`Businai end'Professiom Cade:The Comrecmr's License Law does not apply m m
owner of property Who builds or improves thereon,and who does such work himself 507 - FINAL PLUMBING
o IN gh his own employees.provided th, h p nsm s mended or ...._..._.... ......_._._ _ __._ _ __..,_. _.._;
offered( sale lf'h e e the Wild"g p vemcm -Id th n one year - - "-
completmn,me owner-budder will Mvo the WI of Prov ng thus he did Am Wild or s I'' Pl �.- t
improve for purpose of rale.).
s1 coi,t owner ofthe property,am exclusivelydProfessiwird Iicenudcomrmmtato dCiJ:I`d Pt •.[? c:n
_ - conswn tw does no(Sec.7044,Business nM property
Professions Code:)The Cer ducror's ,,,
License Lew does no,apply to ci owner th property who l Ica sor eimproves Nereoo,
:. S ..andwho e,Licens.forsuch-projects.with.e.caosmcmrtm.luxaN.pursmn,.m.the. .______.... _._......__.-.—___.-.____.ti _____.__—
Conwnols License law.
_ ❑lam exempt tinders&" B'&PCfar Wxrmson
Owner"� ,u' "Dote
WORKER'S COMPENSATION DECLARATION
. • I„':•'Ihemyaffirmunder mit f.. _ .. ._.. -.
by pe y o pe0ury one o(Ne following mfour Wort
❑ I h and-will mo m a'�Cenifc t o('cons37M of
Labor
de Workers
. C pen aeon.-a p d d far by Section 3700 of the WWr Code, for Ne
;,, 'perform ce of me work f h ch thi puma a issued.
v J
111 heti Bndwill maintain Worker's Compar,udan ldsbmnce,u mquir<d by Segtion
3700 of the Labor Code,for the peifortnance of the Work for which this permit is
_- sued My W rkee'Compe' ton Insumme carrier aml 1.Polity umber w
r3' �"/"G �NV4Policy co,/--/�;�0////V�70G �/ ,� f r ra tit.lb srl $Hr''. y 3 a - dt Id,.
fit CERTIFICATION OF EXEMPTION FROM WORKERS _ J;� v .k.rA. lsf,
..._;:. COMPENSATION INSURANCE r ._-
abfi section need not W compleeJ if the permit is for one hundred dollars -
ISI00)orless.), n
�I cm fy that n the Performance of the w rk f ' hich this permit a mued„1 - _- -� i�_,t 1 , -Tw'�i '-
'shall nm employ any person in any trer so as to become subject m the Workers
NSI CTOAPPLICANP IIf.'aherDmkm Nn CioftEeme of Esemtion.you should
-bac
it
AN
A. all Com notion .visions of the lsbor Code . .-
1 pe p y u mull
� Q foMwnh comply wird such provisions or this patron shall be deemed rcvak<J '
a-� --' CONSTRUCTION LENDING AGENCY
1 hereby'-Giro that there is anon buction leading ugen y fur the peifmm nee
Lender's
Ne wb k fm'which Nie perm t ri issued IS- 309].C'v C) _ ____
rti ndeFs AddZL
,al .r �/
V..O I comfy that I have read this Application and st a that the above information is l(///t/J�/`—'
W-"H' correct 1.Agree I comply with all city and county Ordinances and state Iowa relating
to bis ld ngc nswwon ndh by mho see represlmarives nfth'pcitymene�upon
the above-menituneJ n (or' tion u
c`lo sawn 'fy rid keep harmleu the City of Cupenino`egainv
h liebilisies ju rte,a an sec which may in any way amine against said V
V. City in” n
can e gr of this pe L' _'
'APP[ A U\DF TA OV OMPL,Y WI ALL NON�POIYT Issued by' Date
Z.
vc cur r ., Re-roofs
' W 11ih R RIALS DISCLOSURE Oam -- y
pplwan re ung omupun stere cr hmdl harallo a--on' Type Of Roof. �.._....-..
a fnedbyme Cupenrw un, pal Code Chepter9 l] um,b He IN ndS fery'
Code Section 3551643 I I IT ` i u ill- s 1� ,'It ,,,' i ' I ,I1.k.YE. . ..
f QYa No t , r '', _ All roofs.shall be inspected prior+to.any roofing material being installed..... .
District?
ordev¢ev hich If a roof is ihstalled without first obtaining an inspectionk I agree'to remove
r WIIINemrc iam,nfuwrc Wil, mcu amuse m t ityManagement-
q all new materials for inspection Applicant understands and will comply with
r Ihnve,ce/ISh, oxi�' •- . . ,_..
epP c n or
emu hernrdo ons efined by me Bay Arta Air Quality
4. ° all non-point source regulations ,
Nous m len' s rc uiremenss.under Cheper.6.95 of the .�.
rt _
Califn6a HealttyC a no 35505;3553Jad35534.l understand thatIbebuildingdu I a maL,hat it is my responsibility to ramifytheoccupant ofihe 1 s, mei prior ro issuance of..Certificate of
a. neY. 4,1-3,101- Signature of Applicant Date
- -
J
ow All roof coverings to be Class "B” or better
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