02040049 (2) CI Bre EIPERMIT
wc DIVISOF ION 0 CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1052 TUSCANY PL HARRIS ARTHUR S AND ANDREA B 02040049
OWNER'S NAME: APPLICATION SUB DATE
HARRIS ARTHUR S AND ANDREA B 04/11/2002
PHONE: SANITARY NO. CONTROL NO. '
y O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
�'w C BLDG ELECT PLUMB MECH
v i LICENSED CONTRACTOR'S DECLARATION Job Description
i¢_O 1 hereby amen that I am licensed under previsions of Chapter 9(commencing P
u,�J wsth Section 7")of Didslrn3nflhe Baxmess and Pr..I—ian.Cale.and my license OUTLET REPAIR.
is in full force and effect.
i z a License Class Lic.p
O a U Dam Contractor
i a.G ARCHITECTS DECLARATION
O,a_, I understand my plans shall he used as public records
:8
i i cap Licensed Professional
o Onot N
BUILDER DECLARATION'
I hereby,(firm that at 1 am exempt from the Cessions r'n :License Law for the
t?a following exon.(Section 703 1.5.Business and Pmlke io li Cade:Any city or counre $18.7
E F G xmkh requires n protone.a6c,to constrchest a mlac ntfor such
dannrsn.or repair any structurstatement
priortotc ceahoequ the provisions
applicant for Cmin,muuofiensele a Lacdsateue,9 -
(ont '.Icenzdpueiu4nn7")of iunfthftheBunorsandPrfesvonsCoe) r rArea Valuation
(w, a th Sect mn and
he cion 3 of the Business nip imt,Any si l.nam oIs-
or \t ,'j k l P
the he Is 31.5 b Ian,applicant
p li and Ice bass for alleged elcmpu 1.Any mo malty
of ran mo 1031.5 by nny hundred
o ll ror a permit subjects the applicam ro a civil Penalty '
prom more man five nnnaew aomvs(ssllo). 10 j1PN I L•...:•.. Occupancy Type
°1,as owner of the pmpcny,or my employees with wages as their sole compensation.
will Eo the work,and the stmclum is not iarended or offered for sale(Sec:7W4,
Business and Professions Code,The Contractor*s License Law does net apply to an 505 — FINAL EBgV#RtI10ftyRptions' .
ow
mer rf pmpcny Who builds or imp rhes thereon,and who does such work himself
or through his own employees.provided that such improvement
mens arc not intended or _
,o0arcd for sale If. �bow theWilding o reprocream iz&Old within one year of
omplc,ion the owner milder will have the burden of pmv ng that he did not build or
improve for puryose of sale.).
...._ ._ ..p .. __-_ -_--- ------ "...". . ..... . . ..".. ._" ._ .......
as
_ °I, owner d he mleny,. am naively contracting with licensed contractors to
onsuuct the project(Sec.7U44,Business elle Profosinns'Crbe:)The Contractor's o i• I
License Law docs not apply to an owner of property who builds or improves thereon,
> and who connotes for-such.projectswith a corwacmr(x)licensed pursuant In the. . _.__. .__..__. .._ . ._.._.. .._-._. .. .
Contractors License Law.I .
IS&
' Ilam ca pt undr •NC for reason �B pm�.L
tXwncr ,- WORKER'S COMPENSATION DECLARATION FINALE
^®E
I hemby affirm under Penalty of perjury one of he fallowing declanniuns:- ��� l 1 L
200fs
° I have and will maintain a Cenificam'of Consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
_ performance of the work for which this Permit is issued., .
0 1 have and will maintain Worker's Compensation Insurance.rii required by Section BUILDING
3700 of the uthar Cale,for the Performance of the work for which this permit is
issued.M Wadr,aCom tion insurance cani<r poll Policy nbmber are:.
` -- y. .. pence .., ..
Cemer.:r o I,I�ji l_d•.:i...;.Polity Nn.o r t t't
CERTIFICATION OF EXEMPTION FROM WORKERS' .t '') .,1I rcl•)1
'COMPENSATION INSURANCE, '
I"' (Thi;scci'ori rte d nut he u,mplemd if the permit is for one hundred dollars
($1W)or lens.)
"1 Ic nfymlin in,jerfiormarcc oflhe vxork'17orwhiehths permit"issued,l
shall not employany person in any n as to become subject m the Workers
Compensation ncrs
pp e¢
. AoI licwiaticn Laws of CaliforniaCelifnmin D,
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should ,•
become subject 10 the m
Worker s Compensation provisions of the Labor Code,you most
O O forthwith comply with such provisions or this permit shall be,deemed revoked.
".. _ .."" .. ." . _ . . . _
"�" W ' -CONSTRUCTION LENDING AGENCY 1
t ..,
thereby which that mereiss construction lending s.C.) for thfperfnrman2e
A4 r of the work for which this pemnit is issued(Sec.JU91,Civ.C.)
.Q -Lender's Name-�.. ,.c.... •".". .. .. .. -._ ....." . ... _ .._ _ .. ........ _ .
Q Z Lenders Address" - . . 1,.
U O l Iagrey In.,I hale with this city
and
and stale the the above information is
coined I agree to comply with all city nod comply ordinances and stew laws elating
-
OU to b.,,gmelimedor anO,fori authorize reprcxenmtives of this city menmr upon
W the anu(We)agree to save.nd for inspection
and keep
purposes.
.,y' (We)agree asap extrenndk which
applexi mayinthe wayof acme
Against /
U W liabilities,judgments,mars end ingenues which may in any way occme against said / l
U.Z. City mconsequence UND)E fthe ANDSAND WILpeariarLCO f'
A ('LICA', UNUE ANUS AND N'ILL COh1PLV'WItHALL'NONP INT' -
S uacEc .A ,T=sem. fit Issued by: Date
igna ApI,1ant1C.n Tac'—moi' ter ' -! ,Dan. Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE'' '
,Willthc applicurt or future building account start in handle huaardous ma¢nal Type of Roof ..
asdefined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety s
nae Section 2ssl2(al ( uAll fhalbeip cteddprstoany_roofing,material,being installed..
AdhL. W 1th aipplcn t ft re,building occ p t .eequip equipment roof iss[ wt fit obtaining an inspection, I agree toremov_e
costd ns _
as defined by the Bay AnsA Q Illy Managema,t
all new materials for inspection. Applicant understands and will comply with
oY /To
all non-point'iource regulations.
I It clean the Weariless metered,mgmm.m,'under Chapter 6.95 of the
Califdinia Hcalm&Safety CodCSeitidns25505.25533und25534.1undcntandihat
if the Wilding does not currently have a tenant:that it is my responsibility to notify the
��up c Ih:requirements e inner hien indst bP' r to issu ce 1.of a Certificate ie of
P / ra,l i Signature of Applicant Date
/,i
rte r Dae All roof coverings to be Class"B„ or better
OFFICE. _ _ .